Orthoses as an Intervention for Spine Conditions

Corsets and spinal orthosis can be an integral component of the physical therapy plan of care for spinal pain management. Spinal orthoses can be used during the acute (e.g., following surgery), subacute, and chronic stages of tissue healing and spinal rehabilitation. 

Objectives

  1. Describe the major modes of action of rigid and soft spinal orthoses
  2. Identify the role of the PTA in patient care involving spinal orthoses
  3. Identify common braces used to treat scoliosis
  4. Recognize signs and symptoms of adverse fit of spinal orthoses
  5. Communicate signs and symptoms of misfit to the supervising PT and appropriate personnel

Primary Goals of Spinal Orthoses

  • decrease pain
    • by limiting motion
    • by providing greater abdominal support
  • correct deformities
    • by applying pressure to the spine, abdomen, and torso
  • prevent motion
    • by using materials that are inherently stiff and/or rigid

PTs and PTAs recognize the effects of postural impairments on spinal pain. Optimal lumbar posture can be an important contributor to pain reduction, and orthoses may facilitate maintaining optimal posture.

Evidence-Based Support

A systematic review by Goodwin and colleagues (2016) found that there is relatively weak evidence to support the use of orthotics on WHO-ICF elements, such as impairment reduction and increased participation in patients with a history of vertebral compression fracture.

In a recent comparative study for treating non-specfic low back pain with physical therapy alone or physical therapy & rigid orthotic bracing, there was no signficant difference in pain or postural control between the groups, and some improvements in reported disability in the PT + bracing group (Azadinia et al., 2017a).

Lariviere et al., (2019) compared the effects of active muscle stabilization, LSO use and muscle stabilization + LSO use with controls and found that LSO use had some effect in increasing stiffness (e.g. stability), when compared with active muscle stabilization alone.

Li and colleagues (2015) compared rigid versus soft orthoses as a pain management intervention for older adults in the subacute phase of thoracic vertebral compression fracture and found no signficant difference in pain or function between the two orthotics after 4 weeks of consistent wear. Morrisette and colleagues (2014) compared outcomes in pain and disability between PT + inelastic bracing and PT + elastic bracing in patients with acute, subacute, and chronic low back pain. Their results indicated the inelastic bracing group showed greater improvement in reported disability after two weeks of use.

Patients, some providers, and members of the public may have questions or concerns about bracing and its effect on reducing muscle strength. In a recent review of the literature for lumbar bracing, there is inconclusive evidence that bracing leads to weaknened lumbar musculature (Azadinia, et al., 2017b). Continous monitoring of a need for bracing, measures, and goals should inform decisions to trial and/or continue bracing as an intervention for symptom management and improved function

 

Azadinia, F., Ebrahimi-Takamjani, I., Kamyab, M., Parnianpour, M., & Asgari, M. (2017a). Comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain: A randomized trial. Medical Journal of The Islamic Republic of Iran (MJIRI), 31(1), 150-157.

Azadinia, F., Ebrahimi, E., Kamyab, M., Parnianpour, M., Cholewicki, J., & Maroufi, N. (2017b). Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature. The Spine Journal, 17(4), 589-602.

Goodwin, V. A., Hall, A. J., Rogers, E., & Bethel, A. (2016). Orthotics and taping in the management of vertebral fractures in people with osteoporosis: a systematic review. BMJ open, 6(5), e010657.

Larivier, C, Boucher, J-A., Mecheri, H., Ludvig, D. (2019). Maintaining lumbar spine stability: A study of the specific and combined effects of abdominal activation and lumbosacral orthosis on lumbar intrinsic stiffness. Journal of Orthopaedic & Sports Physical Therapy, 49(4) 262-271.

Li, M., Law, S. W., Cheng, J., Kee, H. M., & Wong, M. S. (2015). A comparison study on the efficacy of SpinoMed® and soft lumbar orthosis for osteoporotic vertebral fracture. Prosthetics and Orthotics International, 39(4), 270-276.

Morrisette, D. C., Cholewicki, J., Patenge, W. F., Logan, S., Seif, G., & McGowan, S. (2014). A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of lower back pain. Spine, 39(21), 1733.