Guide to Wearing Your California Spinal Brace™

  • Reference Number: HEY-620/2017
  • Departments: Neurosurgery

Introduction

This leaflet gives you general information about your spinal brace.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your physiotherapist or neurosurgeon, but may act as a starting point for discussion.

Your consultant should have explained the reason for having to wear your spinal brace.  This leaflet will concentrate on providing you with the information on the physiotherapy input you can expect and instructions for your spinal brace.

If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you. Share the information this leaflet contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you.

What is a Spinal Brace and why do I need it?

A spinal brace is a device designed to limit movement of the spine. It is most commonly used to manage spinal fractures but can also be used for other reasons such as supporting your spine after surgery. Limiting the movement of the spine through wearing a spinal brace helps the healing process. It may also help to prevent further injury or damage and can help to minimise discomfort.

Can there be any complications with wearing a Spinal Brace?

Movement cannot be completely stopped within your spine and so occasionally a spinal brace may not be sufficient to manage your condition and you may require other treatments.  Wearing a spinal brace will cause some weakness of the muscles around your spine, as the spinal brace will essentially be doing some of the work of these muscles. However, when you no longer require your spinal brace you will be advised to gradually stop using it and you will be provided with an exercise program to strengthen your muscles again.

Applying your Spinal Brace

Use of the spinal brace could cause pressure leading to redness or, in extremely rare circumstances, breaking of the skin. Experienced physiotherapists will measure and fit you into the spinal brace to ensure it is not ill fitting.  Furthermore you will be instructed to remove your spinal brace daily when you lay down to sleep.  The physiotherapist will measure you and determine which spinal brace is most suitable for your size and shape.  This spinal brace may or may not have a chest plate (depending on your diagnosis) however the instructions are the same for both.  Initially your physiotherapist will fit your spinal brace while you are lying down. They will then give you instruction on the way in which the spinal brace should be applied and removed.

Your Spinal Brace should be applied / removed in:

(The physiotherapist will tick appropriate option)

OPTION 1 LYING
  1. Lying on your back, bend your knees so that your feet are flat to the bed.
  2. Lift your bottom up off the bed and slide the back panel of the brace underneath you.
  3. Lower yourself onto the brace.
  4. Check the brace is located centrally within your back with the bottom of the brace lying over your buttocks.
OPTION 2 LYING
  1. Roll onto your side.
  2. Slide the side panel underneath you at waist level.
  3. Roll onto your back.
  4. Check the brace is located centrally within your back with the bottom of the brace lying over your buttocks.
OPTION 3 SITTING
  1. Sit over the edge of the bed as outlined in lying to sitting section (see below).
  2. Maintain an upright posture throughout applying the brace.
  3. Reach for the brace and wrap it around your body.
  4. Position the back of the brace centrally and level with the top of your buttocks.

                                     

5.  Fold the front panel of the brace over your stomach and ensure it is aligned with the centre of your body.

6. Velcro the side of the brace in place as below.

                                                

7. Reach back with both hands to find the two bottom straps, pull them forward and attach to the front of the brace

8. Now repeat the same procedure with the top straps.

9. If your spinal system has a chest plate bring the straps that are attached to the back of the brace over your shoulders and through the metal fastener on the front, pull up and Velcro back onto the strap.

If your brace has shoulder straps bring the straps over your shoulders and back under your arms. Crisscross the straps behind your back. Next, bring them forward on each side and clip them together at the front.

Moving from Lying to Sitting Up

Roll onto your side and swing your legs over the edge of the bed, whilst pushing up with your arms (see following diagram). Please note the following:

  • If you are sitting in order to apply your spinal brace please do so immediately after assuming the sitting position.
  • If you are sitting in preparation to stand please sit for a moment before standing to ensure you do not become dizzy.

                                      

Chest Plates

Your spinal brace may or may not have a chest plate attached to it depending upon your diagnosis.  If you have a chest plate the application and removal process for the spinal brace is exactly the same. The chest plate will be fitted by your physiotherapist and should fit flush with the upper third of your breastbone. If at any point the chest plate is touching your neck the spinal brace has ridden up too high and needs reapplying lower down in line with the top of your buttocks.

Removing your Brace

To remove your brace return to the position it was applied in.

  • Undo the shoulder straps if you have them and loosen from under the armpit so you can slip your arm free.
  • Undo the chest plate straps by unfastening the Velcro and sliding out from the metal loop.
  • Undo the side straps on the main body of the brace (on one side only). One at the top, one at the bottom and the long strap underneath so the brace can open up and be removed.
  • Please ensure you only open one side of the brace, as this will make it much easier when reapplying your brace and gaining a good fit.
  • Place it in a position where it can be easily reached for when you need to reapply.

