Long Term Lumbosacral Bracing and Its Adverse Effects on Low Back

Abstract

Chronic low back pain CLBP is defined ldquoas the pain or stiffness localized below the costal margins and above the inferior gluteal folds which may be accompanied with sciatica and persist for ge 12 weeks.rdquo Most of these patients present with non-specific and gradually progressive back pain. Low back pain is found to be the most debilitating condition leading to low level of quality of life QOL and disability among women with this complaint. Usually it has been observed that in chronic cases of low back pain patients get used to wearing lumbar corset or brace or belt on long term basis which can have a lot of adverse effects on their back. This causes the soft tissues of the region to shorten adapt and restrict the motion further in the spinal segments. A 63-year-old female presented with disabling low back pain that inhibited her from bending forwards and backwards. Visual Analog Scale Oswestry Low Back Pain Disability Questionnaire and Fear Avoidance Beliefs questionnaire FABQ were taken as baseline information for outcome measures. Range of trunk forward flexion was measured using Schoberrsquos test and the difference was less than 1cm. She was treated in our physiotherapy department with Ultrasound UST and Interferential Current Therapy IFT over lower back region. The patient and her relatives were taught how to wean-off lumbosacral belt gradually by keeping it on for few hours a day initially. Forward-bending exercises in sitting position to stretch the back muscles and other home exercises like mobility exercises along with back muscle isometrics using the wall were taught. After seven days of treatment there was a significant improvement in VAS Oswestry Low Back Pain Disability Questionnaire and FABQ scores. From this it can be noted that back mobility exercises are the key to improve chronic back pain. Studies have highlighted the importance of strengthening especially of the lumbar spine extensors in CLBP patients and had also emphasized on abdominal strengthening to facilitate trunk stabilization. The patientsrsquo mobility in the lumbar region improved and her dependency on the belt reduced gradually. Based on this study we infer that prolonged use of lumbar corsets lumbosacral belts lead to lumbar immobility which further can lead to weakness of back and core muscles. Educating the patient regarding the same and emphasizing more on lumbar mobility exercises on a regular basis can reduce pain improve the range of motion along with decrease in fear avoidance behavior.