When we discuss Orthotics, we far too often make the assumption that this is all about the foot and ankle, perhaps the knee, and occasionally the hips. All of my posts thus far have really been focussed on the importance of skeletal stability in reducing, managing or preventing pain, and this does often begin with gait and posture. This situation isn’t helped when you consider that the good old ‘Functional Foot Orthosis’ (FFO) has become known as an ‘Orthotic’, thus fuelling the assumption that Orthotics is all about the foot; we need to be careful however, not to forget that the role of the Orthotist is to ‘straighten’ and to brace, and this is equally as important in all other parts of the body. What I want to do in this post, is to provide a whistle stop, and incredibly basic, introduction to the other types of orthoses that would be used from the pelvis up.
Your back supports your torso and head, and consists of 26 bones all with their own muscles and ligaments which allow you to bend forwards, backwards, side to side and also rotate round. Poor back health is a major issue with some staggering statistics. For example:
– Back pain will affect 80% of us at some point in our lives.
– One in six working days lost in the UK is due to back pain.
– It is estimated that back pain costs the NHS, business and the economy over £5 billion a year.
Back pain can occur due to damage to the bones, ligaments or muscles of the spine and can occur suddenly due to a trauma such as a whiplash injury or can be a chronic and degenerative condition such as arthritis. In any case the results are devastating to the sufferer.
We need to remember that the correct orthosis potentially has several jobs to do, ranging from immobilising specific body parts in order to promote the healing of tissue, correcting deformities, restricting motion to prevent harmful postures, to increasing the range of motion or strengthening muscle, thus it is crucial that the correct device is prescribed, and the appropriate advice given. Let’s begin with the lower spine, and specifically with what are called ‘Lumbasacral’ orthoses. These are generally used for issues with the lowest part of the spine, often for such conditions as Spondylolisthesis – this is a disease which causes one of the lower vertebrae to slip forward onto the bone directly beneath it. A Lumbasacral orthosis is usually used to prevent movement, thus preventing further damage or pain.
Scoliosis is something that more people may have heard of, and put simply, this is a curvature of the spine. This is, in the most serious cases, managed with surgery, but orthotics play their part here too. It is generally believed that where a spinal brace is used, in 80% of cases, the curve will remain the same size, thus sometimes removing the need for surgery for some. One of the big issues for researchers in recent years, has been how to develop a spinal brace that provides the right amount of immobilisation and support, whilst still permitting the wearer to function – even standing and sitting for example. Modern Orthoses are generally fantastic at doing both, but as they are all fitted to meet a specific need, the amount of bracing or movement you are permitted, will vary.
Moving up the spine to the neck, we move on to ‘Cervical Orthoses’, or more commonly known as the neck brace. These can range from soft collars, which are designed to provide support and to restrict movement, right up to a ‘Halo’ assembly, which can involve the head and the shoulders in order to brace a more serious neck injury for example. As with all bespoke orthoses, the type of brace prescribed will be determined by the specific requirements of the wearer, and whilst the anatomical needs will always take priority, the Orthotist will also take lifestyle into account where possible. There are a multitude of braces available today, and your Orthotist will discuss these with you if and when required.
We often refer to orthotic intervention in other areas above the pelvis, which don’t necessarily involve the spine, as ‘Upper Limb Orthotics’. These can cover issues with the shoulder, the elbow, the wrist, the hand or even individual fingers, and again, they are all designed to do different jobs, depending upon the needs of the wearer. Lehneis (1977) stated that the role of Orthotics is not only to enhance function, but to protect the limb in a functional position. This is particularly the case with upper limb Orthotics. Let us use ‘Lateral Epicondylitis’, or tennis elbow as you may know it better, as an example here. This can be treated with surgery or injections, but these are not risk free, and can have long-term effects. Wearing a simple Counterforce Orthotic brace however, keeps pressure off the inflamed muscles, by spreading the tension to different parts of your arm – thus enhancing function whilst protecting the damaged area in a functional position. A simple brace such as this, can keep people playing tennis and golf, which are the big two sports where this is common, whilst removing the need for surgery or injections.
I know this is a awful lot to take in in one post, and I’m sure that I’ll revisit some of these in greater depth as time goes on, but I guess my point here is to take some of the focus off of the foot, and help us to realise that orthotics are for the whole body, not just for Christmas – whoops, sorry, I appear to have mixed my clichés! You are clearly not going to pop along to your Orthotist and ask for something as complex as a Halo neck brace, as this will undoubtedly be something that will be provided if required; however, how many people are living with back pain and thinking that there’s nothing that can be done, or worse, that surgery is the only option? How many people give up playing sports like tennis or golf because of excruciating pain, when actually, a chat with an Orthotist might see you back on the court or the green in no time? Make an appointment to see your Orthotist, and discuss what they might be able to do to help you reduce your pain.