Top Clinical Pearls for Lumbar Supports
Evidence-based chiropractors employ data to establish treatment algorithms. But what happens when that data changes? While we may have performed due diligence to develop a management protocol, new research will likely change that protocol over time. The best example would be how, in the past decade(s), the management of chronic tendinopathy has flipped from suppressing inflammation (tendonitis), toward generating a controlled inflammatory response (tendinopathy).
Providing “best practices” requires continual testing and evolution. But when was the last time you questioned the utility of everyday practice? For me, this occurred last week, when a long-time patient told me how much better she felt after her physiatrist prescribed a lumbar support belt. My long-held belief was that lumbosacral support belts had value in isolated instances… but I needed to know- was my belief still correct, or had new literature surpassed my understanding?
This week’s blog will highlight the most up-to-date evidence on four types of lumbosacral supports, then provide clinical pearls for indications, contraindications, and implementation -including a live video demonstration.
Earlier studies confirmed that lumbar belts might not help to prevent back problems. (28,29) But does current data show any utility for the management of back pain? Here’s a quick summary of the latest evidence on four lumbosacral supports.
1. Elastic Lumbar Support Belts
“Five of the six randomized controlled trials were of good quality, with all of them showing the use of lumbar support usually reducing discomfort and improving quality of life in individuals with low back pain. The prescription for wearing lumbar support for 6-8 hours per day for at least one month showed positive results.” (1)
2019 Journal of Health & Allied Sciences Systematic Review
Mechanical Actions
Elevate intraabdominal pressure (2,3)
Decrease lordosis (4)
Reduce trunk range of motion regionally and segmentally (4,5)
Decrease lumbosacral compressive force and spinal load (6-8)
Decrease intradiscal pressure (9)
Protect from soft tissue creep (10)
Clinical Effects
Reduce muscle fatigue (3)
Decrease pain intensity and functional impairment (2,5,11,12)
Decrease pharmaceutical consumption (11,12)
Over 80% of stenosis patients wearing a lumbar belt report >30% improvement in walking distance (13)
Improvement correlates with compliance (14)
No negative effect for long-term use (6 months) (15)
Typical Indications
Acute or sub-acute LBP
Segmental instability
Uncomplicated compression fracture
Stenosis
Clinical Considerations
Wear the support over thin, breathable clothes
May be more effective than rigid braces for chronic LBP (4)
Patients should avoid wearing elastic braces at night
Contraindications include significant hypertension, as the brace increases blood pressure (16)
2. Rigid Lumbosacral Orthosis (LSO)
Mechanical Actions
Added trunk stiffness over elastic braces (17)
Improved postural control (18)
According to BCBS of North Carolina, LSO brace medical necessity includes (19):
“To reduce pain by restricting mobility of the trunk”
“To facilitate healing following an injury to the spine or related soft tissues”
“To support weak spinal muscles and/or a deformed spine”
Clinical Effects
Reduce muscle fatigue (3)
Decrease pain intensity and functional impairment (2,5,11,12)
Typical Indications:
Instability
Spondylolysis
Degenerative spondylolisthesis
Post-surgical LBP
Clinical Considerations
Typically more expensive than elastic brace options
May be more uncomfortable, resulting in lower compliance
3. Pregnancy Support Belt
“The study concluded that wearing maternity support garments during pregnancy could have beneficial effects in women such as LBP and pelvic girdle pain alleviation, improvement of functionality and mobility, and reduction of risk of fall during pregnancy” (20)
2019 Journal of Pregnancy Systematic Review
Mechanical Actions
Supports the abdomen and lower back of pregnant women (20)
Clinical Effects
(Limited) evidence suggests symptomatic benefit (21-24)
Alleviation of LBP and pelvic girdle pain (20)
Improvement of functionality and mobility with reduction of fall risk (20)
Typical Indications
Pregnancy-related LBP
Clinical Considerations
Adverse effects reported include fetal heart rate changes, and skin irritation (21)
Providers should check with the patient’s Ob/GYN before dispensing
4. Sacroiliac Support Belt
“Pelvic belts improve health-related quality of life and are potentially attributed to decreased SIJ-related pain. Pelvic belts may therefore be considered as a cost-effective and low-risk treatment of SIJ pain.” (25)
Mechanical Actions
Decrease motion around the SI joint transverse axis (27)
Decrease ligamentous strain (27)
Decreased rectus femoris activity (25)
Clinical Effects
Decrease pain and improve function (25)
Improve gait cadence and velocity (25)
Improve postural steadiness during locomotion (25)
Typical Indications
Sacroiliac dysfunction, particularly hypermobility
Clinical Considerations
Clinicians may screen patients who are likely candidates to benefit from an SI belt by applying a compressive force through both iliac crests while the patient walks, i.e., simulate the belts compressive force.
Avoid prolonged hip compression in patients with co-existing gluteal tendinopathy or greater trochanteric pain syndrome.
In conclusion, current literature indicates that lumbosacral support belts are safe with few side effects. (26) These orthoses are not necessarily protective (28-30); however, they may help manage symptoms. And contrary to popular opinion, long-term use will not likely cause muscle weakness. (15)
Do you have your own tips for support belts? We would love to hear them. Leave your comments to help make this blog better!
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Paungmali A. Effectiveness of Lumbar Support in Management of Low Back Pain: A Systematic Review. Online Journal of Health and Allied Sciences. 2019 Jan 30;17(4). Link
Anders C, Hübner A. Influence of elastic lumbar support belts on trunk muscle function in patients with non-specific acute lumbar back pain. PLoS One. 2019;14(1):e0211042. Published 2019 Jan 24. doi:10.1371/journal.pone.0211042 Link
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