Pain perception? It’s also about the mind

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A very nice patient of mine, who suffers from low back pain, recently left my studio, after a check-up, with a prescription for a psychological consultation as well as one for specific physiotherapy sessions.

Judging by the look on her face, she was clearly thinking “but my pain is for real, I’m not making it up!”.
This is the reaction I have also had from several other chronic patients when trying to explain the concept of “central sensitisation” to them.

So, let’s try and clear up this question. It is necessary to understand that pain acts as a defence mechanism for the body, as it allows us to understand if, and when, we are in danger.

This mechanism can sometimes end up not working efficiently, producing either not enough pain or too much. In the first instance, we have a problem: if we are unable to perceive danger, we run the risk of doing ourselves serious harm.

In the second case, on the other hand, even non-painful stimuli, such as a light pinch or normal movements, cause us pain.

Such excessive pain is due to nerves in the body that have become too sensitive and fire too easily.

At an early stage after a trauma it is a physiological, ie normal, event due to the brain releasing chemicals that make the nerves more sensitive.
Essentially, pain is, as we have said, a protective mechanism whereby the brain reminds us to be careful with the part of the body that has just been damaged. This kind of pain is reversible and wears off in the space of a few weeks.
Sometimes, however, this protective response can persist longer than it should, to the point of interfering with our perception of pain.

In the literature, this phenomenon is termed “central sensitisation” and it can be compared to a badly set home alarm system that tends to be triggered unnecessarily.

So, signals of peripheral origin can lead us to perceive pain without real cause, or transmission errors can occur centrally. In other words, the problem can lie with our brain incorrectly modulating how much pain we feel.

It is now common knowledge that stress, sleep disorders and depression can negatively influence healing and favour chronicisation. This is why it is important, when faced with chronic patients, also to investigate all the psychological factors that can come into play. 
As a further consideration, literature data show that even the most powerful painkillers currently on the market are able to reduce pain by no more than 30-40%, and do so in no more than 50% of patients.  

In short, the pharmacological approach alone may not be sufficient for treating chronic pain. It can therefore sometimes be necessary to use complementary psychological approaches designed to help patients manage their pain in a more adaptive way, and understand how an individual’s relationship with his pain influences its intensity and the limitations it brings.
They need to appreciate that the brain plays a key role in our perception of pain, and that this perception merely reflects the way it is being processed.

In addition to the perceptual aspects described above, pain also has an experiential component that is entirely personal and subjective; in other words, emotional, cognitive and socio-cultural factors come into play influencing our experience of pain. If we step on a drawing pin, for example, our brain will register pain, but if we step on the same drawing pin while escaping from a lion, our brain may not register any pain at all. 

Many patients really need to understand the true cause of their back pain, even though it is notoriously difficult for us to establish whether it is a bone, joint, muscle or nerve problem. Often, it is none of these, being due, rather, to an area that is working badly and needs to be re-educated to withstand loading. But patients can find it very hard to understand and accept our explanations of how the brain, too, plays a decisive role in the whole experience of pain.
When we tell a patient this, we are not saying that they are inventing their pain, only that there are highly complex mechanisms that can come into play, which must be understood and, if necessary, reset in order to manage the condition.

Nowadays, the scientific community shares the view that patients are more than just the result of their X-rays or MRI scans; that the detection of a herniated disc means nothing unless it is seen in the context of the patient’s clinical conditions and symptoms. We need to stop telling patients, on the basis of these examinations, that their back is in poor shape or looks like that of a 90-year-old woman, because such negative messages serve only to feed a vicious circle that can be difficult to break.
The idea of having a broken, fragile and irreparably damaged body will only make the pain even more entrenched, and condition other aspects of the patient’s life, causing them to limit their movements or physical activity.

And these, too, are responses that can contribute to the persistence of pain.

