TLSO – The Boston Brace – Spinal Support That Heals

Treatments to correct injuries and disorders of the spine can vary widely, but in many instances a back brace is an effective method for allowing patients to minimize pain, correct irregularities, speed recovery and/or regain an active lifestyle.

TLSO Braces are prescribed to patients of all ages with spinal irregularities ranging in a wide degree of severity. TLSO stands for Thoraco-Lumbo-Sacral-Orthosis and this type of brace is often referred to as a “Boston Brace.”

Children with scoliosis are most often prescribed a TLSO brace. These braces provide back support and limit the progression of a spinal curvature as the individual grows. The Boston Brace is the most common back brace in use for scoliosis treatment. It corrects curvatures with small pads that are fitted against the ribs. The body is held upright and experiences pressure towards the front of the brace body. It extends from the hip to the tip of the shoulder blade. Most patients wear the brace for 20 to 23 hours each day. It can be removed to participate in physical activities, however. The Boston Brace is most effective in treating curves in the lumbar and thoraco-lumbar area of the spine.

Back braces can come in two different forms – soft and rigid. The Boston Brace is a rigid brace, often comprised of molded plastic which is specifically fitted to the patient.

In addition to scoliosis, the TLSO or Boston Brace is commonly used to help patients that have experienced a fracture or undergone fusion operations. A TLSO minimizes discomfort for the patient and actually assist in the healing process.

There are also back braces that feature slight variations of the standard TLSO Brace. The Cervico-Thoraco-Lumbo-Sacral-Orthosis Brace is one example. This brace is similar to the Boston Brace in the method of support it utilizes. However, it incorporates bars which extend from the body towards the head. Attached to these bars is a ring designed to support the patient's neck. This brace is still considered a form of the TLSO Brace. Some patients benefit from wearing braces throughout the night. To minimize discomfort and encourage a good night of sleep, patients are often prescribed a Charleston Bending Brace. This brace is molded specifically to the body of the patient as well.

Choosing the right type of brace depends heavily upon the condition and specific support needed. Physicians are an invaluable resource for guiding patients in their choice of equipment. Most back braces can be outfitted with additional accessories to provide more stability in certain areas of the spine. These accessories include items such as lateral shoulder supports. A variety of plastics and technological advances have also allowed for the development of braces that are less visible, more supportive and can easily be worn under clothing.

Clavicle/Collarbone Injuries in Sports

A broken collarbone, or clavicle fracture, is one of the most common injuries that athletes face when competing in contact and even non-contact sports.

What is the clavicle? The clavicle is a long bone that runs between the scapula, or shoulder blade, and the sternum.

What causes clavicle fractures? A common cause of clavicle fracture is the stress that the collarbone suffers when a person stretches out his or her arm to break a fall; in this case, most of the weight of one's body is distributed to the collarbone, which can then snap under the pressure. Additionally, a fall directly to the shoulder area, or any direct blow to that region can cause a serious collarbone injury to an athlete.

Symptoms of clavicle fracture can include pain at the site of fracture, restricted arm motion, and discolored skin around the affected area. For serious collarbone injuries, you might be able to see the fracture because of the bone misalignment. A doctor will perform an X-ray to determine the severity and properly diagnose a clavicle fracture.

Who is likely to incur this type of injury? Athletes at all levels of competition, from football and cycling to equestrian and skateboarding. Clavicle fractures have been suffered by the likes of NFL quarterbacks Matt Leinart and Tony Romo and put out wide receiver Danny Amendola just this past NFL season.

How to avoid a collarbone injury? Though clavicle fractures, like any other types of bone fractures, are unavoidable in certain cases, there are steps that can be taken to lessen their likelihood and minimize the potential for risk.

• Ensure you intake the recommend amounts of Calcium and Vitamin D, nutrients that bolster bone integrity. Lacking these essential dietary components can put you at higher risk of clavicle fracture and could require longer recovery time.
• Develop the protective muscle tissue around the clavicle. Because the clavicle is supported by stabilizing muscles, those who do not get enough exercise to develop this protective muscle tissue may also have a higher change of clavicle fracture.
• Wear proper padding and protection during practice and competition.

What is treatment like? Treatment is relatively simple and usually does not require surgery. Additionally, recovery time is not terribly long - typically, healing will occur in about 2 - 4 weeks for children and 4 - 8 weeks for adults. For most sufferers of clavicle fractures, a cervical sling, splint, cervical brace or other type of support needs to be worn throughout the recovery process in order to restrict the fractured bone from moving.

MMAR Medical offers several different types of collar braces, including a hook-and-loop style that is buckled around the wearer's back, a front-closure splint that contains padding in the clavicle area, and a figure-eight splint with a prong buckle front closure. With the proper use of a brace, those who have suffered clavicle fractures can usually avoid surgery for their condition so long as the affected area is adequately protected and does not suffer any additional trauma.

Annular Tear Causes, Symptoms and Treatment

What Is an Annual Tear?
An annular tear is a tear in somewhere in the annulus fibrosus. This is a ligament that makes up the capsule of the disc that’s found between the vertebrae. These discs act as cushions between the vertebrae, which are bony, and allow the spine to move and to absorb shocks. The discs are made up not only of the annulus fibrosus, but the nucleus polposus, which is inside the disc. The inner annulus and the nucleus have no nerves and so can’t feel pain, but the outside of the annulus does have nerves and the person may feel pain if it’s injured. However, sometimes an annular tear doesn't produce pain.

Symptoms
If the annular tear produces pain, it will be because the substance in the nucleus polposus has leaked out and come into contact with the nerves. This causes the body to react through an inflammatory response. The disc might also have ruptured or might be bulging between the vertebrae. This will cause a sharp pain in the back, and numbness, tingling and weakness felt in a leg or the legs. Any sudden movement, including sneezing or coughing, can make the pain worse. The pain is eased when the person stands up and is still.

Causes
Annular tears can be caused by the normal wear and tear of aging. The tear can begin as a small hole that doesn’t cause problems, but it may enlarge. If it enlarges, the gel-like substance of the nucleus can begin to leak out. Sports, especially contact sports like football, can also lead to annular tears. Annular tears can also be caused by very strenuous exercise, especially that which requires lifting heavy objects or bending. Being overweight and obese can put stress on the spine and lead to an annual tear as well.

Diagnosis
The tear can be diagnosed by a doctor using an X ray or a CT scan. The doctor can also inject a dye into the nucleus, which will show the extent of the damage. An annular tear can be rated from zero, which means that the disc is normal, to 6, which means that the tear is large enough for the nucleus to leak.

Treatment
Sometimes an annular tear will heal spontaneously, and create scar tissue that, to an extent, keeps the nucleus from leaking. Sometimes the patient can apply a cold therapy pad or compress to the area. These can be applied several times a day in 15 minute sessions. After that, replace cold with a thermal wrap or compresses can be applied to the injured area. The patient can also take NSAIDs like ibuprofen to ease the pain. Unlike a lot of back problems, an annular tear isn’t helped much by resting in bed. Long periods of time in bed can only weaken the back muscles.

A physiotherapist might recommend exercises, massages and hydrotherapy. Though surgery is usually not needed for this type of an injury, surgery can be undertaken if nothing else works. During recovery, the patient will be fitted with a lower back brace or a soft lumbar support. Most patients do recover from annular tears and can make lifestyle changes, like taking up exercise and losing weight, to prevent them from happening in the future.

To learn more about annular tears, visit the MMAR Medical Annulus tear or sprain article in our injury library.