In recent years, back braces have been controversial among physicians and therapists, but for the most part, they continue to be a commonly used device after a back injury or surgery.
As an OT, back braces are used in my everyday practice, and it seems that every physician has a different opinion about how they should be used, but it’s clear that these braces can have a significant impact on how patients progress in terms of functional outcomes.
In this article, I’ll discuss the benefits and disadvantages of using a back brace after a back injury or surgery.
The purpose of a back brace
After an injury or surgery, a back brace is used to maintain proper posture and avoid torsional movement that includes bending or twisting. In other words, it’s like a constant reminder to keep your back straight. It doesn’t completely correct posture, but it prevents extreme bending and it reminds you to maintain spinal precautions so you don’t bend or twist.
Is a back brace effective?
Growing research is finding that back braces are not effective after a lumbar fusion or compression fracture, and less doctors are ordering back braces for their patients.
One article reviewed 7 studies and reported “there is no evidence for the effectiveness of bracing in patients with traumatic thoracolumbar fractures.”
|Effectiveness of bracing for thoracolumbar fractures||National library of medicine||No||2009|
|Efficacy of bracing: Systematic review||Pubmed||No||2018|
|Short-Term Impact of Bracing in Lumbar Spinal Fusion||Pubmed||No||2021|
|Bracing for thoracolumbar burst fractures without neurologic deficit||Pubmed||No||2014|
Why do doctors order back braces?
Back braces or ordered by a doctor as a precaution to ensure patients avoid bending or twisting after a major injury or surgery. Recently, there is new evidence that back braces may not have a significant impact after a lumbar surgery or compression fracture, but many doctors are unaware of this growing evidence, and continue to order back braces for their patients when doing so may cause more harm than good.
Why doctors differ on how a back brace should used
Some doctors require their patients to wear a brace anytime they get out of bed while other doctors may require wearing the brace on bed.
Many of the doctors I work with ask that the patient wears the brace if the bed is greater than 40 degrees or anytime the patient is out of bed.
What are the types of back braces?
There are all types of back braces, but the main types are the soft and rigid TSLO. A soft brace is minimal in design. It straps around the lumbar region and may be fitted with a sternal column with straps under the arms to prevent lordosis.
Some soft TSLO braces also have straps like a backpack that go over the patients shoulders. This is a different design to help maintain good posture.
The soft TSLO is also the ideal brace for comfort and mobility. It’s not too difficult to don and doff, and can usually be done by the patient.
The clam shell brace is very different in design to the soft TSLO. It’s hard and looks like a turtle shell encapsulating the back and thorax.
It can be designed and adjusted by an orthotist but it’s very rigid and difficult to don and doff. The clamshell brace is usually donned while laying supine in bed. This process may also cause significant pain and discomfort and make dressing and bathing extremely difficult.
They can also cause skin breakdown and pressure injuries if worn too long.
Back braces can result in worse rehab outcomes
While back braces can help maintain a correct posture after trauma, they limit functional activities, independence, and may result in a longer rehab stay.
While this is probably not as big of an issue with the soft TSLO, it is a huge issue with the clamshell TSLO. The soft brace may cause patients to be extra cautious with ADLs and mobility, but a clamshell brace may limit patients from partcipating in any mobility or functional activities.
If the patient lives alone, there is little chance they can even put a clamshell brace on and get dressed unless their doctor allows it. In many instances, a patient may benefit from a brace for safety reasons, but clinicians should always realize that immobilization leads to worse rehab potential.
Is a back brace really neccessary?
Most of the recent literature is not supportive of back braces, but there is still not enough research to completely take them out of the picture.
Wearing a brace is still a gray area. Most doctors will recommended a back brace with a spinal injury or surgery while a select few will avoid them. In the end, it’s ultimately up to your doctor and you.
If I had a lumbar surgery and compression fracture, I personally would not wear a brace, but I would striclty adhere to spinal precautions which include no bending, lifting, or twisting. If I had a burst fracture or spinal cord injury and my doctor recommended a brace, I may wear a brace for a period of time, but I would ask for a second opinion from a doctor who typically doesn’t recommend wearing a brace.
Back braces have been around for ages and they continue to be misused and can have a significant impact on persons daily routine by limiting independence.
The research for their clinical use is growing and is mostly against wearing a brace but there is still limited evidence to suggest that it’s always wrong to wear a brace.
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David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.