backbeltsandlow backpain final 8 2011

8/13/2019 Backbeltsandlow Backpain Final 8 2011

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Industr ial Back Belts and Low-Back PainFrequently Asked Questions

Q. Do back belts prevent overexertion back inju ries in employees who lif t andmove materials?

A. According to research, back belts are not effective in preventing musculoskeletal low-

back pain. The National Institute for Occupational Safety and Health (NIOSH) studied8,000 hourly retail workers for two years. This study found that elastic support back beltsdid not reduce the incidence of back injury claims or low-back pain (Wassell, et al.,2000).

Q. What is the best way to prevent low-back injur ies?A. No single technique will prevent all injuries. The best approach is to use acombination of methods. Implementing an ergonomics program will produce the bestlong-term results. Remember, no two workplaces are exactly alike; not every one ofthese controls will be possible at your workplace.

Engineering Controls

Change or modify tools, equipment or machinery to reduce the physical demands of thejob. Engineering controls also include the use of assistive devices (e.g., crane, forklift,conveyor) to handle materials.

Work-Practice ControlsChange the way job tasks are performed to reduce the frequency and duration ofexposure to risk. One example is reorganizing the order of job tasks to allow musclerecovery between tasks requiring excessive force. Another example is using a differentmanual technique to reduce force requirements.

Administ rat ive ControlsThese include job rotation, job enlargement and gradual introduction to work, such as a

pre-shift warm-up and stretching program.

Training ControlsMake employees aware of low-back pain early-warning signs, the importance of earlyreporting, the biomechanics of the spine, and the risk factors and proper bodymechanics when manually handling materials.

Personal Protective Equipment ControlsExamples include kneepads and vibration-dampening gloves.

Q. How do back belts work?A. There are several theories about how back belts could help protect the lower back

when performing strenuous lifting or forceful exertions.

Physically: Some say that the belt puts pressure against the abdominal wall duringexertion and increases intra-abdominal pressure (IAP), thereby possibly increasing spinestability. Research has found, however, that the belt does not have the same effect forall movements and muscles.


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For example, the belt significantly increased IAP in forward- and side-bending, but not inback extension (Cholewicki, et al., 1999). Another study found no changes in IAP withbelt users performing various types of lifts (McGill et al., 1990). A review in 2000 of 33studies that measured IAP found no evidence that IAP increased when wearing a backbelt (Van Poppel, 2000). If IAP is increased with back belt use, its unclear whetheror not this actually protects the spine.

Psychologically: Back belt manufacturers say that the belts help remind the user to liftproperly and use good body mechanics. No field studies, however, support thisstatement.

Q. What do health and safety authoriti es say about back belt use?A. The U.S. surgeon general, U.S. Department of Defense, NIOSH, Washington StateDepartment of Labor & Industries, and Workers Compensation Board of BritishColumbia have all opposed the use of back belts for the prevention of low-back pain.They all cite scientific evidence that finds no benefit to wearing a belt to prevent backinjuries from strenuous or repetitious lifting, pushing or pulling. The Occupational Safety& Health Administration (OSHA) states, Back belts are not recognized by OSHA aseffective engineering controls to prevent back injury. While they may be accepted byindividual workers because they feel as if they provide additional support, the

effectiveness of back belts in the prevention of low-back injuries has not been proven inthe work environment. Thus, OSHA does not forbid the use of back belts and similardevices, nor does it endorse their use.

Q. What are the risks o f using a back belt?A. There are multiple risks:

Increased Blood Pressure: Some studies have found an increase in blood pressurewhen lifting and wearing a belt (Rafacz et al., 1996; Rabinowitz et al., 1998; Marley &Duggasani, 1996). Another study found no significant changes in blood pressure whenwearing a back belt while lifting (Bobick et al., 2001). The conflicting research probablyhas to do with the lifting tasks themselves. Static lifts increased blood pressure; dynamic

lifts did not. Loads weighing more than 29 pounds increased blood pressure; loads lessthan 17 pounds did not. Back belt users should use caution if they are already have highblood pressure and/or are at risk for cardiovascular stress.

