1. Department of Orthopaedic
Trauma Medicine
Year 1, Sem. 2
Subject – Biomechanics
Topic – Biomechanics of the
Spinal Orthotics
BY
Mr. Oduor Wafulah
9th November, 2022.
2. Uses of spinal orthotics:
1) Pain (back pain)
2) Restriction of spinal motion.
3) Postural care and postural correction.
4) Augment other therapies
3. General classifications of spinal
orthosis
Flexible orthotics:
Or corsets
They are
constructed out of
strong fabrics or
elastic materials
with a variety of
stiffer supports
Rigid spinal orthotics
They are used when
greater control of
motion or posture is
required.
They are fabricated
from high temperature
thermoplastics or light
weight metals.
There are wide
varieties with a broad
selection of pads and
coverings.
4. Therapeutic benefits of spinal orthosis
Intra abdominal pressure:
They create cylinder effect, exert pressure on the
abdomen, and raise intra-cavitary pressure and reduce
the intra-discal pressure especially during forward
bending.
Muscle relaxation:
Support the vertebral column and relaxing the
abdominal and erector spinae muscles
Decreasing the need for contractile support of the
vertebral column may relax the muscles and reduce
existing pain.
5. Restriction of motion:
The primary method employed for motion control
is the three point pressure system.
A rigid system is used when cervical, thoracic and
lumbosacral motions are sought to be limited to the
greatest possible degree.
The amount of limitation varies between the
various segments.
Reduction of motion will reduce pain and spinal
instability and offer constant proprioceptive
feedback, reinforcing positive behaviors.
6. Postural realignment:
↑intra abdominal pressure, relaxation in
muscle spasm, and restriction of movement
can assist in facilitation of improved posture
and reduce compensatory posture related pain.
E.g. In case of scoliosis, the use of orthosis
may prevent a spinal progression, stabilize the
curvature and may offer some degree of
posture correction
8. Flexible Orthoses Or Corsets
1) Sacroiliac corset (binder):
Made from a combination of fabrics, elastic, laces and
velcro offering multiple adjustments
Encircle the waist from the iliac crest to the greater
trochanter and extending anteriory to the symphysis pubic.
Provide postural stability and reinforcement.
2) Lumbsacral corset:
Made from heavy fabrics with laces and hooks.
It is designed to limit motion, maintain three point pressure
system and to reduce pain
9. 1) Thoracolumbosacral corset:
The same construction and function of lumbosacral
corset except it includes a shoulder strape to restrict
spinal motion to the thoracic region as well as to the
lumber spine
10. Rigid Orthoses
Lumbsacral orthosis (Williams Extension Lateral control):
Fabricated from light weight materials such as leather and
vinyl.
A single three point pressure system limits trunk extension in
lumber spine and increase interabdominal pressure.
Lordosis is decreased, pelvic and thoracic bands exert a medial
force that tend to limit lateral trunk motions, no limitation of
trunk flexion
11. Thoracic lumbsacral orthosis
Taylor (flexion/extension control): a pelvic band
connects with two posterior uprights terminating at
the midscapular level of the thoracic region, with an
anterior abdominal closure and axillary straps.
Two three point pressure systems are coupled
together to limit both flexion and extension of the
lumber and thoracic spine.
Knight-Taylor brace
12. Jewett (flexion control): a three-point pressure
system is created with two pads, one across the
sternum and one at the symphysis pubis, providing
the counterforce with a single pad posteriorly to
promote hyper extension and restricting forward
flexion.
Jewett®
hyperextension brace
13. Plastic body jacket (flexion-extension-lateral –
rotary control):
It is typically fabricated with high-temperature
copolymer plastics, a well-fitted body jacket will
restrict motion in all planes.
Anterior and lateral trunk containment elevate
intracavitary pressure, and decrease demands on the
vertebral disks.
Body jackets are frequently used post surgically or
during an acute trauma.
14.
15. Cervical Orthoses
1- Soft collar:
made from soft foam, the collar provides mechanical restraint for
cervical flexion and extension and, to a lesser degree, lateral
flexion and rotation. Although the soft collar provides minimal
restriction of movement, it is a good transitional appliance from
more rigid orthoses, and acts as a proprioceptive reminder to
the wearer to limit head and neck motions.
16.
17. 2- Hard collars (Philadelphia collar):
Constructed from semi-rigid and rigid plastics.
Hard collars provide more rigid stabilization of the cervical
spine and typically offer some type of chin and occipital
support, with the inferior collar extending to the sternal notch
and to the T3 spinous process posteriorly.
General, hard collars such as the Philadelphia collar limit
motion much more than soft collars, but on average still permit
40 to 50 percent of normal cervical ROM
Philadelphia collar
with a thoracic
extension
18. Cervicothoracic Orthoses
3- Sterno-occipital mandibullar immobilizer [SOMI]
Is one of the most common post surgical appliances
It consists of a rigid metal frame with a chin and occipital rest
connected to a chest and back plate, with padded shoulder and
trunk straps.
The added chest and back plates help to reduce cervical
motion by an average of 55 to 75 percent.
Sternooccipital-
mandibular
immobilization
brace
19. 4- Halo cervical orthoseis:
The greatest reduction in cervical mobilization occurs with the
halo-vest appliance.
A cranial ring is secured to the skull using four metal pins.
The ring is attached by four metal bars to a plastic vest and is
worn continuously.
The estimated reduction in all cervical motions is 90 to95
percent.
It also has the ability to provide distracting forces that aid in
the spinal stabilization and in reducing the load of head on the
cervical spine.
Halo device
20.
21.
22. Cervicothoraciclumbosacral
Orthoses
The CTLSO is the most commonly used for the treatment of scoliosis
and kyphosis. Although a number of designs are used for variety of
clients, The Milwaukee brace is without question the most popular.
The Milwaukee brace is designed with a neck ring and occipital pad,
connected to four metal upright bars secured to plastic TLSO, which
extends distally, forming a molded pelvic section.
The advantages of Milwaukee brace:
Each component pelvic, thoracic and cervical can be molded or adjusted
to slow, or even in some cases, correct scoliotic curve. In the case of
idiopathic scoliosis the average 1-year follow up showed an average 20
percent correction for thoracic curves.
The disadvantage is that the brace must be worn for 12 to 18
months,23 hours a day, with the child being out of the brace only for
exercise or atheletic activity. The psychological issues and poor
acceptance by clients and physicians lead to rejection of scoliotic
bracing, even with the more cosmetic, low-profile
