Throughout the history of Chiropractic, the use of back braces for patient care have been both praised and denounced. However, a good back brace, if worn properly, can assist in healing, decrease the chance of further injury, help control pain, support weakened muscles, and promote good posture. Whether or not you use back braces in your clinic, or even believe in the use of bracing, here is some simple logic and a few facts that should encourage you to at least have a few back supports available – even if its only for that “special case” you get every now and then.
First, let’s address the question of Why shouldn’t you offer back braces to your patients, or perhaps a better question is under what conditions might a back brace cause more harm than good? In my research, I learned that there are actually very few spinal conditions that might worsen a patient’s condition if they were to wear a back brace PROPERLY.
For example, a patient with severe muscle inflammation may not benefit from wearing a back brace and, although it may not worsen the condition, it would likely not be of any benefit with regards to reducing their pain level. A patient with certain acute disc issues, such as a sequestered disc, or a women during pregnancy should avoid wearing a brace.
However, the single biggest reason why a Chiropractor would not recommend a back brace to a patient is the simple fear that they will wear it too long and atrophy the core muscles. Although this fear may be legitimate, by simply providing proper instruction and reminding the patient during their chiropractic visits this problem becomes inconsequential.
When might a back brace be of benefit to your patients, or under what diagnosis might a back brace be a good thing? Many. If you are seeing a patient that suffers from low back pain there is a good chance that a properly worn, good quality back brace can help during their treatment and even accelerate the healing process.
- Degenerative Disc Issue - When a spinal disc breaks down and/or herniates, a rigid or semi-rigid back brace can help stabilize and reduce micro-motions at the affected spinal segment. A back brace may also be used to limit bending and twisting and assist in carrying some of the weight the discs normally withstand.
- Spinal Stenosis - Bracing for lumbar spinal stenosis will reduce pressure on and limit micro-motions in the lower spine, both of which can cause nerve root irritation and radicular pain. In some cases, a brace can help adjust posture or shift weight to the abdomen - the goal of unloading pressure from the spine.
- Spondylolisthesis - Using a rigid back brace for spondylolisthesis has been shown to minimize the amount of vertebral slippage and significantly improve walking ability and pain levels. Also, a rigid brace limits excess motion at the affected segment, helping control pain and potentially lessening damage to the joints, nerves, and muscles.
- Osteoarthritis - Instability and painful micro-motions from spinal osteoarthritis may be reduced with the use of a rigid or semi-rigid back brace. Additionally, a brace can reduce pressure on the affected facet joints, alleviating pain and making everyday movements easier, such as moving from a seated to standing position, or vice versa.
- Weak muscles - The elderly or one with weakened muscles from an accident injury can benefit from bracing, especially during times of physically strenuous activity or even to support the core muscles during exercise.
- Lordosis - A brace can help adjust the normal lordotic curve of the lumbar spine and push the spine into a more natural position, quickly reducing pain and muscle fatigue.
What are some key attributes to look for in finding a good back brace for your patients? Here are the biggest complaints you’ll hear from anyone who wears or has worn a back brace - HOT, BULKY, HEAVY, and UNCOMFORTABLE. Compound this with a brace that is hard to put on, hard to loosen and tighten, wears out quickly and the result is a sweaty, frustrating, and miserable back brace wearing experience for your patient. If you are planning to sell or recommend back braces, its ideal to look for one that is lightweight and breathable, easy to put on, easy to loosen and tighten, does a good job of stabilizing – but does have a little give to offer some mobility, and finally, one that is made well and will last. Also, its not necessary to source several different types of braces for different conditions. There are great back brace options available today that are somewhat universal, are very durable and provide ample support from L1 to S1.
Why does it make sense for a Chiropractor to stock and sell back braces to their patients? Simple. If the patient is in your office and looking to you for treatment or advice on how to relieve their low back pain, WHEN should they start wearing their back brace if you are recommending it? Right away, of course. Secondly, whether you recommend that the patient buys a back brace or not, a majority (50%+) of your low back patients are going to go to their local pharmacy and buy one anyway. The travesty here is that they are going to buy a cheap, low quality brace that is going to be uncomfortable to wear, won’t provide the support they need and they will likely wear it for too long because they didn’t get any instructions from their caregiver (you) which could exacerbate their low back problem.
In summary, stocking a good quality back brace can have a ton of benefits for your patients – especially if you are able to show them how to use it properly. It can also put a few extra bucks in your pocket each month.
Dave Hodgson is President and CEO of BMS Great Lakes, LLC (BaxMAX Supports). With a Mechanical Engineering background, he has spent most of his career in the Health and Safety industries, with an emphasis on training and injury prevention.