Very against these based on own personal, jaded opinion on Mckenzie principals, and the ignorant need to perform joint mobs on everyone based on my own personal bias. Anyway had a rep stop by to show me a study trying to change my opinion on lumbar elastic braces. Here is his supporting research: http://www.ncbi.nlm.nih.gov/pubmed/19179915
Effectiveness of a lumbar belt in subacute low back pain: an open, multicentric, and randomized clinical study.
Any smart research people out there can give their opinion?
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Sans the last line since I didn't read the full article; often medical studies for LBP the control group is medication and may education/rest. Probably not active conservative therapy. Based on the location, maybe the control group also includes MHP/CP in addition to rest/meds. Without knowing what the control group really had and whether or not the back brace group had anything else as well; that abstract means nothing.
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For those with risky work and already in pain it's a valuable device to transmit forces through a strengthened muscular cage and less thorough the vertebral column. Analogous to a hard hat or steel capped boots. Not a substitute for self management or focussed manual therapies ( mobs in particular ) to restore a non protected mobile state to the low back, but a worthwhile addition in some cases. Agree with Myo, the extract says too little.
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I have access to the full text and will read it. I am not a smart research person though, so be forewarned. As an aside, I think each brace should be labeled with "this is to remind you to not do anything stupid", and they would likely be proven to work.
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Shill, agree, they do serve to act as a reminder , like the bandage on a sore limb, to be careful. The comment I most often get though, is that their use increases confidence , such that antalgic postures and movements are reduced. I recommend their use as a preventative measure most often , rather than a way out of pain when established. Eg, before you, shovel the cement, lift the beams,encounter a potentially dangerous situation, check, hard hat, boots, goggles, brace.
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No Bonez I don't see that, if anything they are underused. Wearing a brace willl not prevent the recruitment of abdominal muscle, indeed if I see it correctly, theoretically, their use ought to aid in normal recruitment by reducing threat/pain inhibition. At least this appears to be so.
Good points. I think that the positive effect that many people have with the non-rigid braces is simply the compression, the sense that the spine and its environment is more safe, and thus triggers reduced levels and fewer neuromuscular defenses. No direct restrictive mechanical effects whatsoever - it is easy to move within the brace. I agree 100% with Geoff.
I feel that a back brace may aid as a reminder and engender confidence but have found overuse very common. There are certainly times when it's use may be of value, but I feel that direct progressive PRE for paraspinal strength and CSA change is the ultimate goal.
I agree with myostrain on this one. From the article, "For each group the other treatments were left to the discretion of the investigating practitioner." A lot of variables there to change outcomes.
I also agree that they aren't a bad idea for a laborer to use to get them back to work a week or two earlier.
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I didn't read the full text article so I can't look at all the methods. At the very minimum the study looked at what they were attempting to figure out; Belt vs no belt at 30D and 90D. Outcomes were better for Disability, Pain and Medication usage by a clinically significant amount at 30 and 90 days. The EIFEL is a french adaption of the Roland Morris Disability Questionaire which I can't find much research when I did a quick search. I am gathering that this research was done in France, so we can automatically determine that they are working less hours per week than in comparison to your home town....well that might not be as evidenced based.
I agree with Myostrain that a better research method would be to compare belt with exercise, exercise with no belt, belt only and no belt as the control. The method would also have to control for medication.
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