This document provides a comprehensive overview of the spinal column, including its anatomy, function, movements, and the principles of spinal orthosis. It describes the structure of vertebrae and intervertebral discs, the importance of spinal curves, and the mechanical properties of the spine. Additionally, it outlines the various indications for spinal orthosis and the associated effects, both positive and negative.

1. INTRODUCTION
• Spine can be defined as LONG,SLENDER , LIGAMENTOUS
bony structure which is markedly stiffen by rib cage .
• It is a mechanical structure .Vertebrae articulate with
each other in a controlled manner through a complex of
• LEVER (Vertebrae)
• PIVOTS (Facets & Disc)
• PASSIVE RESTRAINTS (Ligaments) &
• ACTIVATION (Muscles)
• It serve as a Sustaining Rod for the maintenance of the
upright position of the body

2. Spinal column possesses stability in two ways :
•INTRINSIC STABILITY by INTERVERTEBRAL DISC &
LIGAMENTOUS FORCES
• EXTRINSIC STABILITY by MUSCLE SUPPORT especially
of the abdomen & thoracic cage
•It is subjected to many forces such as Compression ,
Shearing ,Tension ,Bending , Twisting etc.
•Combination of rigid structure & elastic structure gives
STABILITY as well as MOBILITY to the spinal column.
•Main function of the spinal column is :
•Protect the spinal cord &
•Transfer the load

3. BASIC STRUCTURE OF SPINE
CERVICAL
THORASIC
THORACO
LUMBAR
LUMBAR
COCCYX
SACRUM
INTER-
VERTEBRAL
DISC
1ST
LUMBAR
1ST
THORACIC
1ST
CERVICAL
 CERVICAL = 7
 THORACIC = 12
 LUMBAR = 5
 SACRUM = 5
 COCCYX = 4
TOTAL 33 VERTEBRAE &
23 Intervertebral Disc

4. FUNCTIONAL SPINAL UNIT
 VERTEBRA
 DISCS

5. A Single FSU
• FSU = functional spinal unit
• Simplest functional unit
of the spine
– Two vertebral bodies
– Ligaments & capsules
– Intervertebral disc
• Often used in testing
http://www.eorthopod.com/images/ContentImages/spine/spine_thoracic/anatomy/thoracic_spine_anatomy12.jpg

6. BASIC ANATOMY OF SPINAL COLUMN
• Spinal Column is a DYNAMIC structure composed of
STATIC ELEMENTS .
1. VERTEBRAL BODY (RIGID STRUCTURE)
2. INTERVERTEBRAL DISC (ELASTIC SEGMENT)
• Each vertebrae is composed of 4 parts
1. BODY which transmit the forces
2. LAMINA & PEDICLE which encloses the spinal canal
3.SPINOUS & TRANSVERSE PROCESSES which provides
attachment for muscles & ligaments
4. POSTERIOR ARTICULAR PROCESSES OR FACETS
which guides & limit motion between adjacent vertebrae.

8. Intervertebral Disc Anatomy
• Annulus fibrosus
• Nucleus pulposus
• Vertebral
endplates
Bogduk N, Clinical Anatomy of the Lumbar Spine and Sacrum.
Elsevier/Churchill Livingstone, Edinburgh, Fourth Edition, 2005.

9. INTERVERTEBRAL DISC
• DISC is composed of two elements
• 1. ANNULUS FIBROSUS
• These are obliquely placed elastic fibers which
permit controlled motion.
• Fibro elastic nature of the interwoven pattern of
annulus fibrosus permits motion between the
individual vertebrae.
• Anterior-posterior movement takes place due to
specific arrangement of fibers.
• Orientation of fibers with respect to vertical axis is
approx. 65 degrees .

10. Disc Anatomy – Annulus Fibrosus

11. Disc Anatomy – Annulus Fibrosus

12. • 2. NUCLEUS PULPOSUS
• It is a gelatinous substance which forms the center of
the disc .
• It has properties of gel
• I.V.DISC has particular VISCOELASTICITY which shows
sensitivity to the Rate of Loading or Deformation.
• Disc is a shock absorber & force disseminator of spinal
column & allow for direct control motion .

13. Disc Anatomy - Composition
• Water content in disc is very important for
resistance to compression .
• Throughout a normal day your spine
compresses due to water degress from discs .
• Normal degeneration with age leads to
permanent loss of proteoglycans and water
content .

14. TRIPOD CONCEPT OF ARTICULATION
• Static elements are arranged through their tripod
articulation & ligamentous support to allow for
intersegmental motion .
• Articular processes & cartilaginous disc form pyramid
like structure having apex directed in upward
direction in which other vertebral body fit .
• This tripod configuration gives very stable structure
of spinal column .
• Each vertebra has three articular surfaces
• TWO FACETS & ONE BODY which articulate with
the vertebrae above it .

