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Back brace
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A back brace is a device designed to limit the motion of the spine in cases of fracture or in post-operative fusions. Limiting the motion of the spine enhances the healing process and minimizes the patient's discomfort.
Common back braces include:
Bracing for scoliosis
Back braces are also commonly prescribed to treat adolescent idiopathic scoliosis, as they may stop the progression of spinal curvature in a growing child/adolescent.
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Encyclopedia
A back brace is a device designed to limit the motion of the spine in cases of fracture or in post-operative fusions. Limiting the motion of the spine enhances the healing process and minimizes the patient's discomfort.
Common back braces include:
- Rigid (Hard) braces : These braces are form-fitting plastic molds that restrict motion by as much as 50%; and
- Soft braces : Elastic braces that limit forward motion of the spine and assist in setting spinal fusions or supporting the spine during occasions of stress (for example, employment requiring the lifting of heavy loads).
Bracing for scoliosis
Back braces are also commonly prescribed to treat adolescent idiopathic scoliosis, as they may stop the progression of spinal curvature in a growing child/adolescent. In some cases, the back brace may also help decrease the amount of curvature in the spine. A variety of brace styles are available; the Boston brace is the most commonly used brace for adolescent idiopathic scoliosis (AIS). Other designs include the Milwaukee brace, the Charleston bending brace, and the SpineCor (a soft brace) in the United States. In Europe, however, the SPoRT and Cheneau braces are also used. There has been considerable research and information published in reputable journals on back braces for scoliosis. Issues like patient compliance with treatment, psycho-social impact of brace use, and exercise+ bracing have been looked at. Quality of Life research been attempted, but is difficult due to a current lack of instrument. Bracing is the primary treatment for AIS in curves that are considered to be moderate in their severity and are likely due to progress (determined by curve pattern/type and the patient's structural maturity).
One large issue in bracing for scoliosis is compliance, as mentioned above. Compliance is often impacted by the other above-mentioned factors (psycho-social comfort, excersize), but there are others also, including ability to eat and move, pain, and physical deformation. Back braces, especially the Boston brace, puts a great deal of pressure on the abdomen and can make digestion uncomfortable. Patients should be sure to eat many, many small meals high in nutrients--there is no room for anything else!--especially if participating in sports. Scoliosis braces, like those used for correcting post-operatively and for fractures, inhibit motion to a large extent, though percentages are difficult to find. Patients frequently complain about the inability to tie their own shoes, sit on the floor, etc. Bracing is also painful, though the body can adapt to tolerate the pain. Braces can also deform the patient's existing bone structures, most notably the hips, though there have been complaints about rib cage deformities as well. Each of these contributing issues is an issue in itself.
Unfortunately, it is difficult to "see into" the patient's mind for several reasons. There is not quality of life instrument that can be used to compare different braces impacts--and they are very diverse! Patients talked to of different braces have diverse concerns. For example, those of the Cheneau tend to be more concerned with appearance, while those treated by the Boston are more worried about severe weight loss. Also, doctors tend to be the researchers. Patients often are often uncomfortable with their doctors and/or do not communicate well with them. For example, a patient may tell her doctor, "I am having trouble breathing in my brace," when she means, "When I walk any distance, however short, in my brace with my back-pack, I start coughing violently."
The Boston Brace
This is the most commonly-used brace in the United States. It is a symmetrical brace. It corrects curvature by pushing with small pads placed against the ribs, which are also used for rotational correction (here it tends to be slightly less successful, however). These pads are usually places in the back corners of the brace so that the body is thrust forward against the brace's front, which acts to hold the body upright. The brace opens to the back, and usually runs from just above a chair's seat (when a person is seated) to around shoulder-blade height. Therefore, it is not particularily useful in correcting very high curves. It also does not correct hip misallignments, using the hips instead as a base point. This brace is typically worn 20 hours a day.
The Milwaukee Brace
This was a very common brace towards the earlier part of the twentieth century in the United States. It is a largely symmentrical brace. The brace is made with a harness-like hip area and metal strips rising to the chin, where a collar is. Between the hips and chin, there are corrective thrusts given with large pads. There is little rotational correction. Today this brace is generally used for very high thoracic curves that are severe and out of range of the Boston. This brace is typically worn 20-23 hours a day.
The Charleston Bending Brace
This brace was designed with the idea that compliance would increase if the brace were worn only at night. It is asymmetrical. The brace fights against the body's curve by over-correcting. It grips the hips much like the Boston, and rises to approximately the same height, but pushes the patient's body to the side. It is used in single, thoracolumbar curves in patients 12-14 years of age (before structural maturity) who have flexible curves in the range of 25-35 Cobb degrees.
The SpineCor Brace
This is the only widely-used soft brace currently. The brace has a harness much like the Milwaukee, but then it wraps around the body with strong elastic bands, pulling against curves, rotations, and imbalances. It is most successful when the patient has relatively small and simple curvatures, is structurally young, and compliant--it is usually worn 23 hours a day. While it is expected that patients can participate in activities as strenuous as competitive gymnastics while in brace, it also pulls down against shoulder misallignments which compresses the spine. Long-term results are also, largely, in the making.
