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Braces

Introduction

If you are diagnosed with a spinal disorder, deformity, or potential problem that can be helped through the use of external structural support, your doctor may recommend the use of a back or neck brace. Braces offer a safe, non-invasive way to help you heal from a current condition and/or prevent future problems from occurring. The use of braces is widely accepted. They are effective tools in the treatment of spine disorders. In fact, more than 99% of orthopedic doctors advocate using them.

Braces are really nothing new. They have actually been around for centuries. Lumbosacral corsets (for the lower back) were used as far back as 2000 BC! Bandage and splint braces were used in 500 AD in an effort to correct scoliosis (a spine with a sideways curve). Recently, braces have become a popular way to actually help prevent primary and secondary lower back pain from ever occurring.

Spinal bracing is used for a variety of reasons including controlling pain, reducing the chance of further injury, allow healing to take place, compensating for muscle weakness, and preventing or correcting a deformity. There are other reasons bracing is used. One is based on the theory that braces insulate your skin, producing increased warmth that decreases the sensation of pain much like a heating pad. Another reason is that the increase in pressure produces hydraulic support for your back or neck. Finally, certain types of movement may cause stress to the pain generators in your back. The decrease in range of movement by using bracing may relieve this type of pain.

Braces and supports are most frequently used to treat low back pain, trauma, infections, muscle weakness, neck conditions, and osteoporosis. Braces, belts, and jackets are designed to immobilize and support your spine when there is a condition that needs to be treated. Depending on the model that is used, braces can put your spine in a neutral, upright, hyper-extended, flexed, or lateral-flexed position.

Though the effects of bracing are mostly positive, braces can lead to a loss of muscle function due to inactivity. Bracing can sometimes lead to psychological addiction, so that even when your spinal problem is healed and you are ready to be taken off your brace, you may feel dependent upon it for physical support.

There are more than 30 types of back supports available for spine disorders. This article discusses several common types and why they are used.

Cervical (Neck) Braces

Neck braces are used to stabilize your cervical spine after neck surgery or trauma to your neck, or as an alternative to surgery. They are probably the type of spinal brace you most commonly see people wearing.

There are several types of cervical braces available, including:

Soft Collar

This flexible brace is placed around your neck. It is typically used after a more rigid collar has been worn for the major healing. It is used as a transition to wearing no collar.

Philadelphia Collar

This is a more rigid/stiff collar that has a front and back piece that attaches with Velcro on the sides. It is usually worn 24 hours a day until your doctor tells you to remove it. This collar is used for conditions such as a relatively stable cervical fracture, cervical fusion surgery, or a cervical strain. Another similar type is the Miami cervical brace.

Sterno-Occipital Mandibular Immobilization Device (SOMI)

A SOMI is a brace that holds your neck in a straight line that matches up with your spine. It offers rigid support to a damaged neck and keeps your head from moving around. With this brace, you are unable to bend or twist your neck. The restriction of motion helps your muscles and bones heal from injury or surgery.

If you look at what the name means, you will better understand what a SOMI does. "Sterno" means your upper and middle chest, "occipital" is the base of your skull, "mandibular" refers to your jaw and chin, and "immobilization" describes the support and movement restriction the brace offers. The SOMI is worn on the parts of your body for which it is named. First, there is a chin piece that your lower jaw rests on. Second, the chin piece connects by straps to a headband that is worn across your forehead. Third, the chin piece connects to a chest piece by a front metal extension. Finally, the chest piece then rests on your upper and middle chest, sort of like a vest. This connects to the occipital piece, which supports the base of your head.

The SOMI brace is obviously a bit more complicated and cumbersome than some of the other types of braces, but it provides excellent support for an injured neck.

Halo

The main purpose of the halo is to immobilize your head and neck. This is the most rigid of the cervical braces. It is only used after complex cervical spine surgery or if there is an unstable cervical fracture. The halo looks a lot like the word sounds. It has a titanium ring (halo) that goes around your head, which is secured to your skull by four metal pins. The ring then attaches by four bars to a vest that is worn on your chest. The vest weights the brace to hold the ring and your neck steadily in place. The Halo is worn 24 hours a day until your spine injury heals.

