Back Support Myths and Indications for Spinal Bracing
Back Support Myths
- Wearing a Back Support Creates Dependency and Weakens the Abdominal Muscles
Although the Morris, Lucas, and Bresler study indicate that the use of a back support resulted in a more relaxed state of the abdominal musculature, more current studies demonstrated no evidence of a weakening effect. Back support innovations have, in fact, allowed back pain sufferers earlier return to activity, negating the weakening effects of inactivity.
- Back Supports Cause Poor Body Mechanics
A good quality back support encourages proper lifting technique, because slumping or forward bending in bad posture is more difficult. Lifting properly, in turn, strengthens the legs, abdominals and back muscles.
- You Should Wean Off a Back Support ASAP
Again, this myth is popular because of the misperception that all back supports are clumsy, rigid and prevent movement. A properly fitted back support actually encourages movement. Many people find that the extra support improves confidence and allows a much earlier return to athletic or work activities. Only when restoration of dynamic core stability has been achieved do we begin weaning the patient from the use of their back support.
Indications for Spinal Bracing
In general, any patient with a musculoskeletal disorder who might benefit from immobilization, unloading of the compressive forces on the spine, or postural correction may be a suitable candidate for spinal bracing. In a study reported in the Journal of Bone and Joint Surgery, Perry found that orthopaedic surgeons were divided concerning indications for the use of spinal bracing. While less than 25% advocated the use of bracing for acute strains, post operative discs, or disc syndromes, the vast majority did utilize bracing for the treatment of postoperative fusions and the treatment of spondylolisthesis.
Given the unloading, stabilizing, and proprioceptive feedback effects of spinal bracing, patients experiencing the following conditions may benefit from spinal bracing:
- Acute sprains and strains
- Post surgical fusion, laminectomy, discectomy
- Congenital or traumatic instability
- Disc herniation
- Spinal stenosis
- Postural backache
- Degenerative joint/disc disease
Interestingly, in a study reported in the Journal of the American Medical Association, the Centers for Disease Control and the National Institute for Occupational Safety and Health found no evidence that back supports reduce back injury or back pain for retail workers who lift or move merchandise. Similarly, no statistically significant difference was found in comparing the incidence of self-reported back pain among workers who reported using back supports every day, with the incidence among workers who reported never using back supports or using them no more than once or twice a month. Neither did the study find a statistically significant difference between the rate of back injury claims among employees in stores that required the use of back supports, and the rate of such claims in stores where back belt use was voluntary. A history of back injury was the strongest risk factor for predicting either a back-injury claim or reported back pain among employees, regardless of back support use.
Except for the treatment of specific compression fractures or particular lytic conditions of the spine, there is no scientific evidence to support that one brace is superior in providing greater unloading, better stabilization, or more proprioceptive feedback over another brace. Therefore, patient comfort, ease of use, and price should be considered when prescribing a spinal brace.
A well-fitting, comfortable back support can increase patient confidence and encourage early movement, decreasing the negative effects of immobilization and time away from work and/or recreation. Patients may need to be reminded to avoid overdoing activities until full rehabilitation is achieved. The key to success while using back supports is to incorporate their use into a comprehensive active spine care program.