Chapter Eight: Orthoses for Spinal Pain

Question 1

Back pain effects what fraction of Americans at some time during their lives?

Answer 1

1/2

Question 2

The symptoms of back pain can be due to what?

Answer 2

A specific injury or action: twisting of the back, or lifting a heavy object.
In other cases no trauma occured.

Question 3

What are some pathologic lesions that can cause back pain?

Answer 3

Herniations

Spondylosis.

Question 4

What is nonspecific low-back pain?

Answer 4

Low-back pain that occurs in the absense of an identifiable cause, such as bony injury or disc pathology.

Question 5

What are the area of potential sources of pain?

Answer 5

Intervertebral disk, supporting spinal ligaments, facet joint capsules, and paraspinal musculature, are potential sources of pain.

Question 6

What are innervated by branches of the sinuvertebral nerve?

Answer 6

The posterior longitudinal ligament
Outer lamina of the posterior annulus fibrosus
Ventral dural sac
Blood vessels of the vertebral body

Question 7

What is the sinubertebral nerve formed by?

Answer 7

Ventral rami and autonomic roots from gray rami communicantes.

Question 8

What are innervated by the transverse and descending branches?

Answer 8

Posterior longitudinal ligament at the level of nerve entry

With an ascending branch to the next cranial level providing overlapping innervation at each spinal level.

Question 9

What do the segmental branches from ventral rami supply?

Answer 9

The ventral annulus fibrosus and anterior longitudinal ligament.

Question 10

What do the dorsal rami innervate?

Answer 10

They divide and innervate the paraspinal musculature and facet joint capsules.

Question 11

How is the vast majority of nonspecific low-back pain managed?

Answer 11

Conservatively with rest, analgesics, antiinflammatory medications, physical therapy, manipulation, and orthoses.

Question 12

What are some flexible lumbar orthoses?

Answer 12

Lumbar support bands and belts as well as corsets.

Question 13

What are rigid lumbar orthoses?

Answer 13

Mainly corsets and braces.

Question 14

What are contemporary corests composed of?

Answer 14

Sturdy lightweight canvas or elastic material. Vertical reinforcing stays.
Some corsets include rigid thermoplastic or metal that can be custom molded to the patient.
Perineal straps are usually included
Garters may also be used.

Question 15

What are the trimlines for corsets?

Answer 15

Extend just below the xiphoid process to a point just above the pubic symphysis. They cover the back from below the inferior border of the scapulae to the gluteal fold.

Question 16

What are the trimlines for abdominal belts?

Answer 16

Cover the pelvis, extending from the iliac crests to the pubic symphysis anteriorly and gluteal folds posteriorly.

Question 17

What are included in rigid trunk orthoses?

Answer 17

Stiff plastic or upholstered metal bands in both the vertical and horizontal planes.
Pelvic and thoracic bands are included that lie flat on the torso and terminate at the lateral midline.

Question 18

The mechanical effectiveness of orthoses could result from what?

Answer 18

Intersegmental motion restriction,
Gross motion restriction,
Decreased load on the spinal column.
Increased abdominal pressure
reduced muscle fatigue
Increased postural awareness or proprioception
Miscellaneous effects of massage, heat and placebo.

Question 19

What is the effect most often expected from a brace?

Answer 19

Restriction of motion

Question 20

What is often the cause of back injury?

Answer 20

Excessive trunk motion especially axial rotation.

Question 21

What should be fixated to restrict motion?

Answer 21

Fixation of the pelvis

Question 22

What is more important than intersegmental motion restrictions in the effectiveness of orthoses in patients with low back pain?

Answer 22

Gross motion restrictions

Question 23

What was the conclusion of lumbar supports and motion?

Answer 23

Lumbar supports reduce trunk motion with respect to flexion, extension, and lateral bending, but provide no significant efect on rotation.

Question 24

In direct unloading, what does a LSO do?

Answer 24

It bears some of the load that would ortherwise be transmitted through the lumbar trunk.

Question 25

In indirect unloading, what does a LSO do?

Answer 25

The orthosis transmits little load but raises the intraabdominal pressure enough to unload the vertebral column.

Question 26

What does compressing the abdomen do?

Answer 26

LSOs convert the trunk into a semirigid cylinder, reducing the usual paraspinal musculature workload by shifting a portion of the load from the spine to the entire trunk. A larger percent of the body weight then is supported by the abdomen, relieving the vertebral column to some degree and requiring less back muscle force to extend the trunk.

Question 27

What percent of maximal voluntary activation of lumbar muscle contraction leads to muscle fatigue and pain?