ISICO Telemedicine described in a recently published article

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ISICO’s use of the telemedicine approach during the COVID-19 emergency and the data collected in relation to that experience are the focus of a new article by our team, Feasibility and acceptability of telemedicine to substitute outpatient rehabilitation services in the COVID-19 emergency in Italy: an observational everyday clinical-life study, which has just been published in Archives of Physical Medicine and Rehabilitation.

“This is a hugely important publication,” remarks Prof. Stefano Negrini, scientific director of ISICO, “as it testifies to the work done by ISICO right at the beginning of the COVID-19 crisis when, in our daily clinical work, we switched to the telemedicine modality in order to avoid having to interrupt the care and treatment of many of our patients”.

Here are a few figures: the article examines data collected over a 15-day telemedicine period, during which 325 teleconsulations and 882 telephysiotherapy sessions were provided. Instead, over the entire lockdown period, the remote sessions numbered 3,231 in total, i.e. 2317 telephysiotherapy sessions and 914 teleconsulations. These are impressive numbers, especially if we consider the high level of patient satisfaction recorded (2.8/3).

ISICO has longstanding experience in caring for and monitoring young scoliosis patients (children and adolescents) living all over Italy and also abroad. Precisely for this reason, i.e. in order to find a way of allowing farther-flung patients to travel to the centre less often, it has already experimented with various telemedicine tools. 

In fact, over the years, ISICO patients, some even living in other continents (such as Australia and the USA), have been able to follow long-term treatment programmes, thanks to the availability of online consultations.

Therefore, our temporary recourse to online consultations and treatments following the COVID outbreak and during the subsequent lockdown did not constitute a completely new experience, but rather a speeding up of a process that was already under way. 

“This strategy aims to decrease the heavy impact on the health systems and allow hospitalisation and intensive care of the huge number of patients in need, thereby reducing the overall mortality” explains Prof. Negrini. But “the COVID-19 emergency is hitting hard not only infected patients, but also all the others. In many countries, outpatient services have been fully closed due to the need for physicians to treat COVID-19 patients, and also to reduce the risk of infection linked to travelling. This has left outpatients are on their own and mostly self-managing. This is not acceptable for diseases that can still show sudden, important progressions, even in the space of a few months, and it is even less acceptable in children.”

How did telemedicine at ISICO work? The telemedicine services consisted of teleconsultations and telephysiotherapy sessions, which lasted as long as usual interventions. They were delivered using free teleconference apps, caregivers were actively involved, and interviews and counseling were performed as usual. 
Teleconsultations included standard, but adapted, measurements and evaluations by video and using photographs and videos prepared according to specific tutorials and sent in beforehand.  During telephysiotherapy sessions, new sets of exercises were defined and recorded as usual.

In the article, we considered 3 phases: the first covers the usual services delivered, over a period of  30 working days (January 7th to February 23rd), prior to the discovery of the spread of COVID-19 the second phase (February 24th to March 14th) was the one in which COVID-19 began to impact  on our usual services, but before we started using the telemedicine approach; finally the last data analysed refer to the 15 working days from our introduction of exclusively Telemedicine consultations (starting from March 16th)

What came out of the study?

That “Telemedicine is feasible and allows us to keep on providing outpatient services that meet with patients’ satisfaction. In the current pandemic,” Prof. Negrini concludes, “telemedicine has been shown to be effective in specific areas of care, particularly where technology is involved. To our knowledge there are no published results about the application of telemedicine to patients with spinal deformities,” and the publication of this article shows that “this strategy can provide a viable alternative to closure of many outpatient services”.

Now screening comes online!

