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Back brace vs no brace???

TatiyanaTTatiyana Posts: 194
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
I am just wondering why some of us get back brace restrictions and some not. My surgeon did not even bring up the possibility of a back brace but i see others on here are told to wear them FT. Just curious...
I had an ALIF (2 weeks post op)
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Comments

  • I wore a hard shell back brace that went from under my breast to the top of my hips full time except bed time after my surgery. It was very supportive and I did not feel comfortable without it. I had a spinal fusion at L5 S1.
  • I believe it depends on several factors, including your anatomy, your exact spine problem (some fusions are for spondys, some for herniated discs...), everything involved in your surgery (hardware type, placement, etc.), what your life is like, and your doctor's preferences.

    I asked all 6 spine surgeons I met with about back braces, and they did not all agree. Some said yes, some said no way, and the surgeon I went with said he couldn't say for sure until after surgery, because it depends!

    So, we talked about back brace possibilities and options before surgery. The expectation was that I would be in a softer corset type brace for about 3 months. We knew going in that I had a tough surgery ahead, and I have tricky anatomy. Also, I insisted that I wanted to maximize the chances of this working and not needing another surgery!

    However, when my surgery turned out more difficult than expected (found previously unknown osteopenia & small fractures), and my hardware placement is much more "delicate" than anyone would like, I found myself in a very rigid LSO/hip-spica brace for 3-4 months (I'm at 2 months now). This makes it very difficult (but NOT impossible) for me to move in a way that could seriously compromise the fusion/hardware. It's also protective in case I were to slip (which I did, the day I left the hospital), fall down, get in a car wreck, etc.

    Prior to surgery, we had talked about the possibility of this brace, but definitely did not expect it, and did not expect I might have to wear it for 4 months.

    ( FYI, my brace looks a lot like the one at this URL
    http://www.optecbrace.com/index.asp?page_id=109 )
  • Just like with PT & exercise, surgeons vary greatly in regard to their views on back braces and as Heidi points out it also depends upon your own circumstances.

    In my case (L5-S1 fusion) my surgeon was against braces as he feels that wearing a brace makes the muscles 'lazy' - he would rather have the core muscles starting to work earlier on, believing that the hardware should hold the back solid. But, that is just his view, and I know that other surgeons have different views.
    Keep positive!

    Bruce

    ...an old timer here and ex-moderator

  • I personally think the fact that using a brace could let muscles get weak is a good reason to not use a brace too much just for pain relief (e.g., instead of or prior to surgery). Though I'm sure plenty of folks have gotten very helpful pain relief from using one!

    My doctor believes that the number one priority is getting fusion (and protecting the hardware until that happens), and that muscles can be re-strengthened later--you won't get so weak or so stiff that you can't recover all that with good PT after fusion has taken. I agree with that, and think the brace is a good idea for me (especially since my hardware placement is precarious), although I do truly hate hate hate :''( wearing the brace and sometimes get annoyed at being so stiff and watching my already weak muscles get weaker.

    But, that said, I HAVE been working on my core muscle strength very recently (after getting doctor's permission, and starting at the right "stage" in his recovery plan) using some simple pelvic floor and transverse abdominal contraction exercises I learned from a Pilates instructor/PT. I'm doing exercises while sitting on a ball and not stressing my spine. My therapist and I are carefully going through things to determine what is truly "safe" to do--I've learned that I simply won't do anything that either of us has any doubts about. :S

    The exercises I'm doing now are for deep core muscles and are being done in an extremely low lumbar-stress manner. But, I have to do them a lot during the day! BTW, I also did these same exercises (and others) before surgery to try to strengthen my core in advance of surgery, but at that time did them in a more aggressive manner (including lying on my back, more movement, more reps, resistance, etc.).
  • I thought for sure I'd be in a brace. Three-level spinal fusion. Nope. Heck -- the nurses didn't even care if I got out of bed on my own the first night in the hospital. They left me no call bell, so I had no choice. I guess I have enough hardware in my back to make it unnecessary.

