The effects of three different types of orthoses on the range of motion of the lumbar spine during 15 activities of daily living.

Study Design. Prospective cohort study. Objective. To quantify which 3 common lumbar orthoses of varying rigidity restrict both full, active range of motion (ROM) and functional ROM required for activities of daily living (ADL). Summary of Background Data. Spinal orthoses are implemented to restrict lumbar motion. Despite widespread prevalence of lumbar bracing, the efficacy of these appliances for immobilizing the spine has not been definitively established. Methods. The full, active ROM of 10 asymptomatic individuals was quantified using an electrogoniometer that registered maximum rotation in all planes. Subjects subsequently completed 15 simulated ADLs during which time their functional ROM was measured; performed without a brace and while wearing a corset, semirigid lumbosacral orthosis (LSO), and rigid custom-molded LSO. Results. For flexion/extension, the mean percentage decreases (with SDs) in full, active ROM that were recorded with corset, semirigid, and a custom orthosis were 24.1 +/- 7.9%, 46.8 +/- 7.1%, and 64.7 +/- 8%, respectively (P < 0.001 relative to no brace). In the coronal plane, motion was restricted by 33.9 +/- 8.8%, 51.9 +/- 9.4%, and 49.1 +/- 11.8%, respectively (P < 0.001). Finally, rotation was limited by 39.6 +/- 8.8%, 59.2 +/- 10.2%, and 70.6 +/- 5.4%, respectively (P < 0.001). There were no significant discrepancies between the ROM recorded in the semirigid and custom LSOs for the ADLs. Likewise, functional ROM associated with corset and semirigid LSOs were only different for 2 ADLs whereas significant disparities between values with corset and custom LSOs were observed for 4 simulations. Conclusion. The full, active ROM allowed by lumbar braces evaluated was greater than employed during ADLs in absence of any brace. The motion decrease beyond actual restriction of the braces suggests they will act primarily as proprioceptive guides to regulate movement.