Lumbar supports for prevention and treatment of low back pain

Apr 22 2008

Lumbar or lower back supports - those large belts that people wear around their waists when they lift or carry heavy objects - are not very useful for preventing low back pain, according to a new systematic review.

Although many people use lumbar supports to bolster the back muscles, they are no more effective than lifting education - or no treatment whatsoever - in preventing related pain or reducing disability in those who suffer from the condition, reviewers found.

"We recommend the general population and workers not wear lumbar supports to prevent low back pain or for the management of low back pain," said lead author Ingrid van Duijvenbode, a teacher and member of the research group at the Amsterdam School for Health Professionals in the Netherlands.

"Low back pain is very common and a major health problem in industrialized countries," she said. "Prevention and treatment are important both to [sufferers] and to society, which bears the expense of sick leave due to low back pain treatment."

She and her colleagues looked at 15 studies - seven prevention and eight treatment studies - that included more than 15,000 people. When measuring pain prevention or reduction in number of sick days used, the researchers found little or no difference between people who used supports and their peers who did not.

"There is moderate evidence that lumbar supports do not prevent low back pain or sick leave more effectively than no intervention or education on lifting techniques in preventing long-term low back pain," van Duijvenbode said. "There is conflicting evidence on the effectiveness of lumbar supports as treatment compared to no intervention or other interventions."

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

"This continues the line of research that shows lumbar supports make no difference in treating or preventing low back pain," said Joel Press, M.D., associate professor of physical medicine and rehabilitation at Northwestern University's Feinberg School of Medicine. "Looking at the literature on lumbar supports, it is difficult to make any conclusions because these studies are using supports for many different causes of low back pain. It would be hard to prove any one treatment is effective for every type of back pain, just as it would be difficult to prove that any one heart medication would be good for every type of heart problem."

Press said that lumbar supports are useful only as an additional treatment to exercise and other interventions. He said that the bracing makes it more comfortable for some people to move around.

"I usually tell my patients asking about lumbar supports that while there is not a lot of evidence that it is useful overall, there are still individuals who might benefit from their use," Press said. "But it should be used as an adjunct treatment if it helps to activate patients to increase their activity and exercise."

van Duijvenbode ICD, et al. “Lumbar supports for prevention and treatment of low back pain (Review).” Cochrane Database of Systematic Reviews 2008, Issue 2.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

By Kurt Ullman, Contributing Writer
Health Behavior News Service

http://www.hbns.org