15. VERTEBRAL ARTICULATION

16. SPINAL CURVES
1.CERVICAL LORDOSIS : 7
2.THORACIC KYPHOSIS: 12
3.LUMBAR LORDOSIS: 5
4.SACRAL KYHPHOSIS: 5
5. COCCYGEAL: 3 TO 4
Total 33 vertebrae
23 intervertebral disc
Total length of spine is
45% of body length
out of this ¼ of length
is formed by I.V. disc

17. Curves in the spine
Normal Cervical
lordotic Curve = 31 – 40 degree
Normal thoracic
kyphotic curve = 20 – 40 degree
Normal lumbar
lordotic curve = 50 degree
Cervical spine - most mobile segment
Thoracic spine - least mobile segment
of the spine
Lumbar spine – gradual cephalocaudal increase in motion

18. Spine is arranged in the form of four curves .
1 .CERVICAL LORDOSIS : It is due to wedge shape of I.V.
disc & helps to hold the head in the upright
position for a wide range of binocular vision .
NORMAL CERVICAL LORDOSIS IS 31 – 40 DEGREE
2. THORACIC KYPHOSIS: It is structural & is due
to lesser height of the anterior vertebral border
as opposed to the posterior borders .It increases the
volume of thoracic cavity & forms a thoracic
cage which contain abdominal content .
NORMAL THORACIC KYPHOSIS IS 20 - 40 DEGREE

19. 3. LUMBER LORDOSIS : It is due to wedge shape of I .V.
Disc .It helps in positioning C.G. of the body over it’s
base i.e. on the feet .
NORMAL LUMBER LORDOSIS IS 50 DEGREE .
4. SACRAL KYPHOSIS : It is form only by vertebral
body there is no I.V.Discs in this region . It helps to
increase the volume of the pelvic cavity .
NORMAL SACRAL KYPHOSIS HAS AN ANTERIOR TILT OF
45 DEGREE . .
COCCYX IS FUSED SEGMENT MADE BY 3 TO 4
VERTEBRAL BODIES .

20. MOVEMENTS OF THE SPINE
• Spine has movements in all three planes because
anterior & posterior intervertebral joint has
universal axes. Motion of one vertebra on the other
is controlled by several factors as follows :
1. DIRECTION OF ARTICULAR PROCESSES MAY
RESTRICT ROTATION AS IN LUMBER AREA .
2. OBLIQUITY OF SPINE CAN HINDER HYPEREXTENSION
AS IN THORACIC AREA .

21. 3.RIBS IMPEDE LATERAL FLEXION IN THORACIC
REGION
4 . THICKNESS , SHAPE & COMPRESSIBILITY OF
THE DISC ALSO AFFECTS THE MOVEMENT .
5 . LIGAMENT S & MUSCLES RESIST EXCESSIVE
MOTION .
• CERVICAL SPINE IS HIGHLY MOBILE .
• THORACIC SPINE IS MORE CONSTRICT & VERY
MINIMAL MOTION DUE TO RIB CAGE
ATTACHMENT
• LUMBER SPINE HAS GRADUALCEPHALOQUADAL
INCREASE IN MOTION .

22. CERVICAL SPINE : First cervical vertebra forms free
Movable , condyloid joint with the occipital skull bone
permitting the head to flex , extend & lateral flexion on
the neck . Freely movable pivot joint between C 1 & C 2
allows ample rotation .
In THORACIC & LUMBER SPINE facets are at an
approximately 90 degree to each other in their
respective plane i.e. FRONTAL & SAGITTAL PLANE .
So pure lateral bending is impossible in this region .

23. RANGE OF MOTION
Cervical
Flex = 60 degree
Ext = 80 degree
lateral flex =(45 +45)
Rotation (75 + 75)
Thoracic
Flex = 15 degree
Ext = 15 degree
lateral flex =(15 +15)
Rotation (40 + 40)
Lumbar
Flex = 40 degree
Ext = 25 degree
lateral flex =(20 +20)
Rotation (5 + 5)
cervical
thoracic
lumbar

24. MOVEMENT CERVICAL THORACIC LUMBER
FLEXION 60 15 40
EXTENSION 80 15 25
LATERAL
FLEXION
45 + 45
= 90
15 + 15
= 30
20 + 20
= 40
ROTATION 75 + 75
= 150
40 + 40
= 80
5 + 5
= 10
VARIOUS MOVEMENTS OCCURING IN THE
CERVICAL , THORACIC & LUMBER SPINES :

25. VERTEBRAL GROWTH
• Iliac apophysis is an important sign representing the
completion of vertebral growth .Complete
ossification of iliac apophysis coincide with the end
of vertebral growth .
• This is also called as RISSER’S SIGN which helps to
detect the skeletal maturity .
• The ossification process is called as CAPPING .

26. 5 stages of capping procedure are as follows :
0 = No iliac apophysis
1 = Appearance of iliac apophysis
2 = Development of iliac apophysis
3 = Fusion starts anteriorly
4 = Slight posterior fusion of epiphysis
5 = Complete fusion of epiphysis
Completion of capping occurs at approximately
16To 17 years of age in BOYS & 14 to 15 years of
age in GIRLS .

28. UNIQUE FEATURES OF NORMAL SPINE
1. SPINE IS NOT A HOMOGENOUS STRUCTURE.
consist of rigid bodies & highly deformable disc
2 . SPINE IS NOT STRAIGHT .
3 . SPINE HAS VARIATION IN SIZE & GEOMETRY OF THE
VERTEBRAE & FACETS WHICH GIVES DEFINITE
RESTRICTION OF MOVEMENT .
4.THERE IS NO SOLID CONNECTION AROUND IT.
5. IT IS A CONNECTION BETWEEN UPPER EXTREMITY &
LOWER EXTREMITY
so 100 % immobilization is not possible .

29. DIFFICULTY IN SPINAL ORTHOTIC MANAGEMENT
1. WE CANNOT REACH THE SPINE .
Only spinous processes can be feel from posterior
aspect , so no direct correcting force can be applied
. All the forces has to be transmitted through
transmitter to the spine
2 . IT IS NOT STRAIGHT so it has to be covered all
around by forming a cage like structure .
3. IT IS A CONNECTION BETWEEN UPPER EXTREMITY
& LOWER EXTREMITY so 100% immobilization is
not possible .