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Isico launches online screening. Just connect to the dedicated screening website and you can perform a quick and simple assessment and check whether, with respect to pathologies such as scoliosis or curved back, it is appropriate to carry out a specialist medical visit that investigates further.
The idea, which has been in the works for some time, has had a further stimulus thanks to the departure of Telemedicine during the Covid-19 emergency period. We know how essential an early screening is to set up adequate rehabilitation therapy in case of vertebral deformities.
At Isico, screening has always been done, free of charge for the siblings of our patients. Now the novelty is given by an additional online tool that everyone can access as well in several languages; in addition to Italian and English, the German version is now available as well. 
How does the site work?
After viewing a short explanatory video of Michele Romano, head of physiotherapy in Isico, the evaluation begins either for scoliosis or for the curved back. 
The process is always guided by an introductory video given by Michele Romano. He explains how to make a part of these evaluations through observation only, others where you are asked to take measurements with a ruler and others again to be detected with the help of a simple bottle of water, the Torsion Bottle. 
On the basis of the data entered, it will be possible to know if it is appropriate to contact the evaluation of an expert in vertebral pathology or if there is nothing at the moment to worry about.


The next steps?
Translating the site into other languages ​​so that more people can use it easily. In this regard, we will be pleased to accept those who want to collaborate with us for the translation into other languages, in case you contact the email: isico@isico.it

SEAS: partial resumption of the courses

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Our SEAS courses have not yet been able to restart in full due to the Coronavirus emergency. At the end of August, however, we managed to be present in Slovenia where Michele Romano, director of physiotherapy in Isico, held a first-level course: about twenty participants were allowed to participate to keep the necessary distances and respect the safety protocols. Enthusiastic participation, despite having had to limit the interaction than usual.

After the Slovenian course, Romano was engaged in two SEAS online courses for a number of Russian participants.

A fundamentally important role in the success of this event was played by Dr Dmitry Gorkovsky, who, since 2016, has worked with us on the staging of eight previous courses in various Russian cities: Moscow, St. Petersburg and Novosibirsk.

Michele Romano gave practical demonstrations using a Dummy via Skype and Dr.Gorkovsky replicated these exercises with volunteers from among the participants.

How often should a brace be changed?

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Receiving their first brace is a key moment in the treatment of youngsters affected by spinal deformities.
This is the brace that shows them exactly what the treatment consists of. They learn about the pads, which are carefully positioned to correct their back; they become familiar with the fastener and how to adjust it to the right tightness, as well as how the brace sits under the armpits. They also have to get used to the shoulder pads and, quite simply, the weight of the plastic.

Surprising as it may seem, some youngsters even grow quite attached to their first brace as, over the weeks and months, it starts to become a part of their daily life and less of a problem. This “friend”, which they sometimes find irritating, especially early on, gradually feels less and less bulky, and in fact there will eventually come a point when it is too small. After all, while the brace stays the same, the youngster inside it grows of course!

For this reason, a new brace will be needed from time to time. It certainly isn’t possible to use the same one from the start to the end of the treatment. But there are also other reasons why a brace needs to be replaced, the first and most obvious being that, like any object used on a daily basis and for a number of hours each day, it starts to wear out. Indeed, after a time, it is subject to breaking, or some of its parts may no longer be intact.

A further reason, and this is perhaps the most important, is that the brace, especially the first one, moulds the youngster’s back so much that after a few months it becomes necessary to construct a new one adapted to its changing volumes. Unless braces are updated to take this aspect into account, they simply cannot work at full efficiency.

The young scoliosis patient’s back changes not only as an effect of the brace, but also because he/she is normally still growing.
In this stage of development, it is perfectly normal to get taller and heavier. A brace can usually tolerate slight increases in height and weight, but when these are more marked it will start to feel uncomfortable. Even just looking at the youngster in his/her brace can be enough to tell you that the time has come to start thinking about getting a new one made.  
From the second brace onwards, more time can usually elapse between braces. It may even be enough to get a new one about once a year.

Youngsters are often anxious at the prospect of changing their brace, fearing that the new one will be uncomfortable. Actually, however, they are unlikely to experience the same discomfort they had at the very start of the treatment.
In fact, in most cases they will find the new brace is more “comfortable”, given that it replaces one that had become too short and tight, and so no longer adequate. Furthermore, having already had to get used to wearing a brace, these “experienced” patients will be better able to recognise, quickly, any problems with the new one.
This will allow them to give the orthopaedic technician clear feedback, useful for making it fit better.  

