The advent of the kyphoplasty has totally changed what i see with these folks, in fact I rarely see them any more, when I used to see a lot of them we would avoid flexion, promote extension and promote healing with pain free weight bearing activities
Joined: March 27, 2003
From: Savannah, GA, USA
I usually will see these patient's, mostly workers comp, after the fall off roofs etc. I see them mostly getting braced until good union. I hardly every see a patient while they are in their brace. It would help if they did to decrease all their secondary disability and depression.
And to answer your question, I don't think there is any steadfast practive guidlines for these patients. I would like to know if there is. OCS 1 week!
A word of caution... the spinomed isn't a brace just plopped on and left. The orthotist needs to work with the patient and adjust the brace as changes occur, IF they occur.
Well, a fracture is a fracture... vertebral compression fractures hurt a lot. Initially, I don't think there is much you can do except have the person in bracing. Of course, the person can do activities for the upper extremities and the lower extremities as long as the spine does not have an increase in symptoms. If I were to guess... I believe around the 8 week post compression fracture point in time would be a good time to begin physical therapy.
My patient was not braced at all and no real guide lines given. I had heard at one point to try to work on gentle extension and have been doing lumbar stability work. Other than that not a to sure what to do.
Interestingly when I see this (only a couple of time mind you) in younger patients there has not been a push to avoid motion at the joint as John suggested. It seems reasonable to do so but these patients don't seem to be given this advice.
Joined: August 29, 2007
Really can't we consider stable vs unstable fx? Usually those involving the anterior vertebral body are generally thought of as stable. Bracing was used as it was thought to decrease deformity but I have not seen a lot that suggests it does. Kyphoplasty has changed management for many.
In many cases why can't these be thought of similarily to rib fractures. mobility to tolerance in painfree directions promote extension and trunk activation as a functional brace then restore mobility at boney healing.
I often wondered why MD's were not more concerned about limiting movement when an acute compression fracture is present. But maybe, as you imply, most of these are anterior only and considered stable and thus rehab can progress as tolerated.
But I do still struggle with not wanting to limit motion in this population as it seems like the logical thing to do but maybe MD's just are not seeing a big difference in healing response.
I tend to progress as bonez suggested with mobility to tolerance, gentle extension work and some gentle core work and patient education to avoid flexion and loaded positions.
But I got many different opinions when I brought this topic up to colleagues (some with an approach similar to Bonez and some suggesting immobilization) and that is why I though I would post here.
Joined: May 11, 2004
bonez... you'd be impressed with the spino-med brace. Excellent research on it.
Compression fractures hurt a lot... the patients I have had the opportunity to suggest the spino-med brace were actually pleased with how it also decreased symptoms. No, I haven't done a study... but they were satisfied with it AND wore it - sometimes even longer than I had advised. It's okay wearing that brace longer because it does have strengthening benefits.
Kyphoplasty is a disaster, in my opinion. That "quick fix" has horrible outcomes. Check the research on it... most definitely not impressive.