Spinal Orthotics

• Nomenclature for spinal orthotics (standardized by the AAOS)

  • Sacroiliac
  • Lumbosacral
  • Thoracolumbarsacral
  • Cervical thoracic
  • Cervical
• Normal thoracic kyphosis


  • 20-50 degrees
• Normal lumbar lordosis


  • 20-60 degrees
• Sagittal spinal balance


  • Plumb line C7 to ±2 cm from the sacral promontory
• The spine must be able to resist tension and shear forces in addition to axial load (compression)
• Purpose of spinal orthoses

  • To limit motion of a specific spinal region
  • To decrease the amount of load applied to the spinal region due to deformity, post-operative healing, fractures, pain by relieving limiting motion
  • To serve as a psychologic reminder to restrict motion
• Subjective Assessment


  • History (present and previous medical condition)
  • Chief complaint
  • Device history
  • Goals and patient expectations
  • Other management/interventions (i.e. surgical procedures)
• Additional information needed for scoliosis

  • Age
  • Menarchal status
  • Presence of mature growth (Risser sign: radiograph on the pelvis or hand)
• Objective Assessment


  • Body type (ectomorph, mesomorph, or endomorph)
  • Trunk muscle strength and ROM
  • Postural assessment and alignment
  • Leg Length Discrepancy (apparent)
• Objective Assessment for scoliosis

  • Flexibility of the curve
  • Special test: Adams Forward Bend Test
  • X-ray findings: Cobb's angle (magnitude of the curve), Risser sign (skeletal maturity)
• Body Type


  How much pressure is needed to transmit force to spine? How much pressure can be tolerated by patient?
• Manual Muscle Testing


  • Trunk extension
  • Trunk flexion
  • Trunk rotation
• Trunk extension (Lumbar spine: Grade 5)


  • Can quickly come to the end position and can hold the position without evidence of significant effort
• Trunk extension (Lumbar spine: Grade 4)


  • Can come to the end position but may waver or display some signs of effort
• Trunk extension (Thoracic spine: Grade 5)


  • Raises the upper trunk quickly from its forward flexed position to the horizontal with ease and no sign of exertion
• Trunk extension (Thoracic spine: Grade 4)


  • Raises the trunk to the horizontal level but does so with obvious effort
• Trunk extension (Grade 3: Lumbar and thoracic spine)


  • Patient extends spine, raising body from the table so that the umbilicus clears the table
• Trunk extension (Grade 2, Grade 1, and Grade 0)


  • Examiner must palpate the lumbar and thoracic spine extensor muscle masses adjacent to both sides of the spine
• Trunk flexion (Grade 5)


  • Patient flexes trunk through range of motion, lifting the trunk until scapula clear the table. The neck should not flex
• Trunk flexion (Grade 4)

  • Patient raises trunk until scapulae are off the table. Resistance of arms is reduced in the cross-chest position.
• Trunk flexion (Grade 3)

  • Patient flexes trunk until inferior angles of scapulae are off the table. Position of the outstretched arms "neutralizes" resistance by bringing the weight of the arms closer to the center of gravity.
• Trunk flexion (Grade 2, Grade 1, and Grade 0)

  • Place the hand used for palpation at the midline of the thorax over the linea alba, and use the four fingers of both hands to palpate the rectus abdominis
• Trunk flexion (Sequence 1: Head raise)


  Ask the patient to lift the head from the table. If the scapulae do not clear the table, the Grade is 2. If the patient cannot lift the head, proceed to Sequence 2.
• Trunk flexion (Sequence 2: Assisted forward lean)


  The therapist cradles the upper trunk and head off the table and asks the patient to lean forward. If there is depression of the rib cage, the grade is 2. If there is no depression of the rib cage but visible or palpable contraction occurs, the grade assigned should be 1. If there is no activity, the grade is 0; proceed to Sequence 3
• Trunk flexion (Sequence 3: Cough)

  Ask the patient to cough. If the patient can cough to any degree and depression of the rib cage occurs, the grade is 2. If the patient cannot cough but there is palpable rectus abdominis activity, the grade is 1. Lack of any discernable activity is Grade 0
• Trunk rotation (Grade 5: supine with fingertips to the side of the head)


  • With chin pointed to the ceiling, the patient flexes trunk and rotates to one side. This movement is then repeated on the opposite side so that the muscles on both sides can be examined.
• Trunk rotation (Grade 4: Supine with arms crossed over chest)


  • Other than patient's position, all other aspects of the test are the same as for Grade 5. The test is done first to one side and then to the other
• Trunk rotation (Grade 3: supine with arms outstretched above plane of body)


  • Other than patient's arm position, all other aspects of the test are the same as for Grade 5. The test is done first to the left and then to the right
• Trunk rotation (Grade 3)

  • Patient raises the scapula off the table. The therapist may use one hand to check for scapular clearance
• Trunk rotation (Grade 2)

  • Patient is unable to clear the inferior angle of the scapula from the table on the side of the external oblique being tested. However, the therapist must be able to observe depression of the rib cage
• Trunk rotation (Grade 1 and 0)


  • Grade 1: The therapist can see or palpate muscular contraction. Grade 0: No discernable muscle contraction from the obliquus internus or externus muscles
• Postural alignment
• Anterior and posterior views
• Sagittal view
• Postural deviations
• Alignment: Decompensation
• Alignment: Shoulder and Pelvic Asymmetry
• Alignment: Sagittal balance
• True leg length discrepancy or true shortening

  Caused by an anatomic or structural change in the lower leg resulting from congenital maldevelopment
• Functional leg length discrepancy or functional shortening

  Result of compensation for a change that may have occurred because of positioning rather than structure