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Spine Self Help Devices

A. Back Braces/Belts

When were back braces first used?

Back Braces were used as far back as 4000 years ago. Back then they were used after spine trauma and for spine deformities such as scoliosis.

Who should use a back brace?

If you are diagnosed with a specific spine problem, your doctor may recommend a specific brace. They can be safe and effective if used for the right conditions, the right way, and for the right length of time. Some examples are patients who lack stability of the spine, patients who had recent extensive back surgery, and patients with spine problems who are required to perform heavy lifting.

What benefits do Back Braces provide?

Here are some of the benefits of Back Braces:

  1. Can help control back pain
  2. Can lower the chance of further injury
  3. Can prevent a spine from curving (scoliosis)
  4. Can treat a spine curvature
  5. Can make up for muscle weakness of the spine
  6. Can help the spine heal after an injury
  7. Can help the spine to heal after surgery
  8. Can bring warmth to the spine which can have a healing effect
  9. Can reduce the movement of the spine which can help avoid painful movements
  10. Can bring more stability to the spine

 

Can a Back Brace cause more back problems?

This depends on the reason for the brace. To avoid a problem, it is best to have the spine specialist give instructions on:

  1. The kind of brace that should be used
  2. How it should be used
  3. How often it should be used.

If not used properly and with supervision by a spine specialist, here are some potential drawbacks of back braces:

  1. Over time, muscles can get weaker if the spine relies more on the brace than the muscles.
  2. Patients may use the brace too much out of habit, rather than using it for the right reasons and the right amount of time.
  3. The skin and tissue under brace can get injured if using a brace too much or using it inappropriately.
  4. A skin rash can develop under the Brace
  5. Braces can restrict breathing and swallowing if used inappropriately

What kinds of spine braces are on the market?

Here are some examples of spine braces available:

  1. Neck Braces:

            a. Gel Filled Collars

  • Can be for hot or cold
  • Used for minor neck injuries

             b. Soft Collar

  • One piece device
  • Soft foam device which limits the motion in the neck to some degree.
  • Often used after smaller neck surgeries or minor trauma.
  • Does not eliminate the motion in the neck
  • Can often be removed for periods of time if doctor recommends

           c. Hard Collar (e.g. Philadelphia Collar, Aspen Collar, Miami Collar)

  • Usually two-piece device, made of hard plastic
  • Typically have a chin rest in the front
  • Restrict motion more than soft collar
  • Do not entirely take motion away
  • Are used after major neck surgery or severe spine trauma
  • Are often worn 24 hours a day with few if any breaks

           d. Halo Brace

  • A rigid surgical device
  • Usually screwed into the skull at the top, and a vest is worn on the chest at the bottom
  • Used after severe spine trauma or extensive neck surgery
  • Used for conditions where no motion should take place in the neck
  • Used 24 hours a day until the spine is stable and healed

 

         2. Back Braces

            a. Lifting Belts

  • Often made of cloth or canvas, sometimes with plastic insert in the back
  • Often not doctor prescribed but available ‘over the counter’
  • Designed to reduce low back strain
  • Do not limit mobility much
  • Are best used for specific, more strenuous activities

             b. Lumbo-Sacral Belts

  • Often made of heavy cotton reinforced by metal stays
  • Lightweight, overall soft
  • Tension can be adjusted by Velcro belts or laces
  • Do not eliminate motion
  • Usually recommended to be worn for particular, more strenuous activities

            c. Corsets

  • More rigid than Lumbo-Sacral belts
  • Often made of thick cotton with metal stays
  • Are usually laced up in the front or sides
  • Shorter ones are used for low back problems
  • Longer ones are used for mid-back problems and often have shoulder straps
  • Can be used for spine deformities such as scoliosis
  • Softer corsets are also available for specific spine conditions

          d. Rigid Back Brace

  • Are more rigid than Lumbo-Sacral Belts or Corsets
  • Are often made of hard plastic material
  • Often have Velcro belts to tighten
  • Are used after spine surgery to allow healing
  • Are used after spine trauma to prevent instability

         e. Hyperextension Braces (e.g. Knight-Taylor Brace, Jewett Brace)