A comparison of the Chêneau and Sforzesco braces

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Unfortunately, it has become common to think of braces in the same way as we do drugs. But before we go any further, we need to make one thing clear: whereas we all know that aspirin is not the same as paracetamol, in the case of a brace, the name doesn’t really mean anything specific.
A brace is a product that is made-to-measure for the individual patient, and therefore the success of bracing treatment depends not on the name of the brace, but on how correctly it has been constructed for the particular patient. If the pads are incorrectly positioned, or if the brace is constructed so that it sits too low or presses too much on one side, it may even contribute to worsening rather than improving the scoliosis. 

The names of the different braces, therefore, are meaningful only to those who prescribe them. 

Finally, adding to the confusion, Dr Chêneau gave his name to two completely different types of brace: the first Chêneau is much more symmetrical than the second one, which, on the other hand, is clearly asymmetrical. Although the second Chêneau brace is the one most commonly used worldwide, we prefer to use the first one, for two reasons: first of all, it is discreet (practically invisible under clothes) and second, in constructing it, we are able to apply the same principles that characterise the Sforzesco, which is the brace developed at our own centre. For this reason, the Chêneau that we use at Isico has been given a new name: we call it the Sibilla- Chêneau, in honour of Dr Sibilla, a pioneer of our school.

So, how do the Sibilla-Chêneau and the Sforzesco differ? They differ in several features, which determine the choice of one over the other on a case-by-case basis. The decision to prescribe one type of brace rather than another must always be taken by a medical specialist.

Let’s start with the material: the Sibilla-Chêneau, used at Isico, is of monovalve construction and it is made of polyethylene, whereas the Sforzesco has two valves and is made from a much more rigid material. Its two parts are linked to posterior fasteners, and there is sometimes an aluminium rod at the back, too. Being more rigid, the Sforzesco has shown the same efficacy as the old system of plaster casting, but with the huge advantage of being removable for bathing/showering.

The Sibilla-Chêneau tends to be used to treat milder cases with less rigid scoliotic curves; it is also preferred for pre-pubertal patients. The Sforzesco, on the other hand, is used for more severe scoliosis with more rigid curves (for example, in youngsters with greater bone maturation). 

In some cases, patients start off with a Sibilla-Chêneau brace but subsequently switch to a Sforzesco one if the scoliosis becomes too aggressive (a decision reflecting the concept that the treatment should evolve gradually): on a hypothetical treatment scale, we can say that the Sforzesco (a super-rigid brace) is one step up from the Sibilla-Chêneau (a rigid brace).

At Isico, both these braces are prepared in accordance with the SPoRT (Symmetrical, Patient-oriented, Rigid, Three-dimensional) concept of bracing.

 “Symmetrical” means that the brace, externally, appears almost perfectly symmetrical, which makes it unobtrusive and helps to replicate the natural shape of the human body. In other words, for aesthetic reasons, it is outwardly symmetrical. By contrast, internally the brace acts asymmetrically, exerting a three-dimensional corrective action on the deformity. 

The brace is defined “Patient-oriented” on account of its wearability, and therefore tolerability. Being very closely fitting, it moves with the patient, and it does not restrict arm and leg movements at all. Furthermore, since it is easy to conceal, patients accept it readily, rather than merely putting up with it.

The term “Rigid” refers to the type of material used.

Finally, “Three-dimensional” refers to the corrective action of this type of brace on the spine; technically speaking, the brace pushes in a down-up direction; overall, the transmission of the corrective forces to the spine is carefully balanced in such a way as to obtain optimal correction in all three planes of space, without any of the three being allowed to dominate.

