Back Belts: My Two Cents
[originally published in KCN, November 1999]
Every time I visit one of those “warehouse super-mega stores” I cringe when I see the employees outfitted with back belts as part of their official garb. Not because I’m judging it as some sort of fashion faux pas, but because I know the employer’s purpose of wanting to keep their work comp claims to a minimum, by preventing lower back injuries with these belts, is unfounded. As a matter of fact, these well meaning employers might actually be doing their employees’ backs more harm than good.
I know it may seem hard to believe, but the back belts that are on the market these days do not have adequate objective studies to warrant their use as back injury prophylactics. Unlike drugs and medical devices, there exists no government requirement for those selling back belts to conduct any type of controlled clinical trials which would lend scientific validation to the various claims and assumptions that abound.
One article on the subject stated that the wearing of back belts in the occupational setting has increased to such an extent, that there are now over 70 types of industrials belts to choose from. Their aliases vary also, with common names such as lumbar support belts, abdominal belts, spinal orthotics, back braces, or just simply, back belts. The typical belt that most people are familiar with is black and is made of light weight, synthetic material that has several layers of elastic within its fabric and is usually fastened with Velcro. To help with placement, the belts will sometimes have suspenders or shoulder harnesses.
The basic premise behind back belts is that they provide additional abdominal support. I often joke with my patients, telling them that back belts are essentially “artificial abdominal muscles” (which doesn’t sound too bad to some). By tightening the belt around the waist, an increase in pressure is created within the abdomen which researchers theorize stabilizes the loaded spine. But this doesn’t necessarily mean that they will prevent back injuries.
A study appearing in the Journal of Occupational Medicine analyzed lower back injuries in workers who didn’t wear belts with those that did. The study found that workers who didn’t wear back belts came out with less intensive treatment and lower cost per injury than their belted cohorts. Perhaps one of the reasons this may be is that back belts offer an added “sense of protection” and cause workers to lift heavier items than they normally would. One researcher estimated that back belt users tend to lift up to 19% more weight with their belts on than with them off. I feel the American Red Cross makes a wise recommendation in their “Protect Your Back” class by stating that if you feel the weight of an item is such that you need a back belt to lift it — you should probably get help instead.
Another potentially dangerous aspect of heavy utilization of back belts is that the “support” that back belts provide is something that your abdominal and lower back muscles should do naturally for you. While the use of back belts may be useful in some situations, as I will outline below, increased reliance will literally cause the muscles that would normally be active to take a vacation. The problem is when you need them, they won’t be ready.
So do back belts have any redeeming qualities? The answer is yes. Actually back belts tend to shine when used in the treatment of back injuries rather than in the prevention. The belt itself is not really a “treatment” per se, but rather is a valuable component to the overall success of your doctor’s treatment plan. The back belt can help by reducing pain and offering needed support and protection to the injured area to further prevent reinjury during the treatment and recovery process. Your doctor’s decision to recommend the use of a back belt as part of your treatment plan is based on a number of factors such as the severity, duration, and type of injury or condition you’re suffering from. The type of work you perform, and whether or not the activities in it can realistically be modified, is another important factor. Furthermore, not everyone can safely wear back belts. Patients with cardiac disease are often advised not to wear back belts as the increased abdominal pressure created by the belts tends to boost one’s pulse rate and blood pressure. Patients with bruising, contusions, sunburns, rashes, scabs, or other skin lesions in the immediate belt area should also refrain from their use, as with patients with bowel problems or hernias.
When incorporating a back belt into the treatment plan of one of my patients, I prefer the belts with suspenders. The suspenders play a valuable role in that, once properly fitted, they allow the patient the ability to loosen the belt without losing its placement on the back. Because prolonged use of a belt can tend to decondition the very muscles that we are trying to rehabilitate, I will have my patients gradually wean themselves from the artificial support that a completely cinched belt provides, by loosening it during the non-physically demanding periods of their day. Besides offering valuable support to the lumber spine in the midst of healing a lower back injury, back belts also serve as a “mental cue” to the patients that “they have a back condition” and that proper lifting and posture cannot be forgotten — this is especially important as patients begin to see improvement and feel better, because while the pain may be almost gone, chances are, the muscles and ligaments still have a lot of healing to do. Last, but not least, a loosely worn back belt makes an excellent ice pack holder for patients that are constantly on the go.
The only time that I will recommend a back belt in any sort of preventative manner is to ward off the muscular fatigue that will likely occur if my patients have to involve themselves in a period of heavy or extended physical exertion, especially if they’ve had back problems in the past. But even then, the belt should be used conservatively and only over short periods of time.
So the bottom line in all of this is that back belts need to be utilized properly. The concept of back belts has been used for centuries in the treatment of back pain, but its use in the prevention of it has yet to see its day. “Based on insufficient objective scientific data,” the National Institute for Occupational Safety and Health as well as many other researchers, “recommends against the use of back belts in healthy individuals.” The decision to use back belts on the job should be a voluntary one: a decision made by the employee and not mandated by the employer. Of course, if the back belt manufacturers start producing snappy colors and patterns, I may change my stance.
Sources used for this article:
American Red Cross. Protect Your Back – participant manual. 1994.
Gater. Standing tall. Chiropractic Products. September 1999.
Grew and Deane. The physical effect of lumbar spinal supports. Prosthet. Orthot. Int. 6(2):79-87. 1982.
Hodgson. Occupational back belt use: a literature review. AAOHN Journal. 44(9):438-43. 1996.
Minor. Use of back belts in occupational settings. Physical Therapy. 76(4):403-8. 1996.
Mitchell, Lawler, et. al. Effectiveness and cost-effectiveness of employer-issued back belts in areas of high risk for back injury. Journal of Occupational Medicine. 36(1):90-4. 1994.
Perkins and Bloswick. The use of back belts to increase intraabdominal pressure as a means of preventing low back injuries: a survey of the literature. International Journal of Occupational and Environmental Health. 1(4):326-335. 1995.
Perry. Lumbar support belts. Journal of Occupational Medicine. 34(7):679-80. 1992.low back pain, occupational injury
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