30. FUNCTIONS & GOAL OF SPINAL ORTHOSIS
• FUNCTION OF SPINAL
ORTHOSIS :
1. Correct the Deformity
2. Limit Motion
3. Stabilize the Spinal
Segment
4. Deload the spine
5. Miscellaneous Effects
e.g. Massage ,Heat etc
• GOAL / OBJECTIVE OF
SPINAL ORTHOSIS :
1. SUPPORT
2. PROTECT
3. PREVENT
4. CORRECT
5. REST / IMMOBILIZE

31. MECHANICAL PRINCIPLES OF
SPINAL ORTHOSIS
• BALANCED HORIZONTAL FORCES OR THREE POINT
PRESSURE PRINCIPLE .
• FLUID COMPRESSION
• SLEEVE PRINCIPLE
• AXIAL DISTRACTION
• SKELETAL FIXATION

32. 1. BALANCED HORIZONTAL FORCES:
• It is formed by three horizontal forces , two in one
direction & one in opposite direction .
• This force system is suitable for providing efficient
bending moments for correction of lateral curvature
& derotation of vertebrae .
• Depending upon the length of LEVER ARM from the
point of application of the force, the magnitude of
the force will change .
• This is useful for moderate curve correction .

33. BALANCED HORIZONTAL FORCES( Three point force
systems)
•Example of parallel force system
•∑ FA, FB & FC = 0
•Most suitable for correction of
scoliosis derotation of vertebrae
& immobilization of spine
•Two forces in one direction &
third in opposite direction

35. • The magnitude of forces
is inversely proportional
to their perpendicular
distances from reaction
point
• Therefore magnitude of
force at A,B &C must be
3:2:1
• Pad size must be proportional
to the magnitude of force
• e.g.. Jewette Brace
A
B
C

36. 2 . FLUID COMPRESSION :
• This can be utilized by compressing lower
abdominal muscles externally with corset or
anterior shell .
• It helps in RESTING & UNLOADING the spine .
• The suspended weight of the abdomen in case of
obese patient is supported by the anterior corset
which reduces the lever arm by shifting muscles
backward & make person erect .
• This helps to unload spine by 30 to 40 %

37. MECHANISM OF FLUID COMPRESSION :
• Use of soft tissue to support a
compressive load
• Diaphragm & abdominal
muscles help to compress
the contents of trunk
(abdominal cavity).
• The turgor of fluid under
pressure is employed to
support the spine
• e.g. Corset of LSO,
abdominal belt, binder
• Effective in unloading &
resting the lumbar spine

38. 3. AXIAL DISTRACTION :
• Achievement of
immobilization or
stability by application
of tension, through
distraction
• e.g. When ordinary
paper held vertically and
stretched between the
two hands, becomes rigid
• e.g. Use of vertical
distraction force in
correction of scoliosis < 45°

39. 4. SLEEVE PRINCIPLE
• Construction of cage
around patient’s spine .
• Two semicircular rings
with fixation points one
above the another below
connect them with
uprights, side & posterior
or para spinal
e.g. LSO, TLSO (TC)

40. 5. SKELETAL FIXATION
• It is a surgical procedure
by which spine is stabilize
by external device
fitted on the skull .
• Pins are passed through
the outer table of skull to
stabilize cervical spine.
• They are connected to
TC DLSO by means of uprights .
• Provide 95-100% stability .
• Very much effective for immobilization .

41. B . OTHER PRINCIPLES
1. Placebo effect
2. Kinesthetic reminder
The orthosis irritates
the patient in some
way serving as
stimulus to limit the
activity .

42. LOW STIFFNESS VISCO-ELASTIC TRANSMITTER
• As spine is not reachable directly , the forces must
be transmitted through the structures which are
surrounding the spine e.g. Ribs , Muscles , Fats ,
Water , Air , Viscera etc.
• These all surrounding structures are called as LSVT
i.e. LOW STIFFNESS VISCO-ELASTIC TRANSMITTERS .
• Amount of force transmitted depend on the stiffness
of material through which it is transferred .
• The stiffness of these transmitters varies
considerably . Ribs are more stiffer whereas Fat is
less stiffer transmitter .

43. • As ribs are stiffer transmitters than muscles & viscera
forces can be applied more effectively to Thoracic
spine as compare to the Lumbar spine .
PELVIC BAND
PADS
STRAPS
THORACIC
BAND
UPRIGHTS
LSVT SPINE
RIBS
MUSCLES
FATS
WATER
AIR & VISCERA
S
P
I
N
E

45. Positive effects of Spinal Orthosis :
1 . Trunk support : it is achieved by means of
• Intra cavitary pressure – reduces functional demands on
spinal extensor muscles and vertical loading of thoracic &
lumbar spine .
Elevation of intracavitary pressure is also known as
Hydro pneumatic Unloading .
• Three point force system : helps to support trunk .
2 . Motion control – by means of
• mechanical three point force system .
• Psychological Restraint .
3 . Spinal Realignment – Three point force system helps to
shift the weight from diseased to normal part thus helps
in realignment .

46. NEGATIVE EFFECTS OF SPINAL ORTHOSIS
1 . WEAKNESS & ATROPHY OF MUSCLE : following
reduced functional demand (disuse atrophy ) which
can be avoided by early gradual discontinuation.
2 . TIGHTNESS & CONTRACTURE : following
immobilization & atrophy .To avoid this exercise
program should be started along with rest .
3 . PSYCHOLOGICAL DEPENDANCE :
generally enhanced by overtreatment .
4 . AGGERVATION OF SYMPTOM PATTERN &
PROGRESSION OF UNDIAGNOSED DISORDERS .

