To brace or not to brace? When you are experiencing low back pain, an easy solution is to pick up a back brace to support your spine. The theory makes sense as a back brace helps your spine from moving too much. When you are in pain, such as a lower back pain due to a muscle spasm or arthritis in back, your back feels weak and needs the extra support. It makes logical sense that when your lower back hurts to move, a brace can reduce your back pain by limiting this movement.
There is this counter-argument that when your body relies on a back brace, your muscles get weaker from disuse. If you are suffering from back pain, the fear of your back muscles getting weaker is not a friendly thought. If you ask any Physical Therapist or Chiropractor, you will hear a strong “NO!” It will sound like there is no wiggle room. Black and white answer.
Why are weight-lifters wearing those belts to lift then? Does that make them weak to lift heavy? Huh? There are times we go to Walmart or Home Depot, to see the warehouse employees wear back braces as a uniform. Are they more at risk of hurting themselves or weakened their posture?
In an analysis of many research related to this topic called a Cochrane Database Systematic Review, Negrini S in 2015 showed that there are not many conclusive articles that support a strong yes or no position to wearing a brace or not. As a Holistic Spine and Sports Medicine Physical Therapist Clinic in Long Beach, California, we have heard this question many times “What are your thoughts of wearing a back brace for my back pain (or posture)?”
Our answer is “Yes and no. It depends.” This is different from the strong “NO!” from my Physical Therapy
and Chiropractor colleagues.
Allow us to break it down for you.
#1. Back brace will support my posture
In the research article by Xu, S, they assessed the effectiveness of bracing within the adolescent scoliosis population. Scoliosis is the dysfunctional side curving of the spine. The conclusion is that it did reduce the progression and severity of the adolescent spine from bending more. The downfall is that the brace induced joint stiffness, and thus, the ability to correct scoliosis naturally. There are numerous studies that demonstrated the negative effects of casting or immobilization on muscle fibers and joint nutrition within 48 hours.
The follow-up discussion should be the question of “What are you defining as posture?” Webster dictionary defines posture as “the position or bearing of the body whether characteristic or assumed for a special purpose”. What is your purpose? Are you trying to start a habit, reminding yourself to not slouch, stopping the pain, or need to look upright for a wedding shoot?
You achieve your purpose if you are wearing a back corset brace to help support you to stand tall and not slouch. If you are using it to build a habit and intend on stopping it, then you should wear a brace. The key word to emphasize in this paragraph is “support” and not rely on the brace. A good test is if we see you wearing a back brace walking around the neighborhood of Long Beach, and we ask why are you wearing it, there needs to be a specific answer.
If there is some thought into the rationale and a parameter of when to take it off and on, you will reap the true benefits of wearing a back brace for your posture.
#2. Back brace will make my back weaker.
As stated above, wearing a back brace does make your back weaker after 48 hours of wearing it non-stop. For this same reason, there has been more awareness by the big corporations to stop employees from wearing their back brace constantly while on the work clock. The new direction is to velcro or tighten up the belt brace for specific moments of lifting something heavy.
Stiffness in the spine is a non-negotiable factor to move safely through your spine. You can manipulate the amount of stiffness in your spine with appropriate safe spinal exercises as talked about in Dr Stuart McGill’s research article. If we cognitively brace our abdominal and back stabilizer muscles, there is a pressurized phenomenon stiffness that will activate your core muscle group. Weightlifter wise chose is to build heavy strength, so boosting spine stiffness with a back brace as they build muscular stiffness is a 1-2 combo. Here are the three big exercises that Dr Stuart McGill preaches everyone needs to do to have a stronger back.
Abdominal (back supported) Head Lift (Front Core): Try 3 reps
Support your lower back spine with one hand. Bend the opposite knee as shown in the picture. Look at your navel and slowly raise your head up.
You should only feel this in your abdominal ONLY and nowhere else.
Side Plank: (Side Core): Try 3 reps
Lay on your side and prop your hips upwards. Hold for a goal of 30 seconds.
You should only feel this in your side flank region ONLY.
Bird-dog: (Back Core): Try 5 reps
Get on all 4’s and raise opposite arm and legs upwards. Hold for 10 seconds and alternate.
Research has shown that people with non-specific or chronic low back pain have less muscle strength, endurance capacity and slower reaction time when compared to their healthy cohort. While you are working on building muscular endurance, strength, and reaction control of your back muscles to develop protective stiffness for all activities, we recommend using a back brace when you have lower back pain at strategic times. If you are in a situation where you cannot pace your body, like going to Disneyland or the local mall, we suggest wearing a back brace during the latter half of the trip. You will allow your back muscles to support your spine during the first half of the activity. When your body is fatigued and likely to cause pain, you proactively boost your spine with the support from the back brace.
Our conclusion whether you should wear a back brace for posture correction or back pain relief is based on your purpose or goal. This requires you to be accurate in understanding where your back muscles and spine health is in terms of endurance capacity, motor reaction, and strength. Again, if a Spine and Sports Medicine Physical Therapist in Long Beach was walking around and asked how did you know if your back has poor endurance, a correct answer might be “I have a hard time hold the side plank for 30 seconds”.
If you have no idea on how to measure this and you live in Long Beach or the surrounding cities, reach out to us for a Spine consultation and we can guide you into when and how to properly improve your spinal posture and accurate use of a back brace.
If you are experiencing back pain and desire to stay active and mobile, we have a specific group class that teaches and shows people how to exercise safely. We incorporated everything we teach within our highly praised talk called “How to exercise safely while in pain” into a class called “Restore Alignment, Move More”. This class will change your life and improve your confidence to move if you have low back pain only, have been experiencing on and off pain, and do not want to slow down. We take the guessing that personal trainers and fitness studios may do when they hear you want to stay active but are in pain.
Click HERE to learn more.
Danh Ngo PT, DPT, OCS, SCS
Board Certified Orthopedic and Sports Medicine Specialist
ReVITALize Rehab Club
Bixby Knolls, Long Beach Physical Therapy
We focus on lasting pain relief and mobile so you can stay active without guessing and hoping!