Superman Phenomenon: Sometimes employees think the belt makes them stronger.One study found that subjects wearing a belt increased the weight of the load they werelifting by 19 percent (McCoy et al., 1988). Employers should be aware of thisphenomenon. They should also caution employees against thinking they can safely liftmore weight than theyre physically capable of lifting.

Muscle Weakness: Many medical professionals are concerned about muscleweakness, or atrophy, when the back belts are worn for long periods. Bracing or

splinting an area of the body will restrict movement, and movement is necessary forkeeping the muscles active and strong. One field study conducted on 642 baggagehandlers found that employees who stopped using a belt had a higher number of lumbarinjuries and lost workdays (Reddell et al., 1992). This would suggest that their injuriesmight have been due to muscle weakness from wearing a belt. Employers should beaware of this risk if employees stop using the belt and continue performing the samelifting tasks.


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Q. What are the poss ible benefits o f a back belt?A. NIOSH conducted a laboratory study that found belts reduced some forward- andside-bending of the trunk, as well as twisting when lifting 21-pound boxes (Giorcelli et al.,2001). Test subjects also lifted the boxes more slowly and used more of a squat lift whenwearing the back belt. A back belt may decrease the angle of forward- and side-bendingand decrease twisting when lifting, and that may help remind users to use bettertechnique. This testing was performed over a few days. More research is required toknow the long-term effects on body mechanics.

Q. What should an employer do if a workers physic ian prescribes a back belt atwork?

A. Sometimes a physician will prescribe a corset-like or rigid back brace for patients withdegenerative disc disease and/or who are recovering from back surgery, in order to helpstabilize the spine. If this is the case, follow the physicians orders. This type of back beltserves a very different purpose than the industrial back belt discussed here. It isdesigned to stabilize the spine when moving. In most cases, the back brace is a short-term remedy, since weakening (atrophy) of the abdominal and back muscles (seeMuscle Weakness above) will eventually occur.


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ReferencesBobick, T. G., Belard, J. L., Hsiao, H., Wassell, J. T. (2001). Physiological effects of backbelt wearing during asymmetric lifting. Applied Ergonomics, 32 (6).

Cholewicki, J., Juluru, K., Radebold, A., Panjabi, M., McGill, S. (1999). Lumbar spinestability can be augmented with an abdominal belt and/or increased intra-abdominalpressure. European Spine Journal, 8 (5).

Giorcelli, R. J., Hughes, R. E., Wassell, J. T., Hsiao, H. (2001). The effect of wearing aback belt on spine kinematics during asymmetric lifting of large and small boxes. Spine,26 (16).

Marley R. J., Duggasani, A. R. Effects of industrial back supports on physiologicaldemand, lifting style, and perceived exertion. International Journal of IndustrialErgonomics, 17, 1996.

McCoy, M. A., Congleton, J. J., Johnston, W. L., Jiang, B. C. (1988). The role of liftingbelts in manual lifting. International Journal of Industrial Ergonomics (2), 1988.

McGill S. M., Norman, R.W., Sharratt, M. T. (1990). The effect of an abdominal belt ontrunk muscle activity and intra-abdominal pressure during squat lifts. Ergonomics 33 (2).

Rabinowitz, D., Bridger, R. S., Lambert, M. I. (1998). Lifting technique and abdominalbelt usage; a biomechanical, physiological, and subjective investigation. Safety Science,28 (3).

Rafacz, W., McGill, S. M. (1996). Wearing an abdominal belt increases diastolic bloodpressure. Journal of Occupational and Environmental Medicine 38 (9).

Reddell, C. R., Congleton, J. J., Huchinson, R. D., Mongomery, J. F. (1992). Anevaluation of a weightlifting belt and back injury prevention training class for airline

baggage handlers. Applied Ergonomics, 69 (5).

Van Poppel, M. N., De Looze, M. P., Koes, B. W., Smid, T., Bouter, L. M. (2000).Mechanisms of action of lumbar supports: A systematic review. Spine 25 (16).

Wassell, J. T., Gardner, L. I., Landsittel, D. P., Johnston, J. J., Johnston, J. M. (2000). Aprospective study of back belts for prevention of back pain and injury. JAMA; 284(21):2727-32.

backbeltsandlow backpain final 8 2011

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