47. INDICATIONS OF SPINAL ORTHOSIS
A. PAIN :
1 . NONSENSITIVE TISSUES
a . Disc
b . Ligamentum flavum
c . Interspinous Ligaments
2 . SENSITIVE TISSUES
a . Longitudinal Ligaments
b . Muscles
C . Posterior Nerve Root

48. B . MALALIGNMENT – CONGENITAL / ACQUIRED :
1 .Torticollis ( Wryneck )
2 . Scoliosis
3 . Khyposis
4 . Lordosis
5 . Spondylolisthesis
C . TRAUMA :
1 . Fractures & Dislocations
2 . Herniation (ruptured ,slipped or bulging disc) D .
D . INFLAMMATION :
1 . Osteomyelitis
2 . Tuberculosis ( Pott’s Disease)

49. E . METABOLIC & DEGENERATIVE DISORDERS :
1 . Osteoporosis
2 . Rickets
3 . Osteogenesis Imperfecta ( Osteosclerosis)
4 . Juvenile Khyposis (Scheuermann’s disease)
5 . Spondylosis ( Osteoarthritis)
6 . Rheumatoid Arthritis
F . CONGENITAL DISORDERS :
1 . Spina Bifida
2 . Spondylolysis ( bony defect )
G . NEOPLASMS : (TUMORS)
H . ORTHOSIS FOR POST OPERATIVE CARE :

50. INDICATIONS FOR SPINAL ORTHOSES
(THORACO-LUMBAR)

51. 1 . Low back pain
Causes:
Lumbosacral sprain
Sciatica
Sciatic radiculitis
Herniation of nucleus pulposus
Disc degeneration
Spondylitis – Arthritis of the spine
Spondylolisthesis

52. Low back pain
Goal of spinal orthosis :
• Reduce pain & promote healing .
• Enhancement of intra cavitary pressure .
• Realignment by shifting weight from
diseased to undiseased elements .

53. 2. Fractures
A - Compression Fractures
• Encourage hyperextension
• Axial deloading by thoraco - abdominal supports
• Rigid / Total contact immobilization
• Trunk support
B - Osteoporosis with multiple vertebral
compression fractures
• Elderly Flexible lumbosacral Corset (Reminder)
 Taylor’s brace ( Protection)
• Young More rigid orthosis
C – Posterior Element Fractures
• Control of motion is important
• Plastic body jackets are used .

54. 3. Inflammatory Spinal Arthritis
(motion control is Important!)
a) R.A, Ankylosing spondylitis
TLSO – F – E - R control
orthosis required to resist flexion .
b) Juvenile Spinal Osteochondritis (Dorsal kyphosis)
Schuermann’s disease
Hyper extension brace or ASH brace
Modified Milwaukee
TLSO – F – E – LF - R control brace

55. C. Infectious diseases
Osteomyelitis
Tuberculosis
Motion control is the prime objective
Body jackets & TLSO – F – E – L - R control

56. 4. Tumors
5. Paralytic Disorders - Poliomyelitis
Paraplegia
Spina Bifida-MMC
6. Deformities e.g. Scoliosis , kyphosis
Kyphoscoliosis
7. Muscular Dystrophy
8. Degenerative disorders

57. INDICATIONS FOR SPINAL
ORTHOSES
(CERVICAL)

58. 1. Sprains of the cervical spine
Mild – Soft cervical collar
Moderate - Soft - night time
Rigid – day time
Severe - Four Poster

59. 2. Torticollis
Neurologic origin – No bracing
Muscular origin - Orthosis followed by
surgical release of SCM
( Four poster collar or
molded collar)

60. 3.Degenerative disc disease
Motion control is most important
Head is to be positioned in slight flexion
- Soft Cervical collar - Night time
- Rigid Cervical Collar – Day time
- Four poster collar for reducing pain & promote
healing ( in severe cases)

61. 4. Fractures & Dislocations
Relief from gravitational stress
Orthotic treatment is decided by
a) stability of fracture
b) state of the nervous system
c) extent and stability of spinal fusion
( if performed)

62. Stable fractures
- Initial bed rest & traction
- Poster appliances
- Rigid collar with mandibular
& occipital support
FRACTURE
SITE

63. Unstable fractures
- Skeletal Traction
- Molded HCTO
- Halo devices attached
to molded DLSO
- Minerva jacket
(Post fusion)

64. SPINAL ORTHOSIS :
• According to the material used for fabrication of
orthosis they are classified as
1 . FLEXIBLE SPINAL ORTHOSIS :
Use of soft material like canvas , foam etc.
2 . SEMIRIGID SPINAL ORTHOSIS :
Combination of flexible & rigid material like M.S.
Patti covered with leather or plastics covered with
soft material .
3 . RIGID SPINAL ORTHOSIS :
Molded in H.D.P.E. or ORFIT , AP shell type

65. FLEXIBLE SPINAL ORTHOSIS :
• Provides minimal control of flexion & extension of
the spine .
• Basic flexible spinal orthosis are CORSETS & BELTS
which are generally used for back pain.
• CORSET is an encircling garment with stiffening
reinforcement which attempts to contain soft
tissues under pressure at a desired elevation to
compress bone & other tissue to restrict or prevent
motion or to support the muscle & other soft tissues
.

66. BELTS are same as corset in the function only it is
Uniform in dimension whereas corset extend down
over the buttocks & upper thighs to provide more
acceptable contour.
VARIOUS TYPE OF BELTS & CORSETS :
1.SACROILIAC BELT :
It is 2-4” wide. Made up of canvas .
Helps to stabilize sacroiliac joints . Mainly used
in post traumatic sacroiliac separation.
2 . SACROILIAC CORSET :
It is 4-6” wide .Useful in elevating intraabdominal
pressure & use for post traumatic stabilization of
pelvic joint .