    Linda
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • dilaurodilauro ConnecticutPosts: 9,750
    As Bruce and others mentioned, there are different situations and different variables that will determine if you will need a back brace after surgery. The same applies to cervical surgeries. When I has my first lumbar surgery in 1978, besides using wooden instruments instead of today's surgical items, fusion was done for only folks that had physical jobs. Since I was a programmer and had a desk job, fusion wasnt considered. But I had to wear a back brace (almost like a corset) for 6 months.
    Today, things have changed so much, so the need for back braces will depend on the individual, the surgeon and the actual surgery.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Thank heavens my surgeon thinks like Bruces. He didn't want to use a brace even though it was 3 level and correction to scoliosis. He said the thinking for braces is very conservitive and he would rather me learn to use the muscles then let them waste.
    To get them back to scratch later is a much bigger burden.
    So I was lucky and didn't have to wear one.
    Blessings Sara O:)
  • My doc suggested I used my brace (corset style) when I went for long walks or out to the store, etc. He considered it just a little extra protection early on. After my 6 week checkup at which time I showed the beginning of fusion, he said I could ditch the brace. That made me very, very happy because I am short waisted and it was very uncomfortable.

    I agree that just as we are finding out about exercising, walking and going back to work, every doc seems to be just a little different and every recovery is very different. The only thing, now, my doc is adamant about is that I use my bone growth stimulator every day for 30 minutes. Which I happen to be doing right now!!!!

    Good day to all! We have a rainy day here in Georgia (wait, haven't I heard that before?) and expecting about 4 inches of rain so no walking for me :(
  • What exercises have you been doing? By chance do you have workout sheet or anything you go by that you might share with me??? I'd like to start some muscle strengthening and core work, as well.
    HeidiG said:
    I personally think the fact that using a brace could let muscles get weak is a good reason to not use a brace too much just for pain relief (e.g., instead of or prior to surgery). Though I'm sure plenty of folks have gotten very helpful pain relief from using one!

    My doctor believes that the number one priority is getting fusion (and protecting the hardware until that happens), and that muscles can be re-strengthened later--you won't get so weak or so stiff that you can't recover all that with good PT after fusion has taken. I agree with that, and think the brace is a good idea for me (especially since my hardware placement is precarious), although I do truly hate hate hate :''( wearing the brace and sometimes get annoyed at being so stiff and watching my already weak muscles get weaker.

    But, that said, I HAVE been working on my core muscle strength very recently (after getting doctor's permission, and starting at the right "stage" in his recovery plan) using some simple pelvic floor and transverse abdominal contraction exercises I learned from a Pilates instructor/PT. I'm doing exercises while sitting on a ball and not stressing my spine. My therapist and I are carefully going through things to determine what is truly "safe" to do--I've learned that I simply won't do anything that either of us has any doubts about. :S

    The exercises I'm doing now are for deep core muscles and are being done in an extremely low lumbar-stress manner. But, I have to do them a lot during the day! BTW, I also did these same exercises (and others) before surgery to
    try to strengthen my core in advance of surgery, but at that time did them in a more aggressive manner (including lying on my back, more movement, more reps, resistance, etc.).
  • My doctors believed strongly in wearing a brace after spinal fusion. They even referred to the brace (turtle shell hard brace) as a "fusion brace". I wore one specially made for me at the brace shop in the hospital off and on for about a year after my surgeries. I hated every minute of it too. The members who commented on the fact that a brace can weaken muscles were absolutely right. My core muscles to this day are still weaker than they should be.

    Dick
    Emergency surgery in March of 2006 for spinal infection of L 2 and L 3. During surgery, discovered I had Cauda Equina Syndrome. Spine became unstable after surgery and had 360 fusion with 10 pedicle screws, plates and rods in April of 2007.
  • I only have to wear it when I am up walking or trying to do housework. It causes severe nerve pain in my hips and legs, but the doctor said to wear it anyway!
    My first surgeon was the opposite - he said do not wear it if it makes you hurt worse.
    All depends on the doctor's views!
  • I am also very short-waisted: my ribs practically meet my hips. Plus, I'm very curvy and overweight and just a bit odd-shaped altogether, so, the hard brace has been a nightmare to fit and wear. I had the first brace worked on at least 8 or 10 times (they grind and flare and cut and pad...), but it still never fit well.

