Monday, June 13, 2011

RIGID SPINAL ORTHOSIS: TO WEAR OR NOT TO WEAR



A lot of innovation in Back Orthosis are seen today. More fabricated, durable plastic and  more cosmetic molded were already out but I can still see some prescribed with some obsolete rigid designs. I used to have a NYU book series of Prosthesis and Orthosis during my 2nd year proper that we considered so obsolete for practice today. Most of the samples in that book were made of thick molded metal rods and leather harness. I know one hospital that is still chained to those designs and keep on producing such for patients who suffered Spinal Cord Injury. Those designs have overlooked needed properties to support and maintain proper   body alignment and should not be in the orthosis circle today. These orthoses were made to correct deformities and protect the injured part of the body. Doctors would advised their patients to wear it 23 hrs a day with only 1 hour off during exercise, or to whatever protocol they think it is necessary. For SCI patients, it is  a must, specially to those acute mid to low back injury to prevent further insult but it should not be worn for longer period of time. What if your a person that can move around and it so happened that you have a chronic back problem? This could be tremendously irritating for the patient. 

During period of immobility, the chances of muscle atrophy, muscle weakness and demineralization is more common and the possible incident of acquiring contact dermatitis due to prolong wearing of spinal braces. Thus, delaying the expected recovery time. Exercise of one hour is enough vs 23 hours of immobilization.  The work of an Orthotist once fascinated me with their ideations of helping patients to achieve recovery through corrective devices,  that maybe one day I could also venture in this field but not until I learned other better options not to rely on it in the purist sense.

I love everything about the Spine. Every muscles involved in it, articulatory structures and mechanisms makes me an excited kid. I find treating patients with back problems very challenging. During my early practice, we encountered patients with Spondylosis, Scoliosis, Slipped disk etc. My mind set during those days were you could only have a slim chance of treating such cases and a longer recovery (if there is). But with my awareness in the realms of Manual Therapy, I learned a lot of approach/discipline to influence better spinal articulation, flexibility and muscle re-education without relying too much on braces. It's like your muscles and joints could obey so easily without giving too much force and keep it that way

According to Dr. Jojo Sayson, a Physical Therapist and the first Filipino to have a degree of Doctor of Orthopedic Manual Therapy, together with Alan Hargens they studied Pathophysiology of Low Back Pain during Exposure to Microgravity. Aviation Space and Environmental Medicine (2008). He visited the Philippines and I had the chance to attend on his lecture about this study. I learned from him that most of the astronauts at day 2 already starting to have physiological changes leading to discogenic low back pain and it will be much pronounced at day 5 space mission because of less compression and rotation for disc imbibition to maintain nourishment in the spinal articulation system. Due to less gravitational field, our calcium concentration in our bones become uneven, making it more dense from upper thorax to our head and less from low back down to our lower extremties (Inverted Bird Syndrome). Less calcium density can lead to fracture or could enhance other cycle of somatic injury. To prevent such occurrence, he improvised a spinal harness for space aviators that will aid in promoting enough compression and rotational movement in the back while exposed to zero to microgravity. This study was supported by NASA where he worked as a Scientist.

I have nothing against manufacturers of braces as long as the components of it were well defined for certain individuals. I'm against those orthotists who carelessly design these corrective devices without using much of their analytical skills. Assess further the needs of your client before assembling the corrective device. We are talking about patients here and as I mentioned before on my previous entry; PATIENTS FIRST. Before purchasing a back brace or orthosis, try to consider the purpose of wearing it and most important, your own comfort. Patients should not rely fully their progressions on wearing such device, it is also their obligation to help themselves to be well. It's not a sin to ask about it to your doctor or search for it while considering the pros and cons. Weigh more on the pros before acting on anything your doctor tells you. You can always have a second opinion. 


2 comments:

  1. This is a good product review. For back pain back brace can be a good solution.

    ReplyDelete
  2. I have nothing against manufacturers of braces as long as the components of it were well defined for certain individuals. I'm against those orthotists who carelessly design these corrective devices without using much of their analytical skills. know more about spinal cord injury rehabilitation service

    ReplyDelete