67. 3 . LUMBOSACRAL BELT :
It is 8-10” wide .Extra paraspinal steel inserts are
provided if additional stiffness is desired .
4 . LUMBOSACRAL CORSET :
It is 8-10” wide & encompasses torso & hips.
5 . HIGH L.S.CORSET :
It is 10-12” wide .
6 . L.S.CORSET WITH BROAD ABDOMINAL APRON:
In this anterior apron is made to encompass full
abdomen for better support .
7 . THORACIC RIB BELT : Given for rib fracture to prevent
maximum rib expansion & dislocation .
IN ALL CASES CORSET SERVE AS A REMINDER TO
RESTRICT MOTION & DELOAD THE SPINE

68. 7. THORACOLUMBOSACRAL CORSET :
Here corset extends up to axilla, shoulder straps
encircle the axilla. Usually reinforced by posterior
rigid or semirigid stays extending the full length of
the orthosis .
FUNCTIONS OF CORSETS:
1 . TRUNK STABILISATION
2 . DELOADING OF SPINE
3 . THREE POINT PRESSURE SYSTEM TEND TO
RESTRICT SPINAL MOTION
SPECIAL CONSIDERATION : Posterior stays should be
shaped so as to flatten (not maintain) lumbar
lordosis .

70. COMPONENTS OF SEMIRIGID SPINAL ORTHOSIS
• Semi rigid orthosis provides an efficient mean of
obtaining ABDOMINAL COMPRESSION with an
anterior force & at the same time distributing the
counter force over an extensive area which is three
point pressure principle .
• Most of the semi rigid orthosis has similar basic
components which forms stable base of the orthosis
& helps in providing efficient three point pressures .

71. PELVIC BAND :
• It fall midway between TROCHANTER & ILIAC CREST
•This position avoids bony prominences & provides
attachment for pelvic strap as low as possible consistent
with sitting comfort .
•It also helps to prevent upward
displacement of the brace .
•Lateral ends of the band extend
to the midtrochanteric line to
prevent lateral shifting .
• Posteriorly band crosses
above the inferior edge of
sacrum & below the PSIS .
• Approx . 1-1/2 to 1-3/4 “ wide .

72. THORACIC BAND :
•Superior border is at level of T9-T10 i.e. approx. 1”
below the inferior angle of scapulae .
•In females it can be placed 3” below the inferior
angle to avoid discomfort to breast .
• The higher band placement
is recommended for greater
restriction of motion in lumber
•Lateral ends are at the
lateral midline of the ribcage
i.e. mid-axillary lines .
•The band is placed horizontal
on the body
• Approx.1 -1/2 to 1-3/4” wide

73. LUMBOSACRAL POSTERIOR UPRIGHTS :
• Superior ends are at the superior edge of thoracic band
•Inferior ends at the level of inferior edge of pelvic band
•The distance between
medial edge of the
upright is 1 ½”-2 ½” to
avoid contact on bony
prominences i.e.
spinous processes .
•Width of the upright is
3/4” -1”
•Thoracolumbosacral
Posterior uprights are same as lumbosacral posterior
uprights only here superior border extends up to spine of
scapula & interscapular band is attached to these uprights

75. INTERSCAPULAR BAND :
•Extends from 2” medial to axillary fold horizontally to
the same point on the other side .
• It is placed at the distal 1/3 rd of scapula i.e. approx. 1”
above the inferior angle of scapula .
•This location is designed to place
the axillary strap slightly above
the posterior margin of axillary
fold which helps to prevent
upward displacement of the brace
•It helps in providing 3 point
pressure system .

76. LATERAL UPRIGHTS :
•Superior ends are at the superior edge of thoracic band
& inferior ends are at the inferior edge of pelvic band .
•Extend along the lateral midline of torso approx.
from mid-trochanter to mid-axilla line .
• Width is approx. 1/2”-3/4”
•Provides attachment for full
front abdominal corset .
•Controls lateral bending in the
lumbar spine .

77. OBLIQUE LATERAL UPRIGHT :
•Superior ends are pivotably attached to the lateral
upright & approx. 1”below the inferior border of thoracic
band .
•Inferior ends are rigidly attached to the pelvic band at
the postero-lateral section of the band .
•Length of oblique
lateral upright
is 2”more than
lateral upright .

78. COWHORN :
• It is the anterior extension of thoracic band with
subclavicular pad .
• Band extends forward
horizontally before
curving up around the
Pectoralis major .
• Superior border is
1/2”below the clavicle .
• Lateral border extends just
medial to the delto- pectoral groove
•Subclavicular pads are 2” in diameter .
• It provides rotation control in thoracic spine .

79. FULL FRONT ABDOMINAL SUPPORT :
•Superior border is 1/2 “ below xiphoid process .
•Inferior border is 1/2 “ above pubic symphysis .
•Extends to lateral uprights or posterior uprights
depending on the design of orthosis.
CORSET FRONT :
It is similar to the full front abdominal support ,
only difference is it is attached to the lateral
upright by laces whereas full front abdominal
support is attached to the posterior uprights
utilizing straps .
Corset front is generally worn over the brace .

80. LUMBOSACRAL FLEXION EXTENSION CONTROL
ORTHOSIS (CHAIRBACK):
COMPONENTS :
1 . PELVIC BAND
2 . THORACIC BAND
3 . TWO LUMBOSACRAL POSTERIOR UPRIGHTS
4 . FULL FRONT ABDOMINAL SUPPORT
PRESSURE SYSTEMS :
1.EXTENSION CONTROL : Anteriorly directed force by
thoracic band & pelvic band counter-acted by force
from corset .