  • Keep the spine from bending forward (flexion)
  • Often used after a fracture of the vertebral bone in the front of the spine
  • Also used after specific spine surgeries
  1. Have a metal frame in the front, which puts pressure against the breast bone (sternum) up top and pubic bone at the bottom
  2. Have strong support in the lower part of the mid-back (around T-10) to prevent forward bending (flexion)

B. Back Support Mattresses

Good Sleep hygiene is very important, especially for patients with chronic spine pain. Here are some tips about choosing a proper mattress:

  1. Mattresses are graded based on the number and arrangement of the springs (coils), thickness of the pad, and thickness and type of the mattress itself.
  2. The best mattress is one that is most comfortable and most supportive of the spine, not one with the most coils or springs, or the thickest pad.
  3. The firmest mattresses are not necessarily the best. Often not too firm and not to soft is the best way to go. Medium firmness has been shown to be better for the spine than Highest firmness.
  4. A good mattress should support the heaviest parts of our body: head, shoulders, spine and hips
  5. A mattress should gently support the normal curves of the spine and not stress them
  6. A bad mattress can create poor sleeping posture causing back pain
  7. A good mattress must have a good bed spring which is matched to the firmness of the mattress
  8. A mattress should be spacious enough to allow for nighttime movements. It is often best to go with a larger mattress if possible.
  9. A good mattress should not allow the spine to sink into it, but rather support it.
  10. Mattresses are usually only good for 5-7 years before they lose significant support of the spine.

 

C. Neck Pillows

  1. Are designed to limit the neck’s mobility during sleep, keeping it in a more neutral and comfortable position.

 

D. Ergonomic Chairs

For those of us who spend much of our workday in a chair, having a good “spine chair” is essential and can help with back pain. Highly adjustable chairs are often best. Ergonomic chairs should allow you to adjust for the following:

  1. Sitting height to a point where the feet are flat on the floor
  2. Sitting height to a point where the thighs are horizontal
  3. Sitting height to where the forearms are even with the height of the desk.
  4. With the back flat against the chair, there should be 2-4 inches left between the seat and the back of the knees.
  5. Should allow tilting adjustments for comfort
  6. Should allow arm rest adjustment to keep forearm at proper angle to the desk

Here are some examples of chairs used for spine patients:

a. Exercise ball as office chair

  1. Can help work the core muscles
  2. Should be used with caution in patients with back injuries or recovering from back surgery
  3. Since they do not have a back support, they do not allow the back muscles to rest
  4. Generally best not to use as main office chair
  5. Best used periodically not consistently as a chair

b. Lumbar Support Chair

  1. Has natural spine curvature built in as a molded lumbar support
  2. Avoids slouching forward after sitting for longer periods of time
  3. Can be ordered as a customized chair for your specific spine
  4. Good cushioning can help with fatigue of the back

c. Kneeling Ergonomic Chair

  1. Does not have back support
  2. Shins are supported by bar
  3. Weight is shared between the knees and the hips, rather than hips alone
  4. Less force is placed on the low back and hips
  5. Core muscles are used to balance the spine
  6. The spine, shoulder and neck are aligned

 

d. Recliner Chair

  1. Body is reclined
  2. Feet are propped up
  3. Body weight is not carried by the spine
  4. Can be used with a worktable designed for the chair
  5. Does not use spine muscles to a large degree
  6. May weaken the spine muscles if overused

e. Saddle Ergonomic Chair

  1. Shaped like a Horse Saddle
  2. Positions you somewhere between sitting and standing
  3. Legs are relaxed
  4. No back support

 

E. Spinal Decompression Devices

Decompression devices use mechanical traction of the spine to help with disc and nerve compression. Spinal traction dates back some 5,000 years and was used by the Ancient Egyptians for spine trauma. The hope was that traction would prevent spinal nerve injuries from becoming permanent.

