What is a TLSO?
A TLSO (thoracic-lumbar-sacral orthosis) is a two-piece plastic spinal brace. It works like a body cast that can be removed. TLSO controls your spinal posture, helps reduce pain, prevents further injury and promotes healing.
Wearing Your TLSO
Always wear a T-shirt under the brace to provide a barrier between your skin and the plastic and to absorb sweat. Your TLSO must be worn tightly. This brace should reduce or prevent harmful motion in your back. It should be uncomfortable when you begin moving into positions you should avoid. You should be able to do many normal activities by yourself or with a little help from a caregiver or an assistive device. Ask your doctor for details and restrictions.
Arrange for someone to drive you home. A seat that reclines is the best choice. Firm seats will prevent the back-bottom edge of your TLSO from being pushed upward by seat cushions. Bend at your hip and knees, not your back when getting into and out of a car, sitting or standing.
The TLSO waist groove must be placed low on your waist (the soft space on your side between your hipbone and your ribs). Close the straps evenly and snugly (you may need help). The marks on the straps are a guideline as to how tightly your brace should be fastened. If you can tighten the straps past the marked lines, do so. If the TLSO is “riding up” on you it is too loose. Lie down, move the TLSO to the correct place and tighten the straps again.
Your doctor will tell you when to wear your brace and for how long you will need to wear it.
Putting on Your TLSO
To learn how to put on and take off your brace, watch the TLSO brace video.
Put on your t-shirt. You have been given 3 t-shirts to wear under the TLSO. You can also wear your own t-shirt but it needs to fit snugly with no wrinkles under the brace.
Put your TLSO on while lying down. Move to one side of the bed. Using your arms and legs, move your hips over or have a caregiver pull the sheet under you over to one side.
Roll to the opposite side of the bed almost onto your stomach. Bend both legs by sliding your heels toward your buttocks. Lower your knees and turn your hips and shoulders. Do not twist. Keep your back straight, rolling like a log.
The caregiver should put the back half of the brace in place, making sure the waist indentations on the inside of the brace are just above the hip bones and below the ribs. The posterior section should be placed at the tailbone.
Have the caregiver hold the brace in place and log roll onto your back.
Position the front half of the brace.
Front section should go inside the back section.
Fasten the middle straps first to hold TLSO in place.
Fully tighten both straps at bottom of brace on both sides.
Fully tighten the straps at the top of the brace on both sides.
Retighten the middle straps if needed on both sides.
Check to see that the brace is aligned before you get up and adjust it if needed.
Taking off Your TLSO
You will need help getting in and out of your brace. To remove it, lie down, open the straps, and remove the front shell. Someone must log roll you onto your side or stomach, then remove the back shell. Do not twist or bend your back while the TLSO is off. You must wear your TLSO as told by your doctor.
Getting out of Bed
Log roll onto your side. Drop your legs over the side of the bed and push yourself up to a sitting position.
Getting into Bed
Sit on the side of the bed and lean down on your elbow and forearm. Lift your legs up onto the bed, staying in the side lying position. Log roll from your side onto your back.
If your doctor has told you to wear your TLSO at all times when standing or sitting, you may have sponge baths with the brace off while lying in bed or take showers while wearing the brace. In both cases, clean the inside of the TLSO while you are lying on your bed. If you shower, you should lie on the bed when you are done and sponge bathe the area under the brace. Do not twist or bend your back while the brace is off.
After your skin and the inside of the TLSO are both dry, put the TLSO on again before sitting or standing. You can wear the TLSO with wet straps or dry them with a hair dryer set on low.
Sleeping in the TLSO
Your doctor will tell you if you should wear your TLSO while sleeping or lying down. Your doctor may change these instructions during your course of treatment. If you can remove the TLSO while sleeping, put it on before you get up. If you need to get up and go to the bathroom at night, it may be easier to keep the brace on while sleeping.
Cleaning the Outside of the TLSO
Wipe off the outside with a damp or soapy cloth, and then dry it. The straps may be scrubbed with a brush on the smooth Dacron side. They can air dry while the TLSO is being worn. The hook fastener area will hold best if all the lint is removed.
Cleaning the Inside of the TLSO
The TLSO is lined with waterproof closed cell foam. When you take your TLSO off for your bath, wipe the inside with a damp cloth. If you prefer, you may also use a mild soap that you would use on your skin. Rinse the soap off the brace and dry the inside with a towel or a hair dryer set on “low” or “cool” before you put it on again.
Once a week, wipe out the inside of the TLSO with rubbing alcohol. While the TLSO is off, change your T-shirt and dry any sweat from your skin so all places under the TLSO are dry. Do not use cornstarch on your skin. You may use talcum powder if you like.
Washing Your T-shirts
Your T-shirts can be hand-washed and dried on a towel or drying rack or see the instructions in the package. Wash and reuse the t-shirts.
Your TLSO will make it hard to bend over and make you more top-heavy than usual. Avoid bending over to reach your feet or the floor. Bend at the knees and hips, not the waist. You may need help or special tools to dress, pick things up from the floor, or wipe after going to the bathroom. An occupational therapist can provide tools and teach you new ways to do things while wearing your brace. Be careful on stairs and use handrails. Avoid lifting anything greater than 10 pounds.
How long do I need to wear the TLSO?
Your doctor will decide how long you need to wear your TLSO. You must be sure to follow your doctor’s advice even if you feel better and would like to stop wearing it sooner. Your doctor will be checking your progress and will decide what is in your best long-term interest.
Things to Remember
Do not expect to be able to move in all directions or sit in all types of chairs. The brace is designed to limit certain motions and positions.
You should inspect your skin under the brace daily to check for any breakdown. If you notice areas of breakdown or localized redness, please call the Orthotics Clinic to have the brace adjusted.
When to Call
If your TLSO need adjusting call the Orthotics Clinic to schedule an appointment.
If you have more numbness, tingling, pain, loss of bowel or bladder function or are less able to move or do daily activities call your clinic.
Who to Call
Orthopedic Rehabilitation Spine Clinic
After hours, nights, weekends, and holidays, this will give you the paging operator. Ask for the resident on call for your clinic. Leave your name and phone number with the area code. The doctor will call you back.
If you live out of the area, please call: 1-800-323-8942 and ask for your clinic.