82. 2.FLEXION CONTROL : Posteriorly directed force from
thoracic strap & pelvic strap counteracted by force from
posterior uprights .
Corset helps in increasing INTRA ABDOMINAL PRESSURE
& hence help in deloading the spine .
Also helps in decreasing the lumber lordosis .
Helps to limit the trunk motion in lumber area .
INDICATIONS :
• LOW BACK PAIN
• DISC HERNIATION
• STABLE # MANAGEMENT
• STABLE MIDLUMBER NONCOMPRESSION #
• TO LIMIT MOTION i.e. KINESTHETIC REMINDER

83. LSO F-E-L CONTROL (KNIGHT BRACE ):
• Same as CHAIR BACK orthosis only addition is LATERAL
UPRIGHT .
• Function is same as chair back only restriction of
lateral trunk motion is more effective because the end
of the pelvic & thoracic bands are anchored by the
lateral uprights .
INDICATIONS : 1 . TUBERCULOSIS
2 . LOW BACK PAIN
3 . DISC HERNIATION
4 . MID LUMBER STABLE NON
COMPRESSION # TYPE 2

85. LSO EXTENSION & LATERAL CONTROL
(WILLIAMS ORTHOSIS ) :
• COMPONENTS :
• PELVIC BAND
• THORACIC BAND
• 2 LATERAL UPRIGHTS
• 2 OBLIQUE LATERAL UPRIGHTS
• ABDOMINAL CORSET
• EXTENSION CONTROL : Anteriorly directed force
from pelvic band & thoracic band counter acted by
posteriorly directed force by abdominal corset .

87. LATERAL UPRIGHTS are pivotably attached to the
Thoracic band but not attached to pelvic band .
OBLIQUE LATERAL UPRIGHTS are pivotably attached
to the lateral uprights & rigidly attached to the
pelvic band so it allows flexion .
Abdominal corset is attached to the lateral upright.
INDICATIONS :
1 . SPONDYLOLYSIS
2 . SPONDYLOLISTHESIS
IN ALL THESE DESIGNS FORCE SYSTEM ARE
DESCRIBED IN SAGITTAL & TRANSVERSE PLANE .

89. DESIGN
MOVE
MENTS
F E LF R F E LF R
CHAIR-
BACK
S S S - S - S S S - S -
KNIGHT S S S S - S S S S -
WILLIAM F S S S - F S S S -
CONTROL IN
LUMBER AREA
CONTROL IN LUMBO
SACRAL AREA
COMPARATIVE STUDY OF ORTHOSIS MOTION CONTROL :
F : NO RESTRICTION , S : RESTRICTED MOTION
S- : INTERMEDIATE DEGREE OF MOTION CONTROL

90. THORACO LUMBAR F – E CONTORL ORTHOSIS
(TAYLORS BRACE)
• COMPONENTS :
1. PELVIC BAND
2. TWO THORACOLUMBAR POSTERIOR UPRIGHTS
3. INTERSCAPULAR BAND
4. ABDOMINAL CORSET
5. AXILLARY STRAPS
Thoracolumbar posterior uprights extends up to
the spine of scapula & gives attachment to axillary
straps & interscapular bands .

91. FUNCTIONS :
1 . FLEXION CONTROL FORCE SYSTEM :
Posteriorly directed force from axillary strap &
pelvic strap counteracted by anteriorly directed
force from posterior uprights .
2 . EXTENSION CONROL FORCE SYSTEM :
Posteriorly directed force from abdominal corset
counter acted by anteriorly directed force pelvic band &
interscapular band .
3 . Increases intraabdominal pressure .
4 . If forces are of sufficient magnitude they help
to maintain hyperextension posture .

93. INDICATIONS :
1 . POTT’S SPINE OR TUBERCULOSIS
2 . KYPHOSIS SECONDARY TO OSTEOPOROSIS
SPECIAL CONSIDERATION :
• Chest strap can be added .
• Sternal plate can be added to eliminate axillary
strap as it may be uncomfortable to some patient
causing pressure in axilla .
• Sternal plate helps to distribute forces over large area
hence it is more comfortable .
• It has two straps inferior sternal plate strap &
superior sternal plate strap .

94. TLSO FOR F-E-L CONTROL (KNIGHT TAYLOR )
• It is same as TAYLORS BRACE only addition is
• THORACIC BAND
• 2 LATERAL UPRIGHTS
• It has better control on the lateral flexion in
lumber area .
• INDICATIONS :
• Post surgical / non surgical stable # management .
• Kyphosis secondary to osteoporosis

95. TLSO FOR F-E-L-ROTARY CONTROL (COWHORN )
• It has same components as KNIGHT TAYLORS
but here thoracic band extend anteriorly &
superiorly and attached to the
subclavicular pads .
• Posterior uprights extends up to thoracic
band
instead of spine of scapula .
• Provides control in all three planes for
thoracic & lumbar spine .

97. FUNCTIONS :
1 . FLEXION CONTROL FORCE SYSTEM :
Posteriorly directed force from subclavicular pad
& pelvic strap counter acted by anteriorly directed
force from thoracic band .
2 . EXTENSION CONTROL FORCE SYSTEM :
Posteriorly directed force by abdominal support
counter acted by anteriorly directed force from
pelvic band & thoracic band .
3 . TWO FORCE COUPLE CONTROLLING ROTATION :
a .Posteriorly directed force by subclavicular pad
& anteriorly directed force by contra lateral
thoracic band .

