Orthotic Treatment of Low Back Pain

Introduction

The use of spinal supports and how they function is a matter of debate within the clinical community. Most research is focused on patients with non-specific low back pain and non-traumatic in nature. While the mode of action is often debated between restriction of movement and increasing abdominal compartment pressure, thereby offloading the spine, what is obvious from the literature is that spinal bracing can sometimes reduce pain.

Assessment of the literature is difficult as there is a large volume of poorly conducted trials. They often suffer from the usual issues in orthotic research, lack of blinding, small sample size and difficulties using sham devices. Often they suffer from the biggest issue we see in Orthotic research being that the treatment or device being used is not always what would be done in clinics and everyone is issued the same device. As we know there is not one orthosis that is best for any condition and it will depend on the presentation of the person. 

Generally speaking, spinal supports are not recommended by Nice for the treatment of non-specific back pain. This is generally good advice and treatment should be focused on the most appropriate therapy in this patient group.

Where it becomes less clear is the use of spinal support in people with chronic back pain as a result of trauma, degeneration or other medical conditions. 

Generally, as clinicians we want to help people in a way that is helpful with minimal side effects. It is well documented the effects that living with chronic pain can have on the mental health and quality of life of the sufferer (Fine, 2011).

Medical Causes of Back Pain

• Slipped (prolapsed) disc
• Sciatica (irritation of the nerve that runs to the feet) 
• Ankylosing spondylitis (swelling of the joints in the spine)
• Spondylolisthesis (a vertebra in the spine that has slipped out of position)
• Spinal Fracture
• Clauda equine syndrome
• Cancer

Do spinal braces immobilise the spine?

No, elasticated braces do not immobilise the spine.

 In order to immobilise the spine a significantly large brace would be required something that is generally only used after a recent fracture. They can however limit movement or serve as a reminder to limit movement. Other than the most robust braces if you actively want to move you will be able to. 

Do Spinal Braces make the back weaker?

There has been a number of research papers and reviews looking into if spinal supports make the spine weaker. Most recent reviews have found no conclusive evidence to suggest that this occurs. While there is conflicting evidence with most stating no change, some studies did report an increase in EMG activity and strength when using a spinal support(Azadinia et al., 2017; Fayolle-Minon & Calmels, 2008).

What is apparent in the literature is that back supports can help reduce pain in some people (Million et al., 1981; Samani et al., 2019)and this is something most clinicians have seen in their practice.

Orthotic Options

 

Lumbar Supports

Elasticated Lumbosacral Belt

Made at our factory on Helen Street, Glasgow this is a classic lumbar Sacral (L/S) Belt. It features elasticated panels and three return pull straps.

Handzon Belt

Developed and produced in Glasgow this belt is designed for people with limited hand mobility featuring an easy close design.

Handzon Max

The Handxon Max is a stronger more supportive version of the Handzon belt. It features helpful features like finger loops on the strap to help.

Linea G

This supportive spinal support features elasticated cross over supports and innovative materials such as graphene to provide support.

Orthotic Treatment of abdominal Hernias

Abdominal hernias after surgery are commonly treated with back supports and we have a full guide on this. It is felt that due to the lack of abdominal muscles the loading in the spine is increased. It may also be in relation to poor posture and lack of mobility that often follows major abdominal surgery.

References

Azadinia, F., Ebrahimi, E., Kamyab, M., Parnianpour, M., Cholewicki, J., & Maroufi, N. (2017). Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature. Spine Journal, 17(4), 589–602. 

Fayolle-Minon, I., & Calmels, P. (2008). Effect of wearing a lumbar orthosis on trunk muscles: Study of the muscle strength after 21 days of use on healthy subjects. Joint Bone Spine, 75(1), 58–63.

Fine, P. G. (2011). Long-Term Consequences of Chronic Pain: Mounting Evidence for Pain as a Neurological Disease and Parallels with Other Chronic Disease States. Pain Medicine, 12(7), 996–1004. 

Million, R., Haavik Nilsen, K., Jayson, M. I. V., & Baker, R. D. (1981). Evaluation of low back pain and assessment of lumbar corsets with and without back supports. Annals of the Rheumatic Diseases, 40(5), 449–454.

Samani, M., Shirazi, Z. R., Hadadi, M., & Sobhani, S. (2019). A randomized controlled trial comparing the long-term use of soft lumbosacral orthoses at two different pressures in patients with chronic nonspecific low back pain. Clinical Biomechanics, 69(December 2018), 87–95.