QUESTIONS AND ANSWERS ABOUT TREATMENT WITH THE BACK BRACE

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1 QUESTIONS AND ANSWERS ABOUT TREATMENT WITH THE BACK BRACE 1. Can the belt help Herniated or Bulging discs? BACKGROUND INFORMATION: A bulge is when the inner nucleus of the disc becomes disrupted and partially pushes toward the periphery of the disc, making it bulge. This in turn can press on nerve tissue. A herniation is when the nuclear material pushes clear through and past the periphery of the disc and into the spinal canal, which can also press on nerve tissue. Both of these conditions are referred to as "space-occupying lesions" in that they occupy space in the spinal canal and/or the intervertebral foramina that may displace or put pressure on the nerve t issue that also occupies that space. Answer: Yes, the belt can help patients with herniated or bulging discs. The AMD belt decompresses the disc, thereby decreasing gravitational weight bearing stress to the disc. This usually results in less disc bulge or herniation. The belt also increases disc height and as a result increases the available space for the nerve tissue (spinal cord, cauda equine or periphera l nerve roots) in that region, which in turn decreases the pressure that the disc bulge or herniation can impart to the nerve tissue. Decompression of the disc helps to minimize further disc damage and by increasing imbibition of water and nutrients into the disc, may well result in increased disc health. 2. Can the AMD belt help patients with Lumbar acute/chronic sprain? BACKGROUND INFORMATION: A sprain of the tendons & ligaments or a strain of the muscles occurs as a result of forces that microscopically tear these tissues. Typical healing time is anywhere from about 6 weeks to a year or more, depending upon the severity of the injury, and upon the stage of healing that one is referring to. Stage 1 of healing is referred to as the Active Swelling stage and occurs during the initial hours after the injury. Stage 2 of healing is referred to as the Passive Congestion stage and begins by the 2 nd to 4th day. This is the stage when everything swells up.

2 Stage 3 of healing is referred to as the Tissue Repair stage and begins by the 5th day after the injury. This is the stage when the body infiltrates the damaged tissue with scar tissue. No matter what type of tissue is damaged, the body always heals with scar tissue. This tissue is laid down in a disorganized matrix that (when around joints) does not usually allow for normal function and movement. This phase lasts up to six weeks. Stage 4 of healing is referred to as the Remodeling phase. This is when physical activities such as passive exercise (stretching) and active exercise (muscle strengthening) cause the body to gradually align the scar tissue fibers from a disorganized criss-cross matrix of fibers to parallel orientation of the fibers, which allows for normal joint function and movement. This phase generally lasts 3-6 months, but may last as long as a year or more. Answer: Although the AMD belt would probably be very helpful for acute lumbar sprain/strain, it is considerably more expensive than traditional elastic lumbar support belts which should be tried first. Only if these belts are not adequate and more invasive forms of therapy are anticipated, such as lumbar epidural block, would the AMD belt be considered appropriate and would then also be determined to be cost -effective. Chronic lumbar sprain/strain conditions (those that have lasted a month or more) should be handled similarly. If a chronic sprain/strain condition exists as a result of chronic work or postural stresses, t he belt would probably be quite effective and very appropriate. 3. Can the AMD belt help Spondylosis and Spondylolisthesis? BACKGROUND INFORMATION: Spondylosis is another name for arthritis. This arthritis may consist of arthritic spurs above and below each disc, each spur growing toward the other, or it may be arthritic changes of the lumbar facet joints between the vertebrae. There are facet joints on the left and on the right, wit h the vertebra above and with the vertebra below. Answer: Yes. By reducing weight-bearing stress to the joints of the lumbar spine the AMD belt can be very helpful for this condition. BACKGROUND INFORMATION: for spondylolisthesis: Spondylolisthesis is a non-union or disconnection between the front part of the bone (vertebral body), which supports your weight, and the back part of the bone, which controls bone movement. This non-union usually stabilizes by the early to mid twenties. Nevertheless, it usually results in an increased lumbar curve, called a lordosis (also called sway-back). This increased lordosis is made worse by prolonged standing or sitting.

3 Answer: Yes. By reducing weight-bearing stress to the lumbar spine, the lumbar lordosis, usually increased in cases of spondylolisthes is, is reduced; and stress to the region is reduced. This results in increased stability to the region as well as decreased pain and discomfort. 4. Can the belt help Lateral Recess Stenosis? BACKGROUND INFORMATION: Lateral Recess Stenosis is a condition brought caused by arthritic changes in the bone adjacent to where nerve tissue exits the spinal canal to form the peripheral nerves. The arthritic changes forms new bony material next to the nerves and crowds the nerve tissue, placing pressure on the nerves which may result in pain and decreased nerve function. ANSWER: The belt might help lateral recess stenosis depending upon exactly where the stenosis is located and how much pressure upon the nerve may be contributed by thinning disc space and/or disc bulge. By increasing the disc space and increasing the space between the facet joints as well, this may result in enough additional space for the nerves affected by lateral recess stenosis to achieve some measure of symptomatic relief. This will of course not treat the cause of the stenosis, which will probably continue to progress and may eventually require surgery. However, it is possible for this belt to "buy time" and provide some relief for the patient until such time as surgery becomes unavoidable. 5. Can the belt help Facet Joint Hypertrophy (Facet Joint Arthritis, Facet Joint Degeneration)? BACKGROUND INFORMATION: The lumbar facet joints are located behind the vertebral bodies. Each vertebra has a total of four facet joints. Two joints connecting it with the vertebra above, and two joints connecting it with the vertebra below. Two joints are on the left (one above and one below) and two joints are on the right (one above and one below). These joints are adjacent to the peripheral nerves where they exit the spinal canal and pass through the intervertebral foramina (a hole through which the peripheral nerves pass. And part of each facet joint helps to form a portion of this foramina. For that reason, arthritic changes to this portion of the facet joint can encroach upon the foraminal space and place pressure on the exiting nerve root. In addition, arthritic changes in the facet joint can cause arthritic pain in the joint itself. ANSWER: By reducing pressure on the facet joint surfaces, the belt can help to alleviate facet joint pain; just like reducing pressure on any arthritic joint can help to relieve the pain of the joint. Without the continued pressure as an irritant to the joint, it is more likely that the joint would respond favorably to anti-inflammatory nutriceuticals or medications, and possibly no longer require medication.