98. b . Posteriorly directed force by one side of pelvic
strap & opposite side of subclavicular pad &
anteriorly directed force by pelvic band .
c . This pressure system tends to limit axial
rotation occurring in the thoracic & lumbar spine .
d . Lateral uprights provides lateral flexion control
in lumbar spine .
INDICATIONS :
# in low thoracic & lumbar spines .

99. Conventional cow horn Aspen TLSO

100. TLSO FOR FLEXION CONTROL
(ANTERIOR HYPEREXTENSION BRACE)
• COMPONENTS:
1. Anterior & lateral torso frame
2. Sternal pad
3. Suprapubic pad
4. Two lateral pads
5. Posterior thoracolumbar pad
TWO BASIC DESIGNS ARE :
1. JWETTE BRACE
2. ASH BRACE

101. JWETTE BRACE
In ASH BRACE anterior lateral torso frame is
replaced by + sign upright to make it more
sophisticated & cosmetically accepted .

103. ANATOMICAL POSITION OF COMPONENTS :
1 .STERNAL PAD :
Superior border lies 1/2 “ below sternal notch
with sitting comfort .
2 . SUPRAPUBIC PAD :
Inferior border lies 1/2 “ above the pubic symphysis
Lateral border passes medial to the ASIS
3 . LATERAL PADS :
Lies along the lateral midlines of the body
Starts at iliac crest & cover lower rib cage .
4 . THORACOLUMBER PAD :
Posteriorly covers thoracolumbar area .

104. FUNCTIONS :
Provides three point pressure system to control
Flexion & maintain Hyperextension .
• Posteriorly directed force from Sternal Pad &
Supra-pubic pad counter acted by anteriorly
directed force from posterior thoracolumbar pad .
• Creation of hyperextension posture tends to
increase lumbar lordosis .
SPECIAL CONSIDERATION :
• Only pads should touch the body & not the frame.
•Lateral pad prevent brace from shifting on the body
INDICATION : # of anterior column in thoracic spine .

105. PLASTIC MOULDED BODY JACKET
• It can be CTLSO , TLSO , LSO
• Effective in maintaining trunk alignment
• Provides total contact expect for bony prominences .
• CTLSO & TLSO gives triplaner control .
• LSO gives sagittal & coronal plane control .
• Anterior & lateral trunk containment elevates intra
cavitary pressure .
• Limits thoracolumbar rotation .

107. THORACIC LUMBER LS
CONTROL F E LF R F E LF R F E LF R
CHAIR BACK - - - - S S S- S- S S S- S-
KNIGHT LSO - - - - S S S S- S S S S-
WILLIAMS - - - - F S S S- F S S S-
TAYLORS S- S- F F S- S- F F CI CI F F
KNIGHT
TAYLORS
S- S- S- F S S S S- CI CI S S-
COWHORN S F S- S S S S S CI S S S
ASH BRACE S F F/
S-
F/S- S F F/
S-
F/
S-
S- F F/
S-
F/
S-
F = NO RESTRICTION OF MOTION
S = CLINICALLY SIGNIFICANT RESRICTED MOTION
S- = INTERMEDIATED DEGREE OF MOTION RESTRICTION
CI = COMPENSATORY INCREASE IN MOTION

108. CERVICAL ORTHOSIS :
• Basically cervical orthosis are of 2 types
1 . COLLARS 2 . POST APPLIANCES
FUNCTIONS OF CERVICAL ORTHOSIS :
• Through sensory feedback remind wearer to
limit head & neck motion .
• Provides mechanical restriction of motion .
• Reduce load on cervical spine .
• Retain body heat which aid in healing soft
tissue injury & reduce muscle spasm .

109. BASIC CERVICAL ORTHOSIS ARE OF THREE TYPE :
1 .COLLARS : These appliances provides control
of flexion & extension . Depending on the
material used for fabrication the amount of
motion restriction will change . Basically they
provide mild to moderate restriction but most
of the time work as KINESTHETIC REMINDER .
2 . POSTER APPLIANCES : These are used for
treatment of # may be preoperative or post
operative . Provides F-E-R control .
3 . MOULDED ORTHOSIS :These are given for
F-E-LF-R control & provides immobilization .

110. COLLARS : Collars are devices that wrap around
the neck & are adjustable circumferentially .It
may have provision for height adjustment by
single or multiple layers & of variable firmness.
Depending on the material used they can be :
1. SOFT CERVICAL COLLAR : Provides mild amount of
restriction .These are made up of soft foam or sponge
rubber like DUNLOP SPONGE Some time felt or Evazote
can be use .
FUNCTIONS :
1. Provides mechanical restriction for F & E
2 . Work as reminder &
3 . provide warmth .

112. 2 . SEMIRIGID CERVICAL COLLARS :
Materials used : Thin H.D.P.E.sheet lined with
soft cushion foam .
FUNCTIONS :
1 . Provides moderate amount of F-E control
2 . Work as reminder .
3 . Provide warmth to injured area .
INDICATIONS :
1 . Soft tissue injuries .
2 . Muscle strain .
Provides approx. 20 % motion restriction .

114. 3 . PHILADELPHIA COLLAR :
• It is made up of polyethylene foam with
rigid anterior & posterior plastic strips .
• Covers more of the head & neck .
• Superiorly extends over the mandible & at the
occipital level & inferiorly covers proximal thorax
INDICATIONS:
1 .Sprain/strain
2 . Stable mid Cervical injury .
3.Stable bony & ligamentous injury .

116. ADVANTAGES :
1 . Bihalved & has velcro adjustment ideal
for bed ridden patients .
2 . Easy donning & doffing .
3 . Restrict gross flexion & extension .
4. Now a days available prefabricated .
DISADVANTAGES :
1 . Less effective in controlling rotation &
lateral flexion .
2 . Discomfort able to cardiovascular &
respiratory dysfunction patient .
3 . Requires skill for fabrication .
4. Cost is more .

