Lumbar support cannot be recommended for the management of nonspecific low back pain in the general population, according to a study conducted by a French research team affiliated with CHU Gabriel-Montpied Hôpital, in Clermont-Ferrand, France (Ann Phys Rehabil Med 2016;59S:e29).Charlotte Lanhers and her colleagues conducted a review of 28 studies (limited to English and French languages) evaluating the place of lumbar support in the management of nonspecific low back pain. Studies were required to include rigid orthotics of the trunk to qualify for inclusion in the review.
The researchers found “no official recommendations for lumbar support prescription among the general population.” They found lumbar support to be “effective on function, pain and relative time intervals for dispensing medication with subacute low back pain.” It was also effective with “probability of low back pain recurrence and secondary prevention.”
However, the studies were “heterogeneous” in nature, and the benefits of this intervention were “not highlighted,” probably due to “lack of observance,” which the researchers described as a “limiting factor.” They referred to this as a “bias,” because of the lack of systematic research in the literature, noting that until their review, there was no preexisting meta-analysis.
They concluded: “To date, there is no proof to prescribe lumbar support in the management of low back pain in the general population,” adding that an “individual prescription would be discussed for subacute low back pain or in secondary prevention.”
Howard Liss, MD, assistant attending physician in the Rehabilitation Medicine Department at NewYork-Presbyterian Hospital, in New York City, agreed that there “appears to be a paucity of research on this topic in recent years,” adding that “many of our treatments that seem to be effective do not have strong support in the medical literature.”
He reported that he often encourages patients to wear a lumbar corset when they have persistent or recurrent lumbar pain in the setting of instability (i.e., excessive motion on lumbar flexion and extension x-rays). He also suggests a trial of a corset for patients returning to sports and those who must sit on poorly supported seating. However, his experience has been that only one-third of his patients conclude that the corset is helpful, and “a number of patients find the corset too uncomfortable to tolerate,” he stated.
“Corsets are not the most important treatment option for patients with low back pain,” he stated. “For example, centralization exercises and an education in body mechanics are most important for my lumbar patients.”
—Batya Swift Yasgur, MA, LSW