As explained at the start, another type of Chêneau brace is also used worldwide; in Italy, we call this the Chêneau 2000: it is an asymmetrical brace that uses expansion chambers. It remains clearly asymmetrical, even externally.  We, on the other hand, prefer to use the symmetrical version of the Chêneau, in order to respect the SPoRT concept mentioned above and also because it favours compliance. Indeed, applying our school of thought, we have obtained, in our patients, the best bracing results recorded anywhere in the world, and this is thanks, in part, to the type of braces we use. Naturally, braces only work if patients actually wear them, and the easier they are to conceal under clothes, the more patients will wear them.

Active self correction and stabilization: an Isico letter to the editor

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It has just been published a letter to the editor  “The active self-correction component of scoliosis-specific exercises has results in the long term, while the stabilization component is sufficient in the short term” in the scientific journal Prosthetics and Orthotics International. 

“This is a comment to the study “Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment” –explains dr. Alessandra Negrini, Isico physiotherapist and author of the letter – the authors of the research compared two groups included Scientific Exercises Approach to Scoliosis (SEAS) and core stabilization. Scoliosis-specific exercise schools like SEAS include two main components: active self-correction (ASC) and stabilization. Consequently, a common intervention was provided to the two groups (stabilization) in this study, while the SEAS group also received ASC”.

Follow-up X-rays were taken after only 4 months. According to the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)/Scoliosis Research Society (SRS) criteria, these results should be classified as a very short-term assessment. No significant difference was found between the two interventions. The patients were more adherent to the brace than to the exercise therapy. “Unfortunately, the authors did not mention if there was a difference in the adherence to bracing between the groups: this variable is expected to impact the results more than the type of exercises -adds dr. Negrini – Experts agree that stabilization exercises are more important during the first treatment phase (when the brace maintains for many hours every day the alignment of the spine and exercises are aimed to counteract muscle impairment). Exercises in ASC are more important in maintaining the obtained results when the brace weaning phase starts, when the patients should live sustaining in correction their spine without the brace support”. 

It is important for the future to determine when to start ASC: immediately (even if it could add nothing to stabilization) or when weaning starts (when it could be too late)?

The full letter: https://pubmed.ncbi.nlm.nih.gov/32524898/

Scoliosis: situations to beware of in adulthood

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The importance of keeping scoliosis under control through regular specialist check-ups is well known, and this is also true in adulthood when the condition can continue to evolve, albeit slowly and gradually (by half/one degree per year according to the literature).

Although curves measuring less than 30° are unlikely to progress (and a progression becomes less and less likely the further below this threshold the measurement is), curves greater than 50° will often worsen in adulthood. Accordingly, the frequency of medical check-ups is decided by the specialist on the basis of the individual patient’s clinical situation.

Idiopathic scoliosis – the form most frequently found in children and adolescents – affects females in particular. It is important to remember that there are certain times in the life of an adult woman when her body undergoes major transformations that make it necessary for her to take particular care of her back.

The first is pregnancy: it was once thought that scoliosis was most at risk of worsening during pregnancy, due to the body’s production of the hormone relaxin in preparation for childbirth; it was thought that this hormone, in addition to softening the ligaments of the pelvis ready for delivery, also had the same effect on the ligaments that help to support the spine, thereby temporarily reducing the level of trunk support.
Now, however, it is understood that the postnatal period and early months in the child’s life are the trickiest time for the mother. Indeed, in the first year of life, babies often need to be held or carried, and in the space of just a few months, they become considerably heavier. Furthermore, as they learn to walk, the mother often finds herself having to adopt a forward bent position. Obviously, all this can have a negative effect on the back, affecting posture and giving rise to pain. At the first sign of back support problems (pain, difficulty getting through the day, frequently needing to lie down), women with scoliosis, particularly if it is a severe form, would be well advised to do specific self-correction exercises prescribed by an expert physiotherapist; these exercises strengthen the back and help it to support the spine.

Finally, in menopause and beyond, the clinical situation is at increased risk of sudden worsening.
The body changes and the aging process, which accelerates with the onset of the menopause, can cause a worsening of existing curves and even the appearance of new ones, so-called de novo scoliosis. 

