IPH REHAB : SPINAL ORTHOSIS ADVANTAGE AND DISADVANTAGE

IPHREHAB

Spinal orthosis: 

INTRODUCTION
An orthotic device  is an external device applied on the body to:-

• Limit motion 
• Correct deformity 
• Reduce axial loading
• Improve function in certain segment of the body. 

INDICATIONS:

• Pain relief 
• Mechanical unloading 
• Scoliosis management 
• Spinal immobilization after surgery 
• Spinal immobilization after traumatic injury 
• Compression fracture management 
• Kinesthetic reminder to avoid certain movements 

INTRODUCTION

Duration of orthotic use is determined by the individual situation. 

In situations where spinal instability is not an issue, recommend use of an orthosis until the patient can tolerate discomfort without the brace. 

When used for stabilization after surgery or acute fractures, allow 6-12 weeks to permit ligaments and bones to heal. 

Drawbacks of orthosis:-

• Discomfort 
• Local pain 
• Osteopenia 
• Skin breakdown 
• Nerve compression 

DISADVANTAGE:-

Muscle atrophy with prolonged use. 

Decreased pulmonary capacity .

Increased energy expenditure with ambulation.

Difficulty with transfers. 

Psychological and physical dependency. 

Increased segmental motion at ends of the orthosis. 

Unsightly appearance.

Poor patient compliance. 

Success of the orthosis may lead to:-

• Decreased pain 
• Increased strength 
• Improved function and posture  
• Correction of spinal curve deformity 
• Protection against spinal instability 
• Minimized complications 
• Healing of ligaments and bones 

IPHREHAB : CERVICAL TRACTION TREATMENT

IPHREHAB


Cervical Treatment Set-up

• Neck – placed in 25-30° flexion
• Straightens normal lordosis of C-spine
• Must have at least 15° flexion to separate facet joint surfaces
• Body must be in straight alignment
• Be aware that C-spine traction can cause residual lumbar n. root pain if improperly set up.
• Duration – 10-20 minutes most common

CERVICAL TREATMENT WITH TRACTION MACHINE

• Remove any jewelry, glasses, or clothing that may interfere
• Lay supine, place pillows, etc. under knees
• Secure halter to cervical region placing pressure on occipital process & chin (minor amount)
• Align unit for 25-30° of neck flexion 
• Remove any slack in pulley cable
• On:Off sequence 3:1 or 4:1 ratio

General Technique for Applying Cervical Tx

• Saunders

– Saunders or similar traction devices utilize a sliding track, with placement of the head on a pad on the carriage to decrease the tension load necessary to produce a traction force by eliminating most of the friction

– Stabilization is provided by a head strap and posterior pads that are tightened against the occiput and the mastoid processes 

Cervical Treatment 

Following treatment, gradually reduce tension & gain slack

Have patient remain in position for a few minutes after treatment 

Effectiveness of Cervical Traction

Cervical traction has been linked to 5 mechanical factors

Position of the neck

Force of applied traction

Duration of traction

Angle of pull

Position of patient

IPHREHAB : CERVICAL TRACTION & POSITIONING

IPHREHAB

Traction

Goal

Reduction of signs or symptoms of C or L spinal compression

Utilize maximal traction with minimal force

PARAMETERS

• Body position:prone, supine,hip position, bilateral, or unilateral direction of pull
• Force used
• Intermittent traction:traction time and rest time
• Sustained traction
• Duration of treatment
• Progressive steps
• Regressive steps

Patient instruction

Explain to patient

Position Pt.

C spine can be done in sitting or supine.Supine provides increased relaxation, vertebral separation and easier countertraction

L traction can be done supine or prone

Angle of Pull

C spine Occiput ( C1-C2) 0-5 degrees flexion

• Mid. Cervical (C2-C5) 10-20 flexion
• Low cervical (C5-C7) 25-30 flexion

Effects on Cervical Flexion

Rope Angle

– To effect 25-30 degrees of flexion on the neck the rope angle will need to approach 45 degrees due to the flexibility of the rope resulting in a sagging with the weight of the head

– The angle is 0, or flat for atlanto-occipital and atlanto-axial traction

Inter vertebral Encroachment

Flex, and SB toward unaffected side and rotation toward affected side

Disc- C spine neutral.  Want ligaments to be lax and allow better distraction

Cervical Traction

Application of a longitudinal force to the C-spine & structures

Tension applied can be expressed in pounds or % of patient’s body weight.

At 7% of patient’s body weight, vertebral separation begins 

Human head accounts for 8.1% of body weight (8-14 lbs.)

Greater amount of force is needed widen areas

You want force to be about 20% of body weight

Cervical Traction Positioning

Seated – a greater force is needed to apply the same pressure (due to gravity) than if supine

Supine – support lumbar region (bend knees, use knee elevator, or hang lower legs over end of table & place feet on chair); allows musculature to relax 

Effects of Cervical Traction :

• Reduces pain & paresthesia associated w/ n. root impingement & m. spasm
• Reduces amount of pressure on n. roots & allows separation of vertebrae to result in decompression of disks.

Effectiveness of Cervical Traction:

Cervical traction has been linked to 5 mechanical factors

• Position of the neck
• Force of applied traction
• Duration of traction
• Angle of pull
• Position of patient