Hello Practice Members! I had been treating a patient that developed low back pain after he bent over to pick something up off the ground. He immediately felt a sharp pain. Now, this patient has a history of recurrences of low back pain over many years.[…]
Needless to say, during his course of treatment came a great question, that went something like this:
“Should I continue to wear a back brace when I play tennis?”
My initial reaction was, what your still playing tennis?( lol) I kept visualizing the lumbar spine and all its components like the disc, ligaments and muscles being twisted, and compressed, with each stroke of the racket.
But then I thought, well this patient is feeling 90% improved, to the extent that he feels like he can engage in the activities that bring him a sense of accomplishment and joy. And this is what life is all about!!!
So now you may ask what was my response to him?
Well, I recommended he NOT wear the brace, as I was concerned it may result in dependence on the brace itself and not rely on his own “core” muscle to do what they are designed to do.
After my patient left, I felt my answer was accurate but I wanted to investigate further to see if I was providing the best information available, I mean teachings change so fast in healthcare.
Here is what I came up with.
First, there are different types of belts, such as SI belts(neoprene belts that go from waist and cover the hips), lumbar supports belts (go over the waist and low back NOT the pelvis), lifting belts (leather and thicker and go surround the lumbar spine)
What most people are wearing to play tennis, golf, perform yard work or the belts worn in like home depot are utility/ abdominal lumbar belts. They are flexible (neoprene) and encase the low back.
The theory is that back belts perform the following tasks:
–reduce internal forces on the spine during forceful exertion
–increase intrabdominal pressure
–stiffen the spine
–reduce bending motion
–remind the person wearing the belt to lift properly
Research done by the National Institute of Occupational Safety and Health or NIOSH found NONE of the claims were substantiated by the evidence in peer reviewed journals. The only theory that may be accurate is limiting motion mostly in side bending and rotation but not in the front to back plane.
It appears wearing a back brace does not reduce the rate of injury to the low back.
After reading through this material I thought about my patient and his ability to return back to activity like tennis and yard work.
I then asked this question of myself : Should a person returning to activity after an injury wear a belt?
It appears that wearing a back brace does not necessarily have consequences as long as you don’t try to lift more than you would without wearing a back belt.
Now hear me correctly!!!
Do NOT wear a back belt all day long
Do NOT, NOT work on spinal stability or core training just because you are using a back belt for working in the yard
Do NOT think wearing a back belt is a replacement for learning to move correctly (hip hinge-dead-lift technique or half kneeling lunge to pick up objects)
When my patient returned on his next visit, I let him know I changed my mind regarding wearing a back support during tennis.
I explained that since he was still recovering from his injury, meaning the tissues (muscles, joints and disc) were still undergoing repair/remodeling, (which takes months) it was satisfactory to wear his back brace for brief periods.
These were my rules:
- IF you have pain during your tennis warm up without the brace, don’t even consider playing with the brace. (Your body is just not ready)
- Make sure you continue your spinal rehabilitation we instructed you on for months to come.
- If you notice any swelling in the legs remove the brace
- Use the brace to build confidence in your activity, but understand the research says it doesn’t prevent injury
For all my practice members, I would not recommend wearing a back brace during activity for the prevention of injuries.
Though, I can see where there may be of value when recovering from an injury.
For example, if I can get a person with back pain upright and walking, with a brace, that otherwise could not walk, this has been show to serve the patient well. We know walking 20-30 minutes 5 days a week can help spinal pain.
The same goes for if I can begin a patient on some spinal exercise.
Especially, if I know the exercises themselves are not compromising the spine (because there is not a great deal of motion of the spine during our spinal routines). This at the very least allows the patient to become more comfortable (less pain) and allows me to get the patient involved in their care.
Finally, it allows us to re-introduce activity and sport. One of the greatest fears for patients is having a re-occurrence. Wearing a belt may help build confidence as they ‘dip their toe back in the water.”
With that being said go out, do what you love and love what you do!
We are here for you to help you live the life you always dreamed!!