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A major health problem which also accounts for most of the sick leaves, absenteeism and decreased productivity at most work places is low back pain or lower back pain (LBP). This is a musculoskeletal disorder which results from numerous causes including poor posture, physical inactivity, degenerative diseases, a traumatic event e.t.c. The agony of recurrent and chronic pain associated with this condition often necessitates constant research into the effectiveness of various treatment and management options. Clinicians are often required to offer medical advice regarding the use of lumbar corset in treatment of LBP within the confines of a clinic or hospital setting and beyond.
The use of lumbar corset/support in minimizing and treating chronic LBP has long been in existence. It is more commonly used in post-surgical procedures warranted by traumatic accidents or fractures along the spine to restrict the movement and ensure that the healing process is not disrupted by excessive movement of the spine. However, its use in the prevention and treatment of LBP gradually gained prominence in most parts of the world.
Prevention of LBP could be classified into primary and secondary prevention, where primary refers to the prevention of the onset of LBP with the frequent use of lumbar corset and secondary refers to the prevention of recurrence of the symptoms in individuals already suffering from LBP. This secondary prevention may be referred to as a treatment in itself in certain communities. Some Physical therapists prescribe the use of lumbar corsets for the treatment of LBP whereas others refrain from doing so, in the belief that lumbar corsets render the back extensors and core stability muscles inactive, thereby weakening them further and resulting in muscle wasting. As the case with practically all interventions approved for use in physical therapy, questions as to whether lumbar corsets are effective in both the prevention and treatment of LBP precipitated the execution of numerous researches and effectiveness studies.
It is general knowledge that evidence based practice utilizes the best available research findings to inform clinical practice, taking into consideration patients preferences. As such the highest level of evidence currently approved in the research community is systematic review and meta-analysis. A number of reviews have explored the usefulness of lumbar corset/support in the prevention and treatment of LBP, one of which dates back to 2001. Unfortunately, the findings presented by the authors1 were inconclusive and therefore, suggested that further research be conducted to ascertain the effectiveness of lumbar corsets in the prevention and management of LBP. A more recent Cochrane review2 which is recognized as the gold standard of systematic reviews buttressed the finding that the effectiveness of lumbar corsets in the prevention and treatment of LBP was uncertain as the evidence was conflicting. Lastly, guidelines in the management of LBP in the United Kingdom clearly disallowed the prescription of lumbar corsets due to lack of substantial evidence in its effectiveness.3
I would like to know if you have ever prescribe lumbar corset/support for the primary prevention, secondary prevention or treatment of Low Back Pain in your clinical practice? Share your rationale in the comments below.
Opinions expressed by physiogramworld contributors are their own.
- Jellema P, van Tulder M, van Poppel M, Nachemson A, Bouter L. Lumbar Supports for Prevention and Treatment of Low Back Pain. Spine. 2001;26(4):377-386.
- Van Duijvenbode I. Lumbar supports for prevention and treatment of low back pain. Journal of Evidence-Based Medicine. 2009;2(1):63-64.
- Low back pain in adults: early management | Guidance and guidelines | NICE [Internet]. Nice.org.uk. 2009 [cited 17 June 2016]. Available from: https://www.nice.org.uk/guidance/cg88?unlid=2829652762016215203717