Although men are less often affected by idiopathic scoliosis and are of course spared the major physical and hormonal changes that women go through, they are just as likely as women to experience aging-related scoliosis.
This form can cause postural imbalances severe enough to leave the affected individual with marked forward and/or lateral flexion of the trunk.
In this stage of life, a specialist medical examination is warranted in the presence of the following: onset of pain, an increasingly bent posture, worsening of postural asymmetries, loss of height, and difficulty supporting the trunk, relieved only when lying down.

And the Sosort Award winner is… Isico!

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At the International Sosort Meeting in June, this year held for the first time ever entirely online, Isico recorded another great success.

Dr Sabrina Donzelli, Isico physiatrist, won the Sosort Award, the event’s top prize, for her research entitled: “Predicting final results of Brace Treatment of Adolescents with Idiopathic Scoliosis: First Out-of-Brace are Better than In-Brace-radiographs”. Her study was chosen over the work of 7 other researchers in the running for the award.

Among eight studies selected as oral presentations, the Scientific Committee picked out, as the two finalists, Dr Donzelli’s research study and a study on the genetics of scoliosis by the Montreal-based research group led by Prof A Moreau. “After the initial selection we were asked to submit a complete article to be entered for the Sosort Award” explains Dr Donzelli. “The prize, for the winning study, is a sum of money allowing it to be published in any magazine, as an open-access article, in other words in a format accessible, free of charge, to anyone who might be interested in reading it”.

The other studies running for the award included a long-term follow up of patients with scoliosis, presented by Dr AG Aulisa, a cost analysis of conservative versus surgical treatment, and two studies on Scolioscan©, the ultrasound equipment present as well at Isico’s Milan clinic. 

“Our winning research underlines how important patients’ first out-of-brace radiographs are for predicting the results at the end of their course of treatment,” Dr Donzelli goes on. “The accuracy of the model we developed and tested, is the key factor that won us this prestigious award, which will allow us to publish our work in the coming months.” 

In the course of the online meeting, several of our specialists gave presentations: Alessandra Negrini, Isico physiotherapist, asked “Is swimming helpful or harmful in adolescents with idiopathic scoliosis?”, Dr Fabio Zaina, Isico physiatrist, gave a presentation entitled “ISYQOL, a Rasch consistent tool for quality of life evaluation in scoliosis patients during adulthood: comparison with the gold standard”, while our director of physiotherapy, Michele Romano, spoke about “The effect of dance performance on idiopathic scoliosis progression in adolescents”.

This is the second year running that Isico has not only been among the finalists but also gone on to win the award. 

In 2019, Isico also won an award with a study concerning scoliosis and sport. “The quality of our research has increased not only as a result of our acquisition of increasingly high-level methodological skills, but also thanks to the growing availability of systematically collected data,” explains Dr Donzelli. “In recent years, the data we routinely collect from patients visiting our facilities have allowed us to develop so-called predictive models. In other words, we consider the characteristics of large groups of patients to try and understand whether they allow us to predict their final results, or whether certain risk factors are more important to consider than others when deciding what type of therapy to prescribe. Our growing clinical and research expertise has led to international collaborations. Many others now look to us to provide expert support. We are also seeing an increase in our collaborations with international partners that want to analyse and compare their clinical and radiographic data with our database”.

Summer in a brace

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Summer is here at last and it is finally time to go on your long-awaited summer holidays. The problem is, you have to take a particularly annoying friend with you – your back brace, which is particularly difficult to put up with at this time of year. Yes, spending summer in a brace is another challenge you are about to face, and one that perhaps had not occurred to you until now.

Prospecting to spend your summer in a brace, you are probably starting to think that this piece of plastic can turn, what should be a fun-filled time, into a nightmare!  

So, what can you do about it?