    I'm now in a second brace that I got last week (I lost weight and the first one could no longer be made quite tight enough), which was created from a cast they made of my body (that was fun). So, this one fits better, but is still very uncomfortable; it's already been worked on twice. The casting was created 4 weeks before I got the brace, so I've already lost more weight and it had to be cut down. And, because it was molded from my body, if it's not lined up almost perfectly (left-to-right and top-to-bottom), it tends to pinch and mash more than the other one.

    But, it does help keep my spine stable, and certainly limits my motion a lot, so I wear it just as the doctor ordered: ALL the time except when I'm asleep. Even when I have to get up in the middle of the night to use the bathroom, my husband has to get up and strap me into this thing and then take it off again!

    BTW, I had seen something on spine-health months ago about wearing tight fitting T-shirts under braces. I found that with this hard plastic brace, I sweat like crazy underneath it, so I've been wearing "breathable wicking-type" sports undershirts (e.g., capilene), and they're much better than cotton Ts. The tighter the fit, the easier it is to get the brace on. Also, because of the thigh part to my brace, I wear tight leggings or "sports-type" long underwear (again, something like capiline works well) all the time. It took a while to figure all that out and buy the right stuff (had to buy smaller than I normally would), but now I have a solution that works OK for me. (But, I stay very hot!)
  • I am not sur if I have to wear one but I think I will in the paper work it said brace users need to wear it all the time espcially in the sower to prevent any bend or twist motion at all
  • Hi Kathy,

    I'm doing several things that are variations on contracting and holding the pelvic floor muscles (e.g., Kegel muscles) and the transverse abdominal (TVA) muscles. These were prescribed by my PT based on my doctor's recommendations, and obviously may not be right for everyone.

    I do both quick and endurance Kegel exercises: contract pelvic floor muscles and hold for 2 seconds, release for 4 seconds, repeat 10 times. Then, contract pelvic floor and hold for 10 seconds, release, repeat 10 times. I also contract the TVAs and hold, relax, repeat. And, contract and hold pelvic and TVA simultaneously, relax, repeat. The keys are (1) properly identifying and contracting the pelvic floor and TVA muscles and (2) doing these many times throughout the day (that is tough!). You can do these standing, sitting, or lying down, and can do them just about anytime, anywhere--no one knows you're doing them. I've found that riding in the car is a good time for these, if I can remember to do them.

    I do several exercises while sitting on a ball with both the pelvic and TVAs "engaged" (contract & hold, which keeps my core stable). For each exercise, I get myself stable on the ball, then breathe in deep, exhale, then contract the pelvic floor and TVA muscles together and hold, then perform an exercise (breathing through chest/ribs while doing them), then relax before doing the next one.

    - lift both heels off floor (keeping toes on floor), return to floor, repeat for 1 minute
    - raise one arm in front, then above head, then lower and raise the other, repeat for 1 minute
    - raise both arms in front, above head, then lower, repeat for 1 minute
    - raise both arms out to side, lower, repeat for 1 minute

    I just started these, so I'm not doing them for very long yet. Do these 3x/day. (I also do some ball exercises for my foot drop.) I'll be adding more "sit on ball w/core engaged" exercises soon (e.g., "rowing" with a theraband, maybe "marching").

    HeidiG
  • I am not sure if I have to wear one but I think I will in the paper work it said brace users need to wear it all the time espcially in the shower to prevent any bend or twist motion at all
  • My surgeon is one that is against braces for the same reason that others have posted-- that it reduces muscle strength. He also said to me, "there is very little chance that you could break the rods and screws." But my surgeon is also is the type that had me start PT early on as well.

    Now the two other surgeons that I saw to get an opinion would have put me in a back brace. It was interesting that one of them said, "it is more for patient comfort than anything else."

  • Brace or not, we are all lucky that we are having fusions in this day and age. My mum had a lumbar fusion in 1972 and had to lie in hospital in a near full body cast for 7 weeks while her bones fused. I wonder what fusion surgery will be like in 30 years time...

    Sorry to digress #o
    Keep positive!

    Bruce

    ...an old timer here and ex-moderator

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