Regarding the controversy of lumbosacral supports and braces - an update.

Many health care practitioners believe lumbosacral supports and braces can be used effectively in treatment and prevention of musculoskeletal disorders of the lumbar spine.Ninety-nine percent of 3,410 orthopedic surgeons surveyed in the United States reported prescribing spinal orthoses.1 While there is no hard scientific evidence of the clinical effectiveness of lumbosacral supports and braces as a group, there are retrospective studies that have documented acceptance by patients and improvement of symptoms in from 30% to 80% of the cases.2-4The lower lumbar region is of particular interest because most disorders occur in one or both of the lower two segments. The use of supports and braces in the management of many common disorders will be discussed. Disorders of the sacroiliac joints, spinal fractures, postsurgical management, and corrective braces used in the treatment of disorders such as scoliosis and kyphosis are not within the scope of this article.Medical as well as industrial health and safety literature is filled with the pros and cons of using lumbar supports and braces. Certain factual information concerning the effects of back supports and braces has been known fix many years, while certain other effects remain unclear. While it is true that we have not made many recent discoveries concerning the effects of back supports, we have seen a renewed interest in their use. This renewed interest seems to focus on prevention as well as treatment, as is especially evident in business and industry.There also seems to be increased awareness and evidence of back injuries in sports. This has created interest in and use of back supports, and has led to development of new concepts and designs of back supports.Perhaps another reason for the renewed interest in back supports and braces has to do with the recent changes in attitudes toward the treatment of back disorders in general. Most experts now agree that almost all back disorders can be treated most effectively with early intervention of exercise and patient education. We no longer tell the patient to rest, take it easy, and wait until he or she is completely free of pain before starting exercises and activities. Many practitioners are recognizing that placing a back support on a patient often assists him or her in returning to full function sooner, avoiding the well-documented harmfi.il effects of prolonged immobilization and inactivity.

Use of spinal traction in the treatment of neck and back conditions.

Spinal traction is a time-honored method for the treatment of disc protrusion, degenerative disc disease, and joint dysfunction. Effective treatment is not as easy or as simple to administer as it may appear. Many variations of technique exist, some of questionable value. It must be emphasized that spinal traction is only a part of the total management-treatment regimen, which includes other forms of physical therapy. Without a total management program, spinal traction, like many other empiric methods, has little chance of long-range benefit. Consequently, physicians prescribing spinal traction must be prepared to apply proved diagnostic methods and other treatment methods.

Unilateral lumbar traction.

Unilateral lumbar traction has been theorized to be superior to bilateral lumbar traction in certain cases. Many patients who cannot tolerate bilateral lumbar traction are comfortable with this method. It enables the physical therapist to administer lumbar traction to patients with protective scoliosis who would otherwise be unable to tolerate treatment. Although the theory behind the treatment seems sound, very little unilateral lumbar traction is used clinically because of problems with patient positioning and adaptability of available equipment. This paper described a technique of effectively administering unilateral lumbar traction. The technique involves a heavy-duty lumbar traction harness, with bilateral pelvic straps, that can be used for conventional lumbar traction. It is constructed in such a way that when only one side of the pelvic harness is coupled to the traction source, a stronger force is transferred to that side of the spine. Although separation occurs on both sides of the spine, greater separation and stretching is achieved on the side of the pull.

Classification of musculoskeletal spinal conditions*.

The aim of this article is to present and discuss the classification of musculoskeletal spinal conditions. The major classifications presented are muscle, joint, and nerve root. Many different conditions are presented under each of these major classifications with emphasis on those conditions commonly seen in a physical therapy clinic. The clinical picture of each condition is presented showing the significant findings in the history, structural, mobility, neurological, and palpation exams. Treatment suggestions are presented to help clarify the differences between conditions, and to stress the importance of evaluation and classification before planning treatment. The author also stresses the interrelationship and progressive nature of certain conditions.J Orthop Sports Phys Ther 1979;1(1):3-15.

Lumbar traction*.

The aim of this article is to present and discuss: 1) types of lumbar traction; 2) effects of lumbar traction; 3) indications and contraindications for lumbar traction; 4) effective lumbar traction techniques. There is a review of important points that have been presented in earlier literature, as well as the introduction of new ideas and concepts. A portion of this article deals with the rationale-of using lumbar traction for the treatment of herniated disc and other lumbar spinal nerve root syndromes. There is considerable discussion of poundages necessary to achieve therapeutic results. Detailed description of positioning is presented. The importance of the use of proper equipment for mechanical lumbar traction is stressed. That lumbar traction can be a beneficial treatment for certain musculoskeletal disorders is stressed, but that effective treatment is not as easy and simple to administer as it may seem. J Orthop Sports Phys Ther 1979;1(1):36-45.