Brace
You have to lift a heavy suitcase from the floor; do you brace yourself or just lift it?
You have to lift a bag of groceries from the trunk of the car; do you brace yourself or just lift it?
Now you have to pick up your socks off the floor; do you brace yourself or just bend and pick it up?
If you speak to Stuart McGill, bracing is the ultimate solution to most people’s back pain. If you speak to Peter O’Sullivan, bracing is the cause of most people’s low back pain.
I’m still on the fence for this one, as I do believe there is a sub-group of patients where both points are valid.
In my personal practice, I spend far more time deprogramming my patients against bracing as I find continuous bracing and the paranoia of injuring self to be major contributor to fear, immobility and pain.
This study looked at the EMG and body mechanics of healthy individuals who were asked to brace and not brace while lifting a heavy item (15 Kg) off the floor several times.
Conclusion: “There appears to be no clear advantage of abdominal bracing during lifting, leaving its value for low-back pain prevention unclear.”(Coenen et al 2017)
When in doubt, I do the spinal load test in standing as suggested by Stuart McGill. Ask the patient to relax, hold a 10 lb dumbbell (or any appropriate weight) and extend their arms forward; note LBP.
Then repeat the same movement but this time with abdominal bracing prior to extending the arms; note LBP. Decide if bracing was of value or not!
Reference: Coenen P…O’Sullivan P et al Abdominal bracing during lifting alters trunk muscle activity and body kinematics. Appl Ergon. 2017 Sep;63:91-98.
*McGill S. Back Mechanic. The secrets to a healthy spine your doctor isn’t telling you. 2016 Backfitpro. Canada www.backfitpro.com
Brace
