Back Pain: Home Managements #9 - Bracing or Corseting
In some patients, who are suffering from low back pain, the use of brace or corset is indicated. In definite indication must exist to justify bracing or corseting.
The main indications for the use of low back support may be listed as follows:-
- To reduce spasm- Injury to low back results in pain. Whenever there is pain, the muscles will go into tension which results in protective spasm. This is a muscular phenomenon. This protective spasm increases the intensity of pain. Use of brace or corset helps to decrease the tension of the muscle and also the muscular spasm. As a result there may be pain relief.
- One must be aware that muscular spasm is a temporary phenomenon and is usually self-limited and of brief duration. Hence the purchase and use of brace or corset for the purpose of relief of spasm is rarely indicated. But people who have frequent recurrent episodes of low back pain may use the braces or corsets, if its wearing helps in pain relief.
- Psychological- If the wearing of a brace or corset provides a feeling of security to the patient its wearing may be justified. But one must be careful that it does not lead to total dependence.
- To “uplift” the abdominal muscles- The abdominal muscles exert a “pulling” force on the spine as well as on the functional units of the spine, in particular. A well designed brace or corset “uplifts” and “supports” the abdomen and thus “unloads” the abdominal “pulling” effect on the spine and its functional units.
- A well designed back support is firm and will “uplift” the abdomen. To achieve this, the brace or the corset must have a firm contact at the thoracolumbar junction and over the sacrum. These two contacts provide an effect of “traction” at the lumbosacral area and thus decrease the lordosis of the lumbosacral area. The effect of decreasing the lordosis and how it relieves the low back pain is explained earlier.(Refer-“Low Back Pain-Home Management- Traction”)
- The brace or corset restricts the movement of the lumbosacral spine. At the same time it allows movements at the pelvis and the hip joints during activities of daily living (mainly during bending and lifting activities).
Principles for Bracing or Corseting
- The “uplifting” of the abdomen with a degree of “compression” of the abdominal cavity is needed. Hence the anterior portion of the corset may be designed in such a way to provide both the “uplifting” and “compression” of the abdomen.
- The contour of the hind portion of the corset is very important. The hind portion of the corset must conform to the lumbosacral spine. Metallic strips or stays are inserted to the hind portion of the corset for this purpose.
- It is argued that it is not advisable to keep the low back immobile by using metallic strips or stays because the low back needs flexibility to carry out the activities of daily living. But I prefer the braces or corsets to have metallic strips or stays behind, especially during the acute stage when the pain is severe. In cases of spondylolisthesis, brace or corset with metallic stays is essential.
- A brace or a corset is never be used as a final solution. The main functions of the soft tissues, the muscles, the ligaments and the joint capsules are to keep and maintain the erect position, the mobility and the alignment of the spine as a whole and the functional unit of the spine in particular. Total dependency on a brace or corset allows the soft tissues, the muscles, the ligaments and the joint capsules to relinquish their function as their functions are carried out by the brace or corset. Eventually these structures lose their contractibility, elasticity and strength. Hence, a brace or a corset may become essential to hold the spine in position. Otherwise the spine will literally fail. Hence it is always advisable to use the brace or corset as a temporary measure. Care should be taken to advise the patient the advantages and the disadvantages regarding the use of the brace or corset, prior to its prescription. An exercise programme must be simultaneously implemented so that the adverse effects due to the use of back support may be minimised.
A brace or a corset must be correctly and exactly fitted to a particular individual a readymade brace or corset may not have the correct size or shape for that particular individual. It is also to be noted that a brace or corset that suits a particular individual in a particular position may not suit for the same person in another position. This is because the spine has different conformity and alignment in different positions. For example- the lordosis at the low back while standing may change to kyphosis when he sits.