A Scandinavian study from the mid-1970’s suggested that the majority of patients with disc herniations could avoid surgery by using spine traction devices. Since then, an interest in spinal traction and mechanical decompression has flourished.

  1. Inversion Tables

Inversion tables have been used extensively to relieve back pain. Here are some pointers about the use of Inversion Tables:

  1. Usually places you in the head-down position at various angles
  2. Tables are available for different decline angles
  3. Goal is to relieve nerve compression by using gravity to put traction on the spine (stretching of the spine)
  4. Should not be used in patients with or at risk for Glaucoma, Heart Disease or High Blood Pressure since it increases blood pressure and pressure in the eye
  5. Has not been shown to be effective for long-term relief of back pain
  6. Has been found effective for some patients for short-term relief of back pain
  7. Usually patients start with 2-3 minutes of inversion and can build themselves up to 10 minutes
  8. Inversion is often done 2-3 times a day for the most benefit
  9. Can help in patients with poor posture due to shorted muscles

 

          2. Non-Surgical Spinal Decompression

What is the history of Non-Surgical Spinal Decompression?

Non-Surgical Spinal Decompression was pioneered by Dr. Allan Dyer in 1985. He created the first Spinal Decompression device called the Vax-D in 1991.

What is the theory behind Non-Surgical Spinal Decompression?

Non-Surgical Spinal Decompression uses force to stretch the spine (distraction). This is meant to relieve pressure on a diseased disc. When the pressure is reduced, the hope is that a disc herniation can shrink or that pressure on the sciatic nerve can be relieved, resulting in less back and/or leg pain. The negative pressure inside the disc created by the stretch may also bring more nutrition to the disc to help in the healing process.

Non-Surgical Spinal Decompression may also help with joint pain in the spine, such as facet joint degeneration. The stretching of the spine can reduce the pressure on these joints, giving them potentially a break from the usual weight on the joint. This may help with joint inflammation and joint pain.

How do these Non-Surgical Spinal Decompression machines actually work?

Non-Surgical Spinal Decompression machines use mechanical force to stretch the spine. They consist of a spine table, patient attachments to the table, a mechanical device which creates the stretching force, and a computer which controls it. The patient is placed on the table and the hips, shoulders, or feet secured to the moving parts. The computer is then programmed for specific treatment types. Force is then applied to the body to stretch the spine. The computer can control how much force is applied, how long the force is applied for, and at what angles.

What are the potential benefits of Non-Surgical Spinal Decompression?

Here are some potential benefits:

  1. Non-Surgical
  2. Non-Invasive
  3. No medications are given

Has science proven that Non-Surgical Decompression works?

There are many smaller studies which show some benefit for patients using these devices. However larger scientific studies have not conclusively shown that these devices work as well as medical or surgical treatments. More studies may be needed to directly compare them to the traditional medical and surgical treatments.

Could Non-Surgical Spinal Decompression hurt me?

It is best to see a spine specialist before trying this form of treatments. A specific spine diagnosis is needed. Once this is established, the spine specialist can determine if the Non-Surgical Spinal Decompression devices could cause a problem.

What are some examples of the Non-Surgical Spinal Decompression Devices?

  1. Vax-D
  2. DRX-9000
  3. SpineMed
  4. Accu-Spina
  5. ABS
  6. Z-Grav
  7. DiscForce
  8. Spinetronics

 

3. Home Traction

a. Over-door traction devices use a soft head “halter” and a rope and pulley system to provide the traction. The amount of traction can be controlled either with weights or by hand. These devices can be used for at-home therapy.

b. Pneumatic Cervical devices use an inflatable collar to raise the head. The collar is slowly inflated and increases the distance between the head and the chest/shoulders. This provides gentle and incremental traction of the neck. These devices are available for at-home therapy.