Affiliations: [a] Orthopaedic Surgery, Victoria, British Columbia | [b] Associated Chiropractic Clinics, Saskatoon, Saskatchewan | [c] Canadian Memorial Chiropractic College, Toronto, Ontario
Note: [1] The writers acknowledge help from Ms. Elizabeth Malboeuf; Mr. Errol Thornton, and Mr. Randy Giles with the design and making of the prototypes of the Energex.
Abstract: The principles behind the use of lumbar supports have changed drastically in recent years. Once used for immobilization, lumbar supports and body suits are now being used to encourage mobility and return to function in low back pain patients. Modern concepts regarding the stored/strain energy of elastic garments are introduced, followed by a discussion of how body suits and elastic supports utilize these properties to assist the low back pain patient. A number of different types of elastic garments are illustrated. The use of rigid corsets for low back pain began around the turn of the century with the use of plaster jackets. More recently, heavy nylon, steel stays, and complex plastics have been used for the same purpose. The rationale for this type of immobilization includes assistance for weakened muscles, protection from injury, correction of deformity, control of pain, restriction of spinal movements, and increased temperature.1–4 Some of these proposed physiologic mechanisms have been investigated, including intraabdominal and intradiscal pressure changes, paraspinal electro myographic (EMG) activity, and intersegmental as well as gross spinal motions.4–9 The results ofthese studies have been equivocal, as have the findings of clinical trials investigating the efficacy of rigid orthoses.10–15 Further, certain disadvantages to the use of rigid orthoses have been described, including possible muscle atrophy and dependency. Also, because of the discomfort of the devices and the resultant interference with activities of daily living, patient compliance can be poor.16 Corsets and other similar rigid supports are not commonly used now, except for a few special cases. Elastic body suits or supports are replacing the rigid-backed brace, and the emphasis is shifting from immobilization to assisted mobility and increased function. These new garments are comfortable, and the patient is almost unaware of their presence. In this article the principles of stored or strain (elastic) energy will be reviewed, followed by a discussion of the merits of its use in the back pain patient. We will also illustrate some types of elastic garments available today.
Keywords: Lumbar supports, braces, elastic, strain energy, low back pain
