Using a Back Brace for Lower Back Pain Relief

A lower back brace can be an effective element of a comprehensive treatment plan for certain spinal conditions, and can provide support for the spine as it heals following back surgery.

Also called a lumbosacral orthosis, or LSO, a back brace may be prescribed by a doctor or purchased over the counter. Nonprescription braces are available without a doctor’s recommendation, and it is important to wear these devices according to their provided instructions to prevent further injury to the lower back.

Goals and Mechanisms of Back Bracing for Pain Relief

A back-bracing prescription usually has a few complementary goals:

• Reduce muscle tension and low back pain
• Improve posture to redistribute weight in the spine
• Provide a healthy healing environment for spinal structures
• Increase function during daily activity

See Non-Surgical Treatments for Lower Back Pain

The above goals are achieved by the basic mechanisms of the back brace during use. Mechanisms of pain relief vary somewhat by brace design, but in general a brace is able to:

• Provide additional spinal support. A back brace can add stability when the low back is unstable due to injured or weakened spinal structures. By holding the torso in a safe, supportive posture, a back brace can help provide a healthy healing environment for the current injury and prevent additional injuries.
• Reduce pressure on the spinal structures. A back brace can help unload some of the weight normally placed on the lower back, in the process reducing pressure on the spine’s joints, discs, and muscles. By reducing spinal pressure, a back brace may lessen painful muscle tension that is a common protective reaction following an injury.¹Morrisette D, Cholewicki J, Logan S, Seif G, McGowan S. A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of lower back pain. Spine (Phila Pa 1976). 2014 October 1; 39(21):1733-42.
• Reduce range of motion during healing. A back brace prevents or restricts painful movements, such as twisting the spine or bending forward, backward, or to the side. Limiting painful movements and postures can also help improve awareness of the body’s positioning (proprioception), which allows the wearer to consciously adjust posture for improved back health.
• Reduce micro-motion between vertebral segments. Braces also limit excess micro-movements at a particular spinal segment or vertebral fracture, thereby limiting pain from muscle tension and irritated joints or nerve roots.

Adding a back brace to a treatment regimen has been shown in some studies to improve mobility and pain scores better than only physical therapy and pain medication.¹Morrisette D, Cholewicki J, Logan S, Seif G, McGowan S. A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of lower back pain. Spine (Phila Pa 1976). 2014 October 1; 39(21):1733-42. However, more research is needed to confirm this finding.

Back Bracing for Pain Relief Is Controversial

While it is generally agreed that back braces can help in providing pain relief, the medical literature suggests more rigorous research is needed to address questions about back bracing, such as:

• What are the medical indications for using a back brace?
• How and in what cases are back braces most effective?
• Do back braces cause any negative side effects?

Much of the available medical literature points to limited patient participation and low- to moderate-quality research methods and study design, which limits the information available on back bracing.²Duijvenbode IS, Jellema P, Van Poppel MN, Van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev:CD001823.^,3Healy A, Farmer S, Pandyan A, Chockalingam N. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PLoS ONE. 2018;13(3):e0192094.

Additionally, some doctors suggest back bracing may cause core muscles to atrophy due to dependence on the brace, potentially making the back more susceptible to injury. However, some studies have found no significant reduction in core muscle strength with the use of a back brace.⁴Cholewicki J, Mcgill KC, Shah KR, Lee AS. The effects of a three-week use of lumbosacral orthoses on trunk muscle activity and on the muscular response to trunk perturbations. BMC Musculoskelet Disord. 2010;11:154. The general consensus is that when a brace is worn according to a doctor’s instruction, atrophy is unlikely to become a problem.

It is important to recognize that a back brace is almost never a permanent part of a treatment plan. A lumbar brace is typically prescribed to be worn for a certain number of hours each day, and the regimen may range from a couple days to several weeks. The time frame for bracing is outlined and monitored by the physician to limit dependence on the brace, prevent muscle atrophy, and mitigate other negative effects of prolonged use while ensuring maximum effectiveness.