We see it all the time. The patient comes in to the office and peels off an old worn back brace. When asked why they are wearing it, they will have one of three reasons:
- they have a job with heavy lifting so they started wearing the brace at work and got into the habit of wearing it all the time
- they had an acute injury after a lift or a twist of their backs and someone recommended a brace. It felt better so they continued to wear it, or
- they have a medical condition such as a fracture, scoliosis or a post-op back fusion and have an actual physician order for the brace.
If your physician orders a brace, it is part of a plan of care. We aren’t touching that. Just remember to ask when, and for how long, you need to wear it. This is your physician’s decision.Our other two scenarios are more concerning. In the first one, many companies such as the “big box stores” supply back braces to their employees. Hospitals used to give them to the clinical staff with the instructions to “pull it tight when you lift someone”. In the second scenario, if is used post injury to stabilize the back, the patient doesn’t feel supported without it, so they wear it all the time.
Immediately following a mechanical injury to the back, a brace can add stability and pain relief, if you have to keep moving. Lifting and placement of heavy objects require spinal support, and the brace can redirect the pressure and tension in the back long enough for the back to heal and for any swelling to decrease.
Unfortunately, this is the only way a low back brace (usually bought at a drug store) is of great benefit for the acute but not terribly serious injury. It is definitely a safe guard and a reminder not to move in certain positions with a newly injured back. Unfortunately, prolonged use of the back brace will cause atrophy in the muscles that actually support the back. Instead of strengthening your support, you are weakening it.
The back brace almost becomes addictive as you feel weak and unprotected when you take it off and it becomes very difficult to give up. In the meantime you are gradually leaving your back with no support from your own body.
A back brace is a great support for a couple of days after an injury, but to wear it all the time is encouraging more problems. Much better to get through the worst of the discomfort and work on core strength so your spine support is an “inside job” and not dependent on a piece of neoprene that is actually hurting you.
- Coenen P, Campbell A, Kemp-Smith K, O'Sullivan P, Straker L. Abdominal bracing during lifting alters trunk muscle activity and body kinematics. Appl Ergon. 2017 Sep;63:91-98. PubMed PMID: 28502411
- Kawchuk GN, Edgecombe TL, Wong AY, Cojocaru A, Prasad N. A non-randomized clinical trial to assess the impact of nonrigid, inelastic corsets on spine function in low back pain participants and asymptomatic controls. Spine J. 2015 Oct 1;15(10):2222-7. PubMed PMID: 26101179