How many of you have noticed the employees at the local hardware megastore walking around the store with a back brace as a part of their work uniform? How many of you have thought before, maybe I should wear a back brace to prevent myself from hurting my back when working in the yard? Questions such as these are common in work environment. The idea that a back that is supported with an external brace will be less likely to become injured than one without extra support. The principle makes sense, but what does the research say about this topic?

Low back injuries are the most common workplace injury. In 1998 there were nearly 300,000 lumbar injuries in the USA related to overexertion alone. [i] Research studies have postulated that the prevalence of low back pain is between 60-90% of the population.[ii] In 2008 it was reported that there were 3.4 million emergency room visits related to low back pain alone, a figure that accounts for over 9,400 ER visits each day in the USA solely related to low back pain.[iii] By 2008, the annual cost of healthcare related to low back injuries in the United States had escalated from 28 billion in 1996 to $86 billion in 2008.II,[iv] Needless to say, the emphasis to find ways to prevent low back injuries is warranted due to the escalating cost and frequency of injury. With that said, does the research support the utilization of back belts as a form of injury prevention?

There have been numerous studies done over the course of the last 15 years on the benefit, or lack thereof, of utilizing back belt as a form of injury prevention. Of these, I thought I would share the findings of a few. Wassell and Associates partnered with a large chain of merchandise stores. They broke the stores into 2 groups. Stores whose policy required all material handlers to wear back belts at all times and the contrary stores where utilization of back belts was voluntary. This was a large study, pulling data over 2 years. The experimental group that was wearing back supports at all times was made up of data from 89 retail stores, compared to the control group that was comprised of 71 stores. The results of the study illustrated that there was no correlation between wearing a back support and reduced risk for injury. There were roughly the same frequency and cost of injuries for both groups of participants in the study.i

Another study done in the Netherlands, compared airline baggage handlers complaint of pain, injury rates and days away from work between laborers wearing back supports and those that did not wear any support. This study found that the two groups had almost identical injury rates and further, had no difference in days away from work. II

A third study published in the Journal of Occupational Medicine corroborated the results of the aforementioned studies. They did not find any statistically significant reduction in injury rates for laborers at Tinker Air Force Base. This study did identify an interesting point that would be relevant for further investigation. The study by Mitchell and associates found that while there was no reduction of injuries in the group that was wearing back belts, what they did find statistically significant was that the cost of injuries for the group that wore the back supports was statistically more expensive on average than the control group that did not wear back supports. So not only did the back belts not help reduce injury, but they also increased the cost of injury for the laborers that wore the back supports.[v]

In an effort to illustrate both sides of the debate. The “Home Depot Study” published in the Journal of Occupational Environmental Health in 1996 did demonstrate some support for the utilization of back supports. This study was a statistical analysis over the course of 6 years. The study found that there was a 34% reduction in low back injury rates following the integration of back supports to the workforce. However, there were many other changes made at the same time. Some of these changes included the integration of lift/assist methods (fork lifts and pallets) and the study was not randomized, so the findings were not controlled. With that said, there was a reduction in back injuries following the integration of back belts. [vi]

While there is some conflicting studies, the majority of research that is randomized, controlled studies that aim to eliminate bias demonstrate that there is minimal injury prevention benefit by utilizing a lumbar support in the work environment. The best form of injury prevention for low back pain is proper engineering and continual feedback on proper ergonomics. Providing braces for the workforce just isn’t supported when you look to the research.

[i] Wassell, JT, Gardner, LI, “A Prospective Study of Back Belts for Prevention of Back Pain and Injury” Journal of American Medical Association. December 2000-Vol. 284, No. 21. Pages: 2727-2732.

[ii] Van Poppel, M.N.M., Koes, B.W., “Lumbar Supports and Education for the Prevention of Low Back Pain in Industry” Journal of American Medical Association” June 1998-Vol.279, No. 22. Pages: 1789-1794.

[iii] “Treatment of Low Back Pain – Exploring the Costs”. Results Physiotherapy.

[iv] Boyles, S. “$86 Billion Spent on Back, Neck Pain”.

[v] Mitchell, L.V., Lawler, F.H., “Effectiveness and Cost-Effectiveness of Employer-Issued Back Belts in Areas of High Risk for Back Injury”. Journal of Occupational Medicine. January 1994.

[vi] Kraus, J.F. et al. “Reduction of Acute Low Back Injuries by Use of Back Supports”International Journal of Occupational Environmental Health. 1996-Vol 2. Pages: 264-273.