Back Braces

Back braces, as many other braces, have been used for more than a hundred years. We see braces used in all types of environments yet we still argue about their effectiveness. Many of us that lift weights would not dream of performing a squat exercise without a weight belt. Why? It is very well known that the weight belt adds extrensic support the core and thereby protects the spine and surrounding muscles! So, in knowing this, why do we ever question a braces ability to protect a spine that is already known to be weak or injured? Would not a spinal brace offer the same support to them? Would not a brace offer protection against one's own movements that may be performed improperly? So, why are spinal braces not the first choice in spine management?  Let's discuss a few view points surrounding this treatment.

Weightlifting belts or braces have been used for so many years by workers, weightlifters, and super athletes that you would have a very difficult time convincing anyone that all of those people are wrong. The funny thing is that there is no science that convinced these people that the brace would help, they simply realized as they increased in the weight that they were lifting that they could move more weight with a belt than without! They also began speaking to other lifters that may have been injured and asked if they were wearing a weight belt when they were injured. After gathering the ratio (not realizing that was what they were doing) of people injured with or without a belt, the trend was set that belts help protect you. So if common sense can lead a group of non-medically trained people to realize the benefits of braces or back supports, why wouldn't the medical community come to the same conclusion? Well, maybe they did. Let's look at their side of the table.

There needs to be a debate throughout the medical community over a statement that has severely damaged the image of back braces. Many healthcare professionals have believed a statement that back braces cause weakness. The problem is that there is not a study that shows this! Secondly, when you ask them how they know braces cause weakness, it turns out it is a "they say" argument. It is very frustrating that "they" never have to answer for the rumors that "they" start! Anyway let's consider their point of back braces causing weakness.

If you care enough to follow this analogy you will be left with a difficult argument to dispute. Here is my question for the healthcare professionals that are involved in spinal management. If you have a child diagnosed with Idiopathic Scoliosis at age 4. Their curve is above 25 degrees and they are fit with a Scoliosis brace that covers from their rear end to their upper spine, they wear this brace for 23 hours per day. (this is the common treatment for this condition for those that don't know). This child would wear a brace like this until they reach skeletal majority which is around 16 years old for most people. Though many patients will only wear this brace 12-18 hours per day, the point still stands. Many of these children that suffer from Scoliosis will play sports throughout their teen years. So, here is my question, if spinal braces cause weakness of the muscles, how are the children able to even independently stand up much less play sports such as football or cheerleading without their brace? Yet everyday children all over America are playing such sports and living normal lives even after wearing their braces for more than 8-10 years? Did I mention that the braces have a proven track record for stalling or even decreasing the curve of the spine for these children, thereby preventing a VERY extensive surgery! I have heard from many of such patients that would be outraged to think of braces not being used for treatment of the spine.

Many people will reason that the child is still growing so the muscles will continue to strengthen even in the brace due to this growth. Does this not bare asking, if the muscles can still grow within the brace, isn't it reasonable to believe the muscles are still stretching and firing (having concentric muscle function) thereby creating growth? I mean when I place someone in a cast, the leg becomes increasingly smaller the longer the cast is worn. So lack of stretch leads to lack of growth. This is reasonable. It is this logic that has been transferred to the treatment of the spine.  The problem is that you cannot correlate a leg to the spine. See the leg shrinks or atrophies because the cast encompasses the foot ankle complex, this is where the muscles that control the lower portion of the leg are attached, therefore crossing that joint essentially and functionally kills the muscle making it inactive!

When viewing the spine, you would have to stop ALL forward (flexion) or backward (extension) motion in order to stop the muscles from firing and stretching even within the brace. So unless the spinal brace covers from the mid thigh to the neck there will be stretching and firing within the brace, thereby preventing or limiting weakness and atrophy.

Now, let's take this discussions toward the general population. It is known to everyone that the baby boomer generation is turning 65 this year. They are the largest population in history so this is having a very big effect on our society. The other element about this generation is that they are what seems to Bethesda last of the "grit your teeth and take it" generation. They will push through pain, they are the generation that got America moving through hard work and determination. Well, people do not change, this generation is still tough! I point this out to discuss the next group of medical needs.

I cannot tell you how many seniors that I have seen that have in the last 10 years been told that they have scoliosis. At this point in their stage their is not a great deal that can be done. What happened was their muscles were strong when they were young and they were able to "push through" with life. No one even tested for scoliosis in their time so life went on. As they have aged and their muscles have weakened their scoliosis has become more pronounced, sometimes to a point of restricting breathing!  Sadly, attention has not been called to this scenario enough and Medicare has cut funding for the very braces that we use to treat these patients. Many in this generation have had compression fractures of the spine that have gone untreated over the years. This has led to their posture becoming a forward lean at the upper spine (kyphosis). Had their fractures been treated with bracing at the onset many times we can prevent deformed posture by wearing it for 6-8 weeks.

The body will constantly seek the path of least resistance. If it is faced with pain or weakness it will compensate to achieve the goal, be it walking with a limp, standing with all the weight on one leg when their knee hurts. Another compensation of the spine is to stand and sit in flexion (forward lean). This allows the patient to unload the spine and to "hang" on the muscles for posture. This does not last long before this becomes their fixed posture! Osteoporosis leads to the same outcome. The good news is that if we catch it early, with the use of braces we have seen great results. It truly is a simple solution. When the body can no longer support itself with it's own strength, this brace makes up for the bodies weakness thereby preventing compensations! That easy.

What is sad is that it is so simple yet so complex that Medicare cannot see the importance of bracing even when many of our patients call or write to tell them of their success! The other element that has eroded the help for so many is by choosing a practitioner that offers one type of brace. Be it a physician or an urgent care facility, one brace does NOT fit ALL. Just as different illnesses require different medicines, the same is true for bracing. You must choose a practitioner that understands your problem! This is last element of bracing getting a bad reputation. When a patient is fit with the wrong brace for their condition, it does not work. Instead of the patient or practitioner admitting that the wrong appliance was chosen, they simply say, "braces do not work." This is a shame. If you were given aspirin in place of pepto bismol would you say that aspirin does not work? Of course not! So choose a practitioner that knows what he is doing, one that is certified and licensed in bracing, make it an easy choice, choose Precision Medical Solutions for all of your bracing needs!