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External back braces fail to relieve pressure on vertebral joints

PainSci » bibliography » Rohlmann et al 1999
Tags: back pain, neat, taping, bad news, pain problems, spine, controversy, debunkery, devices, treatment

Three articles on PainSci cite Rohlmann 1999: 1. The Complete Guide to Low Back Pain2. Don’t Worry About Lifting Technique3. Spinal Fracture Bracing and Fixation

PainSci commentary on Rohlmann 1999: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

To determine how much a back brace really braces, German researchers used “telemeterized” implants — steel fixation rods with meters on them! so cyborgy! — to measure the effect of common braces on spinal forces. This is a good experiment. If you have implants stabilizing your spine internally, measuring the stresses on them directly is a pretty clever way of checking to see if an external brace is doing anything.

Three types of braces were examined: Boston overlap brace, reclination brace, and a lumbotrain harness. Unsurprisingly, they found that “none of the braces studied were able to markedly reduce the loads” on the implants. There was some reduction — just not “marked,” nothing to write home about.

More surprisingly, some of their measurements showed that bracing increased loading on the implants! That does seem possible. The spine is an extraordinarily dynamic structure. Somewhat like slouching into a comfortable chair, a brace may actually cause some sloppiness of spinal function, resulting in “resting” on the fixations, rather than using muscle to support and control the spine. That’s just a guess, but it seems like a reasonable one to me.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To determine the effect of a brace or harness on loads on internal spinal fixation devices.

DESIGN: The implant loads were measured in vivo using telemeterized internal spinal fixators.

BACKGROUND: Only limited information exists regarding the load reduction due to a brace or harness.

METHODS: A Boston overlap brace, a reclination brace, and a lumbotrain harness were examined to determine how they affect the loads on internal spinal fixation devices. The implant loads were measured using telemeterized fixators in six patients for several positions and activities, including sitting, standing, walking, bending forward, and lifting an extended leg in a supine position.

RESULTS: None of the braces studied were able to markedly reduce the loads on the fixators. Frequently even higher fixator loads were measured when wearing a brace or harness.

CONCLUSIONS: It does not seem helpful to brace patients after mono- or bisegmental stabilization of the lumbar spine.

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