The SPoRT Brace
SPoRT stands for "Symmetric, Patient-oriented, Rigid, Three-Dimmensional active," which it intends to be. The brace is symmetrical, built with a plastic frame reinforced with aluminum rods. The brace corrects hip misalignments through padding. Large, sweeping, thick pads push the spine to a corrected position. To prevent overcorrection, however, the brace also has "stop" pads holding the spine from moving to far in the other direction. The brace runs from just above the chair to T3 in many instances--it is successful at correcting high thoracic curves. In front, it goes around the patient's breast and up, even to pushing against the collar bone. Though it sounds restricting, it has been tested for comfort while participating in athletics. The theory holds that the support that the brace gives will help the patient's body learn to work as though it had no curve muscularly. Then the muscles would be able to support the spine, preventing further collapse. This brace is used for all curve patterns and types, even ones considered past brace treatment by other schools. The brace is typically worn 22 hours a day, and often coupled with a physical therapy program.
The Cheneau Brace
This brace is designed for use with the Schroth physical therapy method. It utilizes large, sweeping pads to push the body against its curve and into blown out spaces. The Schroth theory holds that the deformity can be corrected through retraining muscles and nerves to learn what a straight spine feels like, and breathing deeply into areas crushed by the curvature to help gain flexibility and to expand. The brace helps patients keep doing their exercises throughout the day. This brace is asymmetrical, and is used for patients of all degrees of severity and maturity. It is often worn 20-23 hours a day.
To the Patient Looking at (Hard) Bracing
From one patient to another
Bracing is not the end of the world. It, very likely, will prevent your curve from progressing to the point of requiring surgical correction.
FOOD--Eat healthily! You will probably lose weight, and you do not want your body to stop functioning well. Try to eat at least five "meals" a day--the usual three and then two snacks, at least. Trail mix is an excellent snack, because of the sugars and proteins packed into tiny spaces. Usually several big handfuls of trail mix can fit into a braced stomach. If you have "breaks" from your brace, lining one up over a meal is a good idea, leaving enough time to digest, so that your body will receive one full meal a day.
EXERCISE--In moderation. Exercising while braced is a good idea because of atrophy--little muscles not being used, and so becoming weak. You need core muscles to stand upright when not braced, so do not lose them! Because of your brace, you will have more difficulty breathing, and your body will take longer to recover from a work-out. Plan accordingly and get plenty of sleep. Also, be sure to eat lots of tiny meals if you are exercising.
SLEEPING--You probably will need to wear your brace at night. Ideally, you should sleep flat on your back, but that can be painful because you are lying directly on the brace's pads. If that is too painful, lie on your side and use a pillow or stuffed animal to help prop yourself up--your brace will want to roll to one side or the other. It is awkward at first, but your body will adapt and soon you will have trouble sleeping without your brace.
FASHION--Your brace will be invisible to all but to other people in braces. However, here are some tips... You will wear a special, long shirt under your brace. Over your brace is worn everything else, including underwear. Remember that you can not feel through your brace--wear belts. Gentlemen, you will not have much of a problem. Ladies, experiment with style! You probably will want to wear a relatively high waist. If that does not work for you, you can try wearing your pants under your brace (orthotists and orthopaedists do not recommend this, but it has worked fine for some). However, in this instance, your brace becomes visible to the world, and beware of rivets and thick waist bands, as the brace can drive them into you. Skirts can hide a brace very effectively, depending on style. Fortunately, the current trend in babydoll tops is very helpful in hiding braces. Tightness in shirts can belie your brace. Large sweatshirts and t-shirts are also good options.
SOCIETY--Your brace is invisible!! Never forget that, and no one cares about how your spine looks. Hugs feel awkward at first, but there is no hug like a Bracehug!
PAIN--Take as much as you can, then get out of the old "Torture Chamber." Take Advil when absolutely necessary. Heavy back-packs can cause pain by the end of the day. If possible, talk to your doctor about having textbooks left in classrooms for you and having a copy kept at your house (doctors can write orders to your school). Also, sitting upright/on hard chairs can be painful after awhile--but slouching/sitting on chairs that you sink into is worse. Lying down can be far more comfortable. But, given the alternatives, bracing is worth it. Surgery is worse.
SUMMER HEAT--You will sweat a lot. Wear more than one brace shirt at a time to help soak all that up; there is nothing worse than a sopping brace from the inside. Drink lots of water. Remember that cool air sinks, so when you are boiling up, lie on the floor. Looser garments allow more air flow and so can help keep you cool. Heat rashes are not uncommon.
BRACE CARE--Follow your orthotist's instructions. Usually, you are instructed to wipe the brace clean with rubbing alcohol at least once a day. If you can, you may want to help keep it smelling fresh by wiping the inside out with a wet cloth. Do not soak/immerse your brace--it will take forever to dry out.
Good luck, and be sure to name your brace! Sherman KA
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