Back Pain/ Orthosis
“Lumbar orthoses encourage patients to become mobile“
LumboLoc and LumboLoc Forte
From Bauerfeind Life Magazin
Adjunct Associate Professor Hee Hwan Tak is the Medical Director at Pinnacle Spine & Scoliosis Centre in Mount Elizabeth Medical Centre (Singapore). Before this, he was Clinical Director of the Department of Orthopedic Surgery at the National University of Singapore (NUS). The focus of his work is on deformations (scoliosis), degeneration, tumors, and fractures of the spine.
Bauerfeind life: What role do lumbar orthoses play in spinal treatment?
Prof. Hee: For patients who are being treated conservatively, lumbar orthoses provide a certain level of external support and immobilization. Also, postoperative patients are reminded by lumbar orthoses that they have just had a surgical procedure. Consequently, they avoid movements which have a negative impact on the back.
How long are lumbar orthoses generallyused for?
Prof. Hee: For non-surgical patients, the duration of use varies depending on the circumstances. In the case of an acute intervertebral disk prolapse for example, the patient usually wears the lumbar spine orthosis for two weeks. For surgical patients, the duration of use is generally two months after surgery. These patients should wear the orthosis constantly, unless they are showering or sleeping on their back.
Are Bauerfeind orthoses reimbursed by the healthcare system in Singapore or do patients have to pay for them?
Prof. Hee: If the patient is admitted to hospital , the orthoses are reimbursed. The patient pays for outpatient costs.
What therapeutic goals do you pursue with lumbar orthoses?
Prof. Hee: Orthoses for the lumbar spine support stabilization of the patient while the affected structures heal. This applies to both surgical and non-surgical cases. Antagonistic torso muscle activity is normally needed to stabilize the spine. Findings published back in 2004 (see Ref. 1) showed that lumbar orthoses reduce the necessity for antagonistic activity by giving the torso a passive stiffness. So the spine’s stability is increased by an external influence. But imposing rigid immobility on the patient is not a price worth paying. Movement is part of treatment.
How can lumbar orthoses contribute to a patient’s mobility?
Prof. Hee: Lumbar orthoses do not limit movement of the spine in any way, as is often assumed. An X-ray study (see Ref. 2) proves that although lumbosacral orthoses limit major torso movements, they do allow small , intervertebral movements. Patients who wear such orthoses are encouraged to move.
How do you see the impact of lumbar orthoses?
Prof. Hee: Success can be measured in various ways. A strong indicator, for example, is a reduction in pain of over fifty percent using the VAS pain score. I know that I am on the right track when I see that there is also a reduction in the use of anti-inflammatory medication and painkillers. The final confirmation for me is the patient’s ability to work.
Why is mobility so important?
Prof. Hee: The therapeutic strategy is to encourage movement of the back while the necessary treatments are carried out at the same time. Physiotherapy and anti-inflammatory medication also play an important role. You could say that moving is living and living is moving. Immobility or long periods of bed rest have a discouraging effect on patients.
You yourself often work with LumboLoc and LumboLoc Forte. When do you use the lumbar orthoses?
Prof. Hee: Generally, I choose the orthoses for conservative or postoperative treatment of patients who need external support for their back. The LumboLoc is well suited to smaller patients. I switch to LumboLoc Forte for larger patients and in cases where greater support is needed, which is generally for postoperative patients. The common denominator of the orthoses is that they counteract significant muscle weakness in the lower back.
The LumboLoc Forte can be enhanced with a lumbar pad or a sacral pad. How do you use these pads?
Prof. Hee: We use the lumbar pad when we want to provide targeted pressure relief to the lumbar spine. The sacral pad can be used in the same way. Deciding which of the two pads to use depends on which area needs to be stabilized more in order to correct posture.
What has won you over the most with LumboLoc and LumboLoc Forte?
Prof. Hee: Both orthoses provide stability and comfort. They sit comfortably and have a good anatomical fit. The elastic, breathable material is very pleasant to the touch. Finger pockets and the tensioning strap system make them very easy to put on and take off. Compliance has so far been excellent for my patients.
Ref. 1: Cholewicki J., The effects of lumbosacral orthoses on spine stability: What changes in EMG can be expected? Journal of Orthopaedic Research 22 (2004) 1150-1155.
Ref. 2: Axelsson P., Johnsson R., Strömqvist B., Effect of lumbar orthosis on intervertebral mobility. A roentgen stereophotogrammetric analysis. Spine 1992;17:678-681.
Images: Ray Chua/The Happy Fish LLP, Bauerfeind