To Brace or Not to Brace?

Support or no support, brace or no brace? Should you wear orthotics? Should you wear a back brace? These are some of the questions that I hear in clinical practice on a regular basis. At first glance, the answer would seem to be that the more support you have, the better off you will be. I mean it makes sense right? If you take the stress off a joint it should remain healthy and pain-free. However, if you have read any of my past articles you will know that I am a huge fan of letting the body work first. The reason for this is that the body is not a static system. Your body is constantly changing, adapting to its environment. A back brace will change the environment that your body is adapting to, but is that adaptation a good one or a poor one?

The answer is, of course, not a straightforward one. But I’ll start with a simple reminder of one of our body’s number one features. That feature is known as adaptability. When we put our bodies through a stressful situation it adapts, becomes stronger. It’s why lifting weights gives us bigger muscles and why repetition creates better memories. Our body is adapting and learning so it will be less stressed when it undertakes the same activity in the future. So what happens when we use a brace such as a lumbar support belt? Well, the idea of the lumbar support belt is to both limit our back’s range of motion and increase the stability of our low backs. I have no complaint with this, it’s exactly how we avoid injury when lifting something heavy. The issue lies in when and how often we use the support belt. I want to use a bit of a silly example to illustrate my point. Imagine you were given a bionic suit. When you put this suit on, lifting 50 lbs would be as easy as lifting 5 lbs, you could run as easily as walk, and leap tall buildings in a single bound. Seems great right? all that lifting, running and jumping with no effort and no risk of injury. However, suddenly you are hit with a new problem. Instead of being active all day, your body has been doing the equivalent of sitting around on the couch all day. Because you never used your muscles, they never had to adapt and become stronger. Over several weeks you lose muscle mass and inevitably at some point, you have to get out of the suit. Your body hasn’t really used its own muscles much for the last while, and when you reach down to pick up a box like you would in your bionic suit, pop! There goes your back! You just lifted with some poor mechanics and no support, the result being that you injured your back. Now I realize that we are a ways off from full bionic suits, but the premise is the same for wearing a brace. If we wear a brace constantly, our bodies will learn to rely on that brace as a crutch. When we take the brace off, we just took that crutch away and we will fall flat on our faces if we try the same movement. 

This is all to say that we are left with 2 options. Either 1. We have to wear the brace all the time for everything we do because it is now an essential part of our mechanics or 2. We learn to use our own brace. It turns out that we are built with our own braces, muscles such as our abdominal wall muscles are designed to provide a brace. If we learn to use that brace appropriately we will have little need of an external one. This is one of the main reasons that core strength should be essential to any workout routine and for anyone who wants to maintain good spinal health. For a strong core, I recommend at least 1 minute every day of a plank exercise, though a 5-10 minute workout with the inclusion of side planks would be even more beneficial. 

Lastly, before you run off and burn all your back braces, I would like to make a very important side note. Braces do in fact have their place. If you have to lift something very heavy and you know your core is very weak, a brace will help prevent an injury. In fact, even if you have a very strong core, a brace can still help prevent injury should you be lifting a huge amount of weight. Even world-class powerlifters use a brace when lifting near their max weights. The main point I want you to take from this is that a brace should only be used near your maximal effort, otherwise you should be using your own core strength because your body will use every tool at its disposal and if that tool gets taken away, you might end up worse off than if you never had it.