News Category: Spine

Bracing the Unbraceable: Boston Brace Shows Positive Results for Large Curves of Scoliosis

The Boston brace has been shown to help people with scoliosis when their spinal curve is less than 30 degrees. But most experts have felt the brace couldn’t keep curves over 35 degrees from getting worse. There is agreement that surgery should be held off until the curve reaches 40 degrees, which poses a dilemma when the curve is between 35 and 40 degrees. These curves are too small for surgery and too big to be helped by a brace.

The authors questioned whether the Boston brace could halt curves that were over 35 degrees. They also questioned if the amount of time the brace was worn each day mattered. The study included 45 girls and 5 boys averaging 13 years old. Each patient was prescribed the Boston brace to treat spine curves of 35 degrees or more. They were told to wear the brace 23 hours each day. They had appointments every four to six months to check their spine curves and to see how many hours they actually were actually wearing their braces. When they reached spinal maturity, they gradually stopped using the brace.

Results were compared an average of two years after skeletal maturity and again about 10 years later. By looking back at the patients’ records, the authors found that the Boston brace was effective in preventing large curves from getting worse. This was especially true when patients actually wore their brace for the recommended amount of time each day.
 
Those who wore their brace for more than 18 hours each day had the best results. Their curves actually improved by about 12% from the time they started using the brace. Those wearing the brace less than 12 hours per day showed an increase of almost 14% in the size of their curves.

The conclusions are clear. The Boston brace can help keep large curves from getting worse in patients with scoliosis, especially when it is worn 18 or more hours per day.

Back Pain Wears Me Out–or Does It?

Many clinicians who treat patients with chronic low back pain believe their patients need to do conditioning exercises for the heart and lungs. They believe these patients limit activity because of their pain, which leads to poor overall fitness. So patients with chronic low back pain are generally prescribed exercises to improve their aerobic stamina.

The first part of this study involved forming an equation to predict fitness levels in people with chronic low back pain. The authors then tested the long-held notion that these patients are generally less fit. The new formula showed that people with chronic low back pain had similar scores when compared with subjects who don’t have pain. The authors found that the patient group with chronic low back pain is “moderately fit” and not significantly deconditioned as commonly thought. However, the authors still suggest that people with chronic low back pain should be given aerobic conditioning exercises in order to help improve their overall ability to do their activities. 

New Thermal Treatments Put the Heat on Chronic Low Back Pain

When the fire of low back pain burns out of control, it may be time to fight fire with fire. A newer surgical treatment for disc problems called intradiscal electrothermal therapy (IDET) may come to the rescue. This type of procedure shows promise as an alternate treatment for people with bad back pain.

In IDET, doctors use a TV screen to guide a special needle into the sore disc. They then slip a heating element through the needle and into the injured zone. When the temperature of the element is raised, it is believed to shrink disc material, reducing a bulge or closing off a torn portion. It also seems to have a calming effect on pain sensors within the sore disc.

Doctors recently tested the benefit of this kind of treatment. They chose 25 patients with chronic low back pain who were having problems after at least six months of non-operative treatments. These patients were considered to be candidates for lumbar fusion surgery, but instead they chose to undergo the IDET procedure.

Before having IDET, they rated their pain  on a scale between zero and 10. They also filled out a form about their ability to function on a day-to-day basis. The authors checked back with the patients an average of seven months after surgery to measure their new pain and functional levels.

The surgery made a measurable difference. The pain levels of nineteen patients (80%) went down at least two points on the 10-point pain scale. Eighteen patients (72%) either stopped using pain pills or were able to get by with significantly less medication. They also reported improvements in being able to sit for longer time periods. The authors also found that patients who went through IDET treatment used less pain medication.

Future studies are needed to confirm this preliminary report. Yet these results suggest that IDET will likely become helpful way to extinguish the fire of chronic low back pain.

Getting Golfers Back on Course

The grass may be greener for golfers who improve the technique of their swing, especially if they’ve been feeling sand-trapped by low back pain. Low back pain is the reason most male golfers stay off course. Golfers’ low back pain has been linked to poor swing technique and the repetitive action of swings.

Researchers videotaped the swing of a 22-year-old male golfer with back pain. They used the video results to create three-dimensional images to plot markers of shoulder, hip, and spine alignment, and to monitor changes in the angles in these body regions as the golfer moved through his entire swing. To see how hard the back muscles were working during the swing, the researchers placed electrodes along the sides of the golfer’s spine.

The images showed several problems in swing technique. The golfer didn’t turn his hips enough during the back swing. He also tended to twist his hips more than his shoulders just before swinging the club downward. Then during the downward motion, he bent his spine too far forward and to the side because he tended to lead with his hips. The electrodes registered extra activity in the spine muscles in this part of the swing. The authors suggest that the awkward movement of the spine combined with the extra muscle activity could cause painful joint compression in the spine.

After the video sessions, the golfer received professional coaching for three months. He also continued doing a series of strengthening exercises for his abdomen and back muscles. The coach had the golfer move closer when preparing for the swing. He also taught better shoulder position. Then the coach worked on keeping shoulders and hips aligned to prepare for the downward motion of the club, and turning the hips and shoulders as a unit rather than leading with the hips.

After completing the coaching sessions, the researchers rechecked the golfer’s swing. The changes in technique were dramatically different from the first time he was videotaped. Instead of twisting his hips and bending his spine in the downswing, he showed good upright alignment of hips and shoulders. This new style helped him hold his trunk steady, and the spine muscles didn’t have to work as hard.  The authors suggest that these changes in alignment and muscle activity might ease torsion and compression on the spine. The golfer was able to resume his sport free of pain.

The authors conclude that helping players with low back pain to modify their technique and to take part in muscle conditioning exercises might help prevent problems of back pain among golfers.