117. 4 . FOUR POSTER COLLAR :
• It is a poster appliance which provides
F-E-LF-R control .

118. DESIGN :
• Anterior section consist of STERNAL PLATE ,
MANDIBULAR SUPPORT & TWO UPRIGHTS .
• Posterior section consist of INTERSCAPULAR
PLATE , OCCIPITAL SUPPORT & TWO UPRIGHTS.
•The uprights are adjustable in height .
• Angular position of plates can be modified by
swivel attachments between the uprights &
plates .
• Anterior & posterior sections are connected by
straps .

120. ADVANTAGES :
• More effective in controlling extension .
• Light in weight & good ventilation .
• Modifications are possible for more effect
• Can be given in tuberculosis patient.
• Semiskilled person can make it.
• Less fabrication time & less cost.
• Various sizes can be kept ready .
DISADVANTAGES :
• Not ideal for bed ridden patients .
•Requires experts for fitting .
•Less effective in controlling rotation .

121. STERNO-OCCIPITAL MANDIBULAR IMMOBILIZER
SOMI BRACE :
• It is a poster appliance consisting of sternal plate , one
anterior upright , occipital support,
& two posterior uprights which extends anteriorly & get
attached to sternal plate .
•Sternal plate is Y shape extending up to xiphoid level

122. ADVANTAGES :
• Can be given for # at T1 level .
• Ideal for bed ridden patient .
• Occipital support arises anteriorly from sternal
plate so easy to apply in supine .
•Height can be adjusted by turnbuckles .
• Adequate ventilation .
• Fabrication time is less & less cost .
• can be kept prefabricated of various sizes .
• Semiskilled person can make it .
• Anterior upright can be easily removed for
eating & oral hygiene .

123. DISADVANTAGES :
• Donning & doffing is difficult .
• Require experts for fitting .
•Control of cervical extension & lateral flexion is
significantly less .
MODIFICATION :
Dacron skull strap can be added which allows
patient to chew yet provide some flexion control .
SOMI brace is frequently used after removal of
HALO .

125. CUSTOM MOULDED CERVICAL ORTHOSIS:
• It markedly restrict all neck motions .
• Can also restrict thoracic motion if extended
down on thorax .
• Extension beyond upper thorax are classified
as Cervico-Thoracic Orthosis .
• They are of two types :
1 . CUIRASS TYPE 2 . MINERVA TYPE
• It can be made up of high temperature or
low temperature thermoplastics .

126. 1 . CUIRASS TYPE :
In this type orthosis extends superiorly over the
chin & covers mandible & occiput .
Inferior border extend 1” above the inferior angle
of scapula or inferior costal line depending on the
degrees of control required
2 . MINERVA TYPE :
In this entire posterior skull is enclosed in the
orthosis & band is provided around forehead
Lower border extends up to inferior costal margin
& for greater control may be extended as a pelvic
girdle .

128. HALO DEVICE :
This orthosis provides greatest control of
cervical motion .
COMPONENTS :
1 . Halo Ring : it encircles the skull .
2 . Distraction Rods : for length adjustment
3 . Shoulder Bars : gives attachment for
distraction rod & distal fixation component .
4 . Distal fixation components : it can be vest
body jacket or pelvic girdle or pelvic hoop or
femoral transfixing pins .

130. COLLAR F E LF R AD
BASIC S-/S F/S- F/S F/S- F
PHILADELPH S-/S S- S- S- F
SOMI S S- S- S- S
4 POSTER S S S- S- S
MOLDED S S S S S
HALO S S S S S
F : No Restriction S: Restricted Movement
S- : Intermediate degree of restriction

131. MODIFIED ORTHOSIS FOR SCOLIOSIS :
VARIOUS DESIGNS OF LOW PROFILE ORTHOSIS:

132. MILWUAKEE BRACE :

133. BOSTON BRACE

134. CALIBER ORTHOSIS :
Generally given for child below one year of age .

135. Lyonnais Orthosis :
It is one piece anterior opening orthosis custom fabricated
from plaster impression .
It extends anteriorly from sternal notch to pubic symphysis .
Lateral trimline & counter force parameter are same as Boston

137. CHARLESTON BENDING BRACE :
Mainly used as a night time bracing .
Brace is made in overcorrected position .

138. TLSO FOR PATIENT HAVING RESPIRATORY PROBLEM .

139. ORTHOSIS FOR OSTEOPOROSIS OR
GERIATIC PATIENTS

140. POSTURE TRIANING SUPPORT ( PTS ) :
Mainly used for osteoporosis also known as Weighted
Kypho Orthosis .
Hyper kyphosis is a common postural deformity in
osteoporosis & secondary to vertebral compression fracture
Kyphotic deformity elongate paraspinal muscles i.e.
extensors & leads to the overall muscle weakness .
PTS consist of sac in which weight is suspended just inferior
to scapula & can be increased maximum to 2.5 lb.
Two mechanism of actions are involved :
1 . Anterior compression force on the spine are reduced by
the counter acting force produced by posterior weights .
2 . Device encourage active back extension & helps in
strengthening the back extensor .

142. SPINOMED :
Specially designed for osteoporosis .
Functionally same as Knight Taylor Brace .
Consist of metallic back pad which is in total contact & can
be molded to provide the hyperextension of selected
segment .
Posteriorly directed
Force is provided by
Shoulder straps &
Abdominal corset .
Wt. is 450 gms .
Indicated for the
Management of
Chronic pain
resulting from
Vertebral Compression Fracture .