There are a lot of factors to consider when deciding to brace or not to brace. And, if so, which brace, when to brace, and how long to brace for.
A commonly used brace is the lower back brace. These braces are modeled after a muscle in our lower abdomen called the transversus abdominus, or the TVA, which runs transversely across our lower abdomen. Just like the brace, it wraps around the torso and functions to provide stabilization to the lower back and pelvis. The TVA is neurologically shut down and weak in a large percentage of the population, and in the majority of lower back pain sufferers. The muscle must first be activated through therapy, such as electro-acupuncture, and the patient taught how to contract it – a process that can take weeks due to chronic mind-body detachment from this muscle. A lower back brace may be helpful to decrease pain. Ultimately, the goal is to learn to contract our own built-in back brace, the TVA, and continue to do so. An ongoing exercise regime worked into your lifestyle, such as Pilates, can help people keep the TVA activated and truly overcome the instability and resultant pain.
I commonly recommend a lower back brace in cases of pregnancy-related low back pain. The sudden increase in abdominal weight causes an increased load on the spine that is often not matched by the patient’s pre-pregnancy TVA strength. The growing baby means the process is relentlessly worsening and a back brace is very helpful to keep pain levels down. Of course, we are sure to work on TVA activation and strength throughout the pregnancy and post-partum period.
Braces are helpful and effective to decrease the load on injured joints and muscles when an aggravating activity can’t be avoided. An example is someone with an ankle sprain who must return to sport before full rehabilitation. Another example is ‘Tennis elbow’ in a patient who must use a keyboard all day at work. They are also helpful for patients with a structural abnormality that cannot be altered or can only be altered surgically, such as severe osteoarthritis of the knee. Again, even if a brace must be worn on an ongoing basis, effort should always be made to strengthen the supportive muscles to stabilize the joint simultaneously.
Overall, braces can be useful to the rehabilitative process for most injuries when used appropriately at the right time and duration. Proper assessment and treatment – including strengthening and stabilizing the muscle and joint – led by a Chiropractor or Physiotherapist is required to regain proper function and ultimately diminish or omit the need for bracing.
Choice Health Centre works in partnership with Jennifer Estabrooks of Estabrooks Orthopedic Bracing for all your custom orthopedic bracing needs, and with Biotech Orthotic Lab in Elmsdale for custom foot orthotics. Please be sure to talk to your Choice Health practitioner about your bracing or orthotics questions.
by Dr Erin Kempt-Sutherland, DC