4 6. QUESTION: Can the belt help patients with Failed Low Back Surgery Syndrome? ANSWER: Depending upon what is the cause of the patient's pain, and what is the reason that low back surgery failed, the belt may be helpful and should be tried prior to risking another surgery. 7. QUESTION: Can the belt help those with sciatica? ANSWER: It depends upon what is causing the sciatica. Many conditions that cause sciatica can benefit from use of the belt, however a few causes of sciatica do not respond favorably to the belt. 8. QUESTION: Can the belt help low back, hip or leg pain caused by Piriformis Syndrome? ANSWER: No. 9. QUESTION: Can the belt help low back, hip or leg pain caused by Greater Trochanteric Bursitis? ANSWER: No. 10. QUESTION: Can the belt help low back conditions caused by a spinal cord tumor? ANSWER: No. 11. QUESTION: Can the belt help low back pain that results from a compression fracture? ANSWER: By reducing weight bearing pressure, the belt may be able to help patients that have suffered a compression fracture of one of the lumbar vertebrae. 12. QUESTION: Can the belt help patients with bone cancer that has metastasized to the lumbar spine? ANSWER: This belt is not intended to treat cancer. However, if prescribed by and under the direct supervision of a patient's treating physician, the belt may provide some benefit. 13. QUESTION: Can the belt be used by pregnant patients? ANSWER: No. The belt can not be worn by pregnant patients at any time during their pregnancy.

5 14. QUESTION: Can the belt worsen any conditions? ANSWER: No. There are no conditions that can be made worse by the belt, since the belt only serves to reduce the effects of gravitational weight bearing. Some patients can experience a muscle spasm reaction to the removal of the belt. This reaction can generally be avoided by instructing the patient to time the use of the belt such that its removal occurs immediately prior to lying down to sleep. 15. Question: How long should patients wear the belt each day? Answer: In order to benefit from a lasting therapeutic effect, it is generally advisable to wear the belt for approximately four hours per day. A noticeable benefit is generally evident after three days of wearing the belt four hours per day. 16. QUESTION: Can patients wear the belt longer than four hours each day? ANSWER: Yes. Although most patients experience adequate relief by wearing the belt only four hours per day, some patients may need to wear the belt longer than four hours per day in order to obtain maximum relief of symptoms. 17. QUESTION: Are there any adverse effects from wearing the belt longer than four hours per day? ANSWER: The only adverse effect that can occur from wearing the belt longer than four hours per day is that with prolonged use, the back and abdominal muscles that support the spine can get weak and dependant upon the belt for adequate spinal support. However, usually using the belt allows the individual to become more physically active, which would counteract this effect. To help insure that individuals do not get dependant upon the belt for adequate spinal support, it is advisable to engage in daily spinal stabilization exercises, especially if the individual is wearing the belt longer than four hours per day. Individuals should consult with their treating physician for recommendations of which exercises would be most appropriate for their particular situation. 18. QUESTION: I've been wearing my belt for awhile now and its working great, but it's getting dirty now. Can I wash it? ANSWER: Yes. The belt can be placed in the supplied washing bag and placed in the washing machine on the "gentle" cycle with a mild detergent such as WOOLITE and warm water. Make sure that the air valve is in the closed position before placing the belt in the washing machine. After completing the wash cycle, the belt should be air-dried.

6 19. QUESTION: How should the belt be positioned? ANSWER: Your physician is the best one to advise you of the exact positioning of the belt. However, in general terms, the belt should be positioned so that the lower edge of the belt is as far above the upper part of the hip bones as the upper edge of the belt is below the lowest part of the ribs. As the belt is inflated, the lower edge expands downward to anchor itself against the upper part of the hip bones and the upper edge expands upwards to anchor itself against the lower portion of the ribs. Once this anchoring occurs, further expansion of the belt results in positive traction to the lumbar spine. 20. QUESTION: How much can I inflate the belt? ANSWER: Inflate the belt only to the recommended amount on the pressure. The air pump has a self limiting valve to prevent over inflation. Do not use other pumps or methods to inflate the belt. Doing so voids the warranty and may result in discomfort, pain or injury. Do not exceed the recommended inflation pressure indicated on the pressure gauge of the included air pump. Doing so may result in discomfort, pain or injury. 21. QUESTION: My belt won't stay inflated. What do I do? ANSWER: First check all the connectors are tight on the pump and the belt. Close the valve on the belt all the way by rotating it clockwise. With the valve in the closed position, attach the air pump and inflate to the desired pressure. Disconnect the air pump. Do not turn the valve counterclockwise until you are ready to deflate the belt prior to removing it. You must deflate the belt each time prior to removing it. 22. QUESTION: How long will the belt last? ANSWER: With proper use and care the belt will last for many years before it wears out and needs to be replaced. 23. QUESTION: What if I loose or gain weight? ANSWER: We include an extender to allow for small adjustments in your weight.(typically 5-15lb) If you gain or loose a significant amount of weight, you may need to buy the next size larger or smaller belt in order for the belt to fit properly.

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