First of all, it is important to understand that this is a challenge that you need to tackle head on, with the vital support of your family, but also drawing on your own resources. In the end, everyone finds themselves having to rise to challenges of some kind in their teenage years. Whatever these consist of, extreme sports or expeditions in the great outdoors, letting someone know how you feel about them, or working out how to respond to a first declaration of love, you, as adolescents, are probably already realising that now is the time to show just what you are made of!

The best thing is to draw on all your reserves of determination and self-discipline. It is also important to listen to good advice. For example, make sure you make the most of your brace-off time each day, and if you are a full-time brace wearer, why not consider spending your holidays somewhere cooler, such as up in the mountains?  

How can I stick to my prescribed brace-wearing time and still enjoy my holidays?  

Unfortunately, when your scoliosis is still “evolving” and liable to worsen spontaneously, deciding to reduce your brace-on time is very risky. Stopping scoliosis from progressing is already very difficult, and if it does worsen it is very difficult to reverse the trend and “correct” the damage.
We understand that the summer is a particularly difficult time if you wear a brace, and that you have to make many sacrifices. However, if you don’t take your treatment seriously, you could end up in the same position as many adults who have your same problem: they avoid going to the swimming pool or seaside because they feel embarrassed being seen in a swimming costume, and in their case, it’s too late to do anything about it.
So, try to stay determined in your battle against scoliosis, also in the summertime, because in the end, the results will make all your efforts worth it.

How can I best manage my brace-wearing time?

The main thing is to make the most of the hours when you can leave your brace off, and it might also be worth choosing to spend your holidays somewhere cooler, such as up in the mountains, especially if you have to wear your brace round the clock. If you are travelling by plane, we recommend that you take your medical prescription with you, translated into other languages as necessary.

In hot weather, there are some simple things you can do to prevent minor problems and discomfort: wash frequently and change your t-shirt often (do this quickly so as not to be out of your brace for too long). You may also want to apply thin panty liners to the brace where it fits under the armpits; these can be changed frequently, especially in the summer, when you sweat more.

In most cases, it is fine to keep your brace on when you go in the sea or in the swimming pool. In other words, these activities don’t have to be concentrated in your hours of “freedom”: you can simply bathe in your brace. Before you do, though, just bear in mind the following rules, take care, and remember that unfortunately not all braces allow you to do this.

Six rules for bathing if you wear a brace:

  • If you wear a Thermobrace device, this must be removed before you enter the water. Do not leave it in the sun, and put it back in place when you have finished bathing. 
  • If you have been in the sea, you will need to rinse the brace well in freshwater to get rid of the saltiness.
  • Dry the brace thoroughly.
  • Do not use hot air from a hairdryer to dry the brace pads and do not expose your brace to the summer sun, because the sun can overheat the metal parts and, as well as making them hot, will cause them to dilate. Basically, as the brace heats up, the holes where the hinges are attached to the plastic shells will expand and become deformed. The danger is that this can ruin the brace, because as the brace subsequently cools down, the metal part will return to its original size while the plastic will remain permanently enlarged and deformed.
  • If the brace pads are covered in Alcantara®, let them dry out thoroughly, as this material is easily spoiled.
  • As an extra precaution, you could use a stretchy seamless fabric tube to “line” your brace before going in the water (SOFT-TUBE or a similar product).

WARNING!

  • You cannot bathe or swim with your brace on if the strip protecting your abdomen is made from leather (another material that will be spoiled if it is allowed to get wet: you must first replace it with a plastic one (talk to your orthopaedic technician about this);
  • If you are trying out your brace, or just about to do so, contact the orthopaedic laboratory for more information, and to find out about the procedures to follow for your type of brace;
  • It is important to follow the above precautions carefully: a brace is a medical device and you should not let it get damaged through negligence.

Do not go in water where you are out of your depth, even if you can swim!

Don’t forget you can find lots more information and instructions in our handbook “Do you wear a brace? Here is Isico’s advice”:

you can download it from the Isico website.