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Back Braces-Should I or Shouldn’t I?

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I was recently asked by a physician patient about the use of back braces. She wanted to know whether I thought their use was indicated, and noted that in her experience a lot of people depend on the back brace to provide support to their lower backs throughout their day at home and at work and at play.

It’s a great question, and like most questions about the back there aren’t any simple answers but I’ll give it my best shot!

In my professional opinion the use of a back brace is best reserved for when patients are in the acute phase of an injury and have severe pain that impairs their ability to do basic activities of daily living without the use of the brace. Translate that to mean for a short time and under certain conditions.

The problem I have seen in my 34 years of practice is that people begin to depend on the back brace to provide the basic stability that should be provided by the deep muscles of the spine, especially the small multifidus muscle groups. This dependency on back braces further complicates the stability of the spine as it encourages a condition called ‘disuse atrophy’ where the multifidus muscles, instead of doing the job they were designed to do, go ‘off-line’ and stop working; fat tissue infiltrates the muscles, and suddenly they are no longer providing the stability that the lumbar spine needs.

Let’s go over the basic arguments for and against!

Here is a list of the “PRO” back brace reasons:

1. Braces used immediately after low back surgery may be helpful for spine stabilization.

2.  Lumbar support braces (the back braces that you can buy at the pharmacy or sporting goods store) can be helpful after an initial low back injury by limiting movement of the spine in the low back area. The limited movement can allow some back injuries to heal by relieving excessive demand placed on the specific joints of that spinal area.

3.  Some users of back braces report that the braces support their abdomen, improve their posture and take some of the load off of their lower back.

4.  Back braces can make transitional movements (such as from a sitting to a standing position) more comfortable during an episode of acute severe back pain.

5.  If you have a labor-intensive job that places stress on your lower back, a back brace may help you when you first return to work after a back injury by avoiding too much strain on your spine.

Here is a list of the “CON” back brace reasons:

1. The use of back braces long-term may result in atrophy of some muscles that support the spine through lack of use. In other words, the muscles and ligaments that do not have to work due to the support of the brace will weaken.

2. When you wear a lumbar support brace, the demand removed from one area of your back may be transmitted to another area nearby, and result in either pain or later injury.

3. Since muscles and ligaments weaken over time with the use of a back brace, the spine becomes vulnerable when the brace is not being worn. The spine then is at a higher risk of injury than it would have been had the brace not been used.

Specializing in the treatment of chronic and severe back pain has led me to the belief that the more we can do to strengthen the stabilizing muscles of the spine the greater the likelihood that we will obtain the best long term outcomes for our patients. In the end that is what really counts…not just making the immediate pain go away, but do everything possible to prevent it from coming back. To this end I believe in the judicious use of back braces and make that decision on a case by case basis.

Getting to the cause of the problem and finding the optimum solution is the ideal approach.

Hope that helps! Don’t hesitate to contact me personally if you have additional questions.

Dr. Jeffrey K. Tunick

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