Symptoms

A rib prominence, uneven shoulders, uneven hips and a leg length discrepancy are the main signs of scoliosis. Some muscular differences can also be seen. As the deformity progresses, it can cause pain and in the more severe cases breathing difficulties.

Treatments

A Thoraco Lumbar Sacral Orthosis (TLSO), such as a Boston brace, is used to prevent or reduce the progression of the deformity.

Where the Scoliosis is purely postural the use of a shoe raise adaptation to address an associated leg length discrepancy can be useful.

Symptoms

The most common symptoms are back pain and back stiffening, which increase with activity. It is also common to develop neurological (nerve related) symptoms such as sciatic pain, muscle weakness and in some cases gluteal (Buttock) muscle wastage. The patient develops an increased lower back arch posture (Lordosis) and a waddle gait, mainly due to tight hamstrings.

Treatments

• Lumbar Sacral Orthosis (LSO) used to stabilize and support the spine in order to reduce pain by providing circumferential support and offloading of the vertebral bodies.

• Rigid Spinal Brace where increased structural control and immobilisation is required.

Symptoms

Moderate to severe back pain is the main symptom, normally aggravated by movement. If the spinal cord has been affected, there may be numbness, pins and needles, muscle weakness and bowel problems also present. Due to the traumatic nature of spinal fractures, other injuries are commonly seen masking these types of fractures.

Treatments

The use of a Rigid Spinal Orthosis is normally recommended to protect the spine and immobilize it in the correct position until the bones heal, which can take between 6 to 12 weeks. A Thoraco Lumbar Sacral Orthosis (TLSO) is normally prescribed.

Symptoms

Spina bifida occulta normally rarely causes any problems. People may have hair growth or a dimple in the bottom of their back.
Spina bifida cystica has different levels of severity. A cyst like sac is evident on the spine. In the mildest form, the sac contains spinal fluid and the tissues that cover the spinal cord. The nerves can be intact or mildly damaged, normally by tethering. In the most severe type, the sac also contains nerves and part of the spinal cord. This can lead to paralysis, muscle wastage and loss of sensation. Hydrocephalus (an accumulation of fluid which causes a significant enlargement of the head) is almost always present in the most severe type, approximally 90% of cases.

Treatments

Will vary depending on the severity but can include:
• Bespoke footwear

• Ankle Foot Orthoses (AFO’s)

• Knee Ankle Foot Orthoses (KAFO’s)

• Hip Knee Ankle Foot Orthoses (HKAFO’s)

Symptoms

Symptoms are not always present. When pain is present it is mainly due to:
• Pressure on the root nerves (the part of the nerve as it leaves the spinal column), causing paralysis of single muscles, radiating pain to arms or legs and lack of sensation.
• Pressure on the spinal cord, which causes muscle spasm, lack of feeling and can cause paralysis of the lower limbs below the affected spinal level. It is also referred to as sciatica.
• Pressure on the cauda equina ( a bundle of nerves in the bottom of the spine so named because they resemble a horses tail), which causes problems with bladder control, numbness in the groin region, pain in the rectum and paralysis of one or both legs.

Symptoms

The disease itself is not painful but problems associated with it, such as fractures, are. There may be restriction of movement in the spine. As the vertebral bodies (the individual bones of the spine) weaken they begin to wedge and become narrower at the front than at the back. This causes the spine to become more bent forwards and the individual develops a “stooped” posture.

Treatments

Fabric Lumbar Sacral Orthosis (LSO) or a semi-rigid spinal brace may provide some mechanical support to the spine and reduce the deforming forces on the spinal column.

What is Spondylosis?

Spondylosis is also known as degenerative osteoarthritis affecting the vertebrae (bones) in the spine. Aging is the main cause of this disease as a consequence of repetitive strain, “wear and tear”. It can affect any area of the spine from the cervical (neck) area to the lower spine.

Symptoms

Pain and stiffness of the spine are the most common symptoms. In the most severe cases neurological (nerve related) symptoms can also be present, such as spinal cord injury (leading to general muscle weakness and lack of sensation below the affected area) and root injury (leading to weakness and lack of sensation along a specific nerve)

Treatments

Depending on the area affected, different Orthosis are used:

• A collar is used to relive neck pain and improve head position, especially at night.

• If the pain is in the lumbar region, a Lumbar Sacral Orthosis (LSO) is used.

The use of an Orthosis is restricted to a minimum, usually a week at the time, as overuse can weaken the spinal muscles causing patients to have to wear it permanently.

What is Osteoarthritis?

Osteoarthritis is often referred to as a “wear and tear” disease. In the back it is often called Spondylosis. The cartilage discs between the bones (vertebrae) become thinner which causes the spaces between the bones to narrow. Bony spurs or osteophytes can develop.

Symptoms

Osteoarthritis affects 8.5 million people in the UK. It develops over time, causing joints to become stiff, painful and sometimes swollen. Pain, stiffness or a lack of mobility in the back can occur. Pain may be directly in the area affected but symptoms can occur elsewhere due to nerve impingement (pinching) e.g. in the leg and this is known as referred pain.

Treatments

Though the degenerative changes cannot be reversed, there are Orthoses which can help reduce the severity of the symptoms. These include:

• Shock absorbing insoles, Functional Foot Orthotics to control excess pronation which may be increasing back pain

• Lumbar Sacral Orthosis (LSO) or Thoraco Lumbar Sacral Orthosis (TLSO) for circumferential compression and to provide a postural prompt or Raised shoe adaptation where a leg length discrepancy may be exacerbating the back pain