Chapter Eight: Orthoses for Spinal Pain Flashcards
Back pain effects what fraction of Americans at some time during their lives?
1/2
The symptoms of back pain can be due to what?
A specific injury or action: twisting of the back, or lifting a heavy object.
In other cases no trauma occured.
What are some pathologic lesions that can cause back pain?
Herniations
Spondylosis.
What is nonspecific low-back pain?
Low-back pain that occurs in the absense of an identifiable cause, such as bony injury or disc pathology.
What are the area of potential sources of pain?
Intervertebral disk, supporting spinal ligaments, facet joint capsules, and paraspinal musculature, are potential sources of pain.
What are innervated by branches of the sinuvertebral nerve?
The posterior longitudinal ligament
Outer lamina of the posterior annulus fibrosus
Ventral dural sac
Blood vessels of the vertebral body
What is the sinubertebral nerve formed by?
Ventral rami and autonomic roots from gray rami communicantes.
What are innervated by the transverse and descending branches?
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.
What do the segmental branches from ventral rami supply?
The ventral annulus fibrosus and anterior longitudinal ligament.
What do the dorsal rami innervate?
They divide and innervate the paraspinal musculature and facet joint capsules.
How is the vast majority of nonspecific low-back pain managed?
Conservatively with rest, analgesics, antiinflammatory medications, physical therapy, manipulation, and orthoses.
What are some flexible lumbar orthoses?
Lumbar support bands and belts as well as corsets.
What are rigid lumbar orthoses?
Mainly corsets and braces.
What are contemporary corests composed of?
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.
What are the trimlines for corsets?
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.
What are the trimlines for abdominal belts?
Cover the pelvis, extending from the iliac crests to the pubic symphysis anteriorly and gluteal folds posteriorly.
What are included in rigid trunk orthoses?
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.
The mechanical effectiveness of orthoses could result from what?
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.
What is the effect most often expected from a brace?
Restriction of motion
What is often the cause of back injury?
Excessive trunk motion especially axial rotation.
What should be fixated to restrict motion?
Fixation of the pelvis
What is more important than intersegmental motion restrictions in the effectiveness of orthoses in patients with low back pain?
Gross motion restrictions
What was the conclusion of lumbar supports and motion?
Lumbar supports reduce trunk motion with respect to flexion, extension, and lateral bending, but provide no significant efect on rotation.
In direct unloading, what does a LSO do?
It bears some of the load that would ortherwise be transmitted through the lumbar trunk.
In indirect unloading, what does a LSO do?
The orthosis transmits little load but raises the intraabdominal pressure enough to unload the vertebral column.
What does compressing the abdomen do?
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.
What percent of maximal voluntary activation of lumbar muscle contraction leads to muscle fatigue and pain?
5%
In healthy individuals. what percent of muscle contraction holds the back in a neutral position?
2%
Why is a lumbar brace important in regards to muscle activation?
It helps reduce the amount of muscle contraction from 5% to 2% which will help prevent muscle fatigue and eventually pain.
Overall, what are the collective results regarding abdominal pressure?
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.
What are the proprioceptive elements a LSO can do?
Improve posture Increase awareness of pelvis Spine positioning Reminding patients to lift properly Remind patients not to overstress the back.
What do the studies show in regards to proprioception?
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.
The effectiveness of LSO bay be affected by individual what?
Central obesity.
What are the miscellaneous effects an LSO can have on a patient?
Local temperature elevation, increased feeling of safety, the placebo effect
What are the adverse effects of wearing lumbar orthoses?
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.
Any bracing technique should include what?
Strong abdominal exercise program with postural reeducation to prevent muscular atrophy once the patient achieves symptomatic relief.
What percent of patients will have resolution of symptoms within 1 week?
40%
What percent of patient will have resolution of symptoms within 3 weeks?
60%
What percent of patients will have resolution of symptoms within 2 months
90%
Neck pain is estimated to effect what percent of the population?
10%
What are the common conditions thought to cause neck pain?
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 .
What are the early treatment strategies for neck pain?
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.
What are the two broad categories of cervical orthoses?
Cervical orthoses (CO) Cervicothoracic orthoses (CTO)
CTOs are most commonly used in what?
Trauma setting for immoblization of lower cervical and upper thoracic spine fractures.
Soft collars provide what?
Limited motion restriction, decreasing flexion and extension by 5% to 15%, lateral bending by 5%-10%, and axial rotation by 10%-17%.
Hard cervical collars provide what?
Motion restriction at 20%-25% flexion and extension.
What can be added to cervical collars to provide better head stabilization?
Chin, occiput, or forehead strap/
In general CO restrict what movement?
Cervical flexion and extension
Lateral bending
Axial rotation by approximately 60%
CTOs improve cervical motion restriction in all planes to what?
Decrease flexion and extension 70-80%
Decrease lateral bending 60%
Decrease axial rotation 60-70%
What is the most prescribed reason for using cervical collars?
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.
What is another benefit of cervical collars?
Improved proprioception and decreased loading to injured muscles or ligaments by increased support to the region.
Increased local temperature
Placebo effect
What are complications of wearing cervical collars?
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.
What is the overall conclusion of CO with neck pain?
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.