                                      

Important information:

Please note the following:-

  1. A thin layer of clothing should be worn between you and the spinal brace to prevent rubbing or sores.
  2. The spinal brace should be TIGHT but COMFORTABLE.
  3. If excessive sweating occurs, please remove the spinal brace and rest for short periods lying down – this is especially important if you have a wound from surgery.
  4. The spinal brace should be kept on at ALL times except when lying flat – you do not need to wear your brace in bed, unless you have been instructed otherwise by your physiotherapist or consultant.
  5. The spinal brace will only limit movement within your back, not eliminate it completely. It is important that you monitor your posture to prevent slouching, and avoid any bending, lifting or twisting.
  6. Bathing and showering is not permitted unless you are given special instruction from your consultant.
  7. If you feel you may need guidance with washing and dressing technique please discuss this with the Occupational Therapist on the ward prior to discharge.
  8. If you have any problems with the spinal brace please do not hesitate to contact the physiotherapy team on the number overleaf.

Exercise

This exercise is aimed at maintaining strength in the muscles that support your back. It should be carried out approximately three times a day, initially repeat each exercise just once and gradually build up (over the period of a week) to 10 repetitions of each exercise three times each day.  If you experience any increase in pain, cease from doing the exercise until the pain resolves, at which point you can recommence the exercise.

You may also be provided with additional exercises to strengthen your back and legs if your physiotherapist deems this necessary.

General Advice

Walking

Initially after your hospital admission your back may be sore as you move; this may increase over the first couple of days but will then improve. You should aim to walk short distances little and often to ensure your muscles do not stiffen up.  Once you are home try to increase the distance you walk daily always paying attention to your posture.

It is important to strike a balance between periods of activity and inactivity. Inactivity can be just as harmful to your back as over activity.

Sitting

Whilst sitting out in a chair you should ensure a good upright posture. You should avoid standing still or sitting for prolonged periods as this will cause your back to stiffen and your posture to deteriorate.

Avoid sitting in soft low chairs as this will cause your back posture to become rounded even with the support of the spinal brace.

Lying

A good firm support is usually desirable; a mattress that is too soft will provide you with little support. You are free to move around in bed but you must ensure, where possible, that your position is not twisted (i.e. legs and body are aligned and pointing in the same direction).

Work

Return to work will depend very much upon the individual and the type of work you do.  It is important that you ask your Neurosurgeon when it is safe to return to work.

Lifting

DO NOT LIFT heavy objects and avoid holding items at arms length. Always use a correct lifting technique, bending at the knees and not at your back (see following diagram).  Avoid bending, twisting or leaning movements as these will increase the strain on your back.

Discharge and Follow Up

Before you are discharged from hospital you will need to be able to apply and remove your spinal brace without the assistance of a healthcare professional. Often patients manage by themselves straight away, sometimes family members / carers are taught how to help apply and remove the spinal brace.  You will also need to be able to sit comfortably in the spinal brace, walk short distances and be able to walk up and down a flight of stairs (if you have them at home).

You may be expected to attend for follow-up X-Rays to monitor the healing process. If this is the case then you will be provided with dates and times for these appointments by your physiotherapist.  Please attend X-Ray first and then to see the physiotherapist.  Please allow good time for these appointments as occasionally there can be delays.

When to stop wearing your Spinal Brace

The spinal brace is usually worn for a period of 8 weeks, to support your back and prevent movement around the fracture site, but this can alter depending on your healing rate and your consultants’ opinion.

After your final X-Ray you will be told if your fracture has healed sufficiently for you to be able to remove the spinal brace. The physiotherapist will discuss this with you and give you further instruction at this point.

You will be advised to wean from your spinal brace gradually to prevent sudden strain on your back and also to help to strengthen your spinal muscles slowly to minimise discomfort. Your physiotherapist will advise you on this, recommending you decrease the time spent in the spinal brace daily over 1-2 weeks.

You may feel stiff initially in the affected part of the spine when you start to wean the use of your spinal brace, this is normal, and will improve as your activity levels increase. The physiotherapist will provide you with exercises to improve this, and also to build up the muscle strength in your spine. If required, you may also be referred for out-patient physiotherapy to further support your recovery.

Once out of the spinal brace, you should try to maintain a good upright posture. The spinal brace will have supported you up until this point and slumping will cause additional strain on your muscles. Heavy lifting should be avoided and return to activity should be controlled. If you have any specific activities you wish to return to please discuss this with your physiotherapist for advice.

Appointment
Date Day Time Attend X-ray prior to appointment? (Yes/No) Physiotherapist

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the:  Hull Royal Infirmary Physiotherapy Department ask for Neurosurgery Physiotherapy)  on tel no: (01482) 674539 or Ward 4 Hull Royal Infirmary on tel no: (01482) 675004

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.