Answer 27

5%

Question 28

In healthy individuals. what percent of muscle contraction holds the back in a neutral position?

Answer 28

2%

Question 29

Why is a lumbar brace important in regards to muscle activation?

Answer 29

It helps reduce the amount of muscle contraction from 5% to 2% which will help prevent muscle fatigue and eventually pain.

Question 30

Overall, what are the collective results regarding abdominal pressure?

Answer 30

overall the literature does not support the hypothesis that orthoses reduce the activity of erector spinae muscles, increase intraabdominal pressure, or significantly impact compression forces.

Question 31

What are the proprioceptive elements a LSO can do?

Answer 31

Improve posture
Increase awareness of pelvis
Spine positioning
Reminding patients to lift properly
Remind patients not to overstress the back.

Question 32

What do the studies show in regards to proprioception?

Answer 32

Braces provide enhanced proprioception through increased cutaneous input, but may also activate mechanicoreceptors of the underlying musculature and joint capsules, providing another source of proprioceptive input.

Question 33

The effectiveness of LSO bay be affected by individual what?

Answer 33

Central obesity.

Question 34

What are the miscellaneous effects an LSO can have on a patient?

Answer 34

Local temperature elevation, increased feeling of safety, the placebo effect

Question 35

What are the adverse effects of wearing lumbar orthoses?

Answer 35

Local pain, skin breakdown, gastrointestinal disorders, decreased vital capacity, increased lower extremity venous pressure, higher blood pressure, and higher heart rates.
Disuse atrophy of lumbar muscles.

Question 36

Any bracing technique should include what?

Answer 36

Strong abdominal exercise program with postural reeducation to prevent muscular atrophy once the patient achieves symptomatic relief.

Question 37

What percent of patients will have resolution of symptoms within 1 week?

Answer 37

40%

Question 38

What percent of patient will have resolution of symptoms within 3 weeks?

Answer 38

60%

Question 39

What percent of patients will have resolution of symptoms within 2 months

Answer 39

90%

Question 40

Neck pain is estimated to effect what percent of the population?

Answer 40

10%

Question 41

What are the common conditions thought to cause neck pain?

Answer 41

Degenerative disk disease, with or without disk herniation, and degenerative arthritis of the facet joints
Posttraumatic neck pain syndrome (whiplash) and pain following repetitive activities .

Question 42

What are the early treatment strategies for neck pain?

Answer 42

Activity modification that aboids neck extension and heavy lifting, use of analgesics and antiinflammatory medications, and physical therapy with heat and ultrasound modalities, injections, and cervical traction.

Question 43

What are the two broad categories of cervical orthoses?

Answer 43

Cervical orthoses (CO)
Cervicothoracic orthoses (CTO)

Question 44

CTOs are most commonly used in what?

Answer 44

Trauma setting for immoblization of lower cervical and upper thoracic spine fractures.

Question 45

Soft collars provide what?

Answer 45

Limited motion restriction, decreasing flexion and extension by 5% to 15%, lateral bending by 5%-10%, and axial rotation by 10%-17%.

Question 46

Hard cervical collars provide what?

Answer 46

Motion restriction at 20%-25% flexion and extension.

Question 47

What can be added to cervical collars to provide better head stabilization?

Answer 47

Chin, occiput, or forehead strap/

Question 48

In general CO restrict what movement?

Answer 48

Cervical flexion and extension
Lateral bending
Axial rotation by approximately 60%

Question 49

CTOs improve cervical motion restriction in all planes to what?

Answer 49

Decrease flexion and extension 70-80%
Decrease lateral bending 60%
Decrease axial rotation 60-70%

Question 50

What is the most prescribed reason for using cervical collars?

Answer 50

Motion restriction, which can be useful for limiting or preventing cervical pain, protecting spinal instability either preoperatively or postoperatively, and protecting the cervical spine in emergency situations.

Question 51

What is another benefit of cervical collars?

Answer 51

Improved proprioception and decreased loading to injured muscles or ligaments by increased support to the region.
Increased local temperature
Placebo effect

Question 52

What are complications of wearing cervical collars?

Answer 52

Skin breadown ulceraction of the bony prominences of the head and neck, including the chin, mandible, clavicles, sternum, and occiput
Ingrown hair
Increased intracranial pressure
injuries caused by a false sense of security.

Question 53

What is the overall conclusion of CO with neck pain?

Answer 53

Evidency is lacking
CO are used for neck motion restriction, thus relieving pain.
Physical therapy appear to be more effective than collar immobilization in patients suffering from whiplash.