Trochanteric Belts

The trochanteric belt is usually prescribed for sacroiliac joint pain or pelvic fractures. The belt fits around your pelvis, between the trochanter (a bony portion below the neck of your thigh bone) and the iliac (pelvis) ridges/crests. It is about five to eight centimeters wide and it buckles in front, just like a regular belt.

Sacroiliac and Lumbosacral Belts

The lumbosacral belt helps to stabilize your lower back. These belts are usually made of heavy cotton reinforced by lightweight stays. The pressure can be adjusted through laces on the side or back of the belt. These belts range in widths between 10 to 15 centimeters, and 20 to 30 centimeters. The sacroiliac belt is used to prevent motion by putting a compressive force on the joints between your hipbone and sacrum (base of the spine).

Corsets

Corsets provide rigidity and support for your back. They can vary in length, and a shorter or longer corset will be prescribed for you depending upon your condition. A short corset is typically used for low back pain, while a longer one is used for problems in the mid to lower part of your thoracic spine.

When people think of corsets, they usually conjure up images of women from earlier centuries who used them to make their waists look smaller. Today, in the treatment of back problems, corsets refer to a type of back brace that extends over your buttocks and is often held up by shoulder straps. Like the corsets of old, these lace up from the back, side, or front. There are metal stays that provide the appropriate rigidity and support for your back.

Rigid Braces

Rigid braces are typically prescribed for low back pain and instability. If greater rigidity is needed to support your spine than can be found in standard back supports, rigid frame spinal bracing is often prescribed. These are stiff braces. They usually consist of rear uprights that contour to your lumbar spine and pelvis, along with thoracic bands. There are also fabric straps on the braces that provide pressure in the front. Common types of rigid models are:

Williams Brace

This type of rigid brace has no vertical uprights in the middle so it allows you to bend or flex your spine.

Chair-back Brace

This type of rigid brace immobilizes your lumbar spine in the neutral position. The chair-back is designed to reduce sideways and revolving movement of your lower spine.

Raney Flexion Jacket

This type of rigid brace reduces lumbar lordosis by holding your lumbar spine in a neutral tilt.

Hyperextension Braces

Hyperextension braces are designed to prevent excessive bending, and it is often prescribed to treat frontal compression fractures that have occurred around the junction of your thoracic and lumbar spine. The brace can also be used after surgery to help you heal from a spinal fusion. It offers support that allows anterior (front) pressure unloading of your thoracic vertebrae by restricting flexion (bending) of your thoracic and lumbar spine.

Hyperextension braces have a front rectangular metal frame that puts pressure over your upper sternum and your pubis or pubic bone. Your sternum is the narrow, flat bone in the front middle of your chest, in the middle of your rib cage. By applying this pressure, the brace encourages spinal extension. There is opposing pressure applied over the T-10 level (the tenth vertebra in your thoracic spine).

The braces offer what is called "three-point stabilization" to the spine through a front abdominal pad, a chest pad, and a rear pad at the level of the fracture. By applying pressure in three points— sternal, pubis and rear lumbosacral— the brace extends or stretches your spine. The most common types of Hyperextension Braces are Knight Taylor and Jewett.

Molded Jackets

Molded jackets are designed to distribute pressure widely over a large area. By immobilizing your body from your neck to your hips, pressure is distributed evenly, taking excess pressure off the overloaded or unstable areas of your spine. These jackets were originally made of plaster of Paris, but now they are typically made out of molded plastic.

Lifting Belts

Lifting belts are designed to reduce low back strain and muscle fatigue that can occur when you are lifting heavy objects. The belt circles around your waist, covering the lumbar region of your spine, and it closes in front. These belts are usually made of cloth or canvas and do not have stays. Some models also have lordosis pads.


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