The mechanics of bending and lifting are hard on the back, especially when lifting heavy objects. Various structures in our backs can be injured during the lifting phase. Muscles can go into spasm, ligaments can be strained, discs (the spacers that cushion the back) can be injured, and more.



You might get away with poor lifting technique for a while, especially if you are young and haven't had a previous low back injury. However, improper repetitive use of the back fatigues these important structures. Sooner or later, your back won't be able to withstand the pressures and injury will occur.

With bending and lifting, the laws of physics come into play. If an object is placed at the far end of a lever it creates more force on the lever than if it is placed at a short distance. When bending and lifting, the back becomes a lever system. The spine is the lever, the hips are the anchor point, and the muscles of the back are the supporting rope (see drawing in the resource box).

Proper bending techniques create a short (and thus strong) lever system. When correctly bending the knees and lifting with the legs, the shoulders are positioned over the hips, creating a short lever. As a result, a smaller force is created on the lever (spine) and the weight of the object travels safely down the back and hips. Additionally, the muscles stay in their shortest and safest position.

Improper lifting can create a long (and thus a stressed) lever system. When lifting only with the back the shoulders are positioned forward relative to the hips. With the shoulders forward, the weight of the object is further away from the hips, creating increased force on the lever (spine). Additionally, the muscles are stretched longer and have to contract with greater force. This combination of a stressed spine and increased muscle contraction can cause the back to fail.

The goal of proper lifting is to keep the shoulders over the hips, keep the low back straight, and thus keep the lever systems short. This is accomplished by bending the knees and lifting with the legs.

Using this proper lifting technique, the back will be straight when viewed from the side. It is also important to keep the back straight when viewed from the front. This is achieved by not twisting the back to the left or right. The easiest way to accomplish this is to make sure the knees and shoulders are pointed in the same direction. In other words, the knees and shoulders should be lined up with each other.

Additional problems arise when the object is either too heavy or of such an awkward shape that you can't bend your knees to pick it up. Getting help is often the best option for picking up these heavy or odd shaped objects.

Along with good lifting technique, use a back brace to help support the back and avoid injury. But when and how should it be used? Following is a strategy for proper use of back braces. I will discuss how often to use a brace, how to use it intermittently, and what types of activities it should be used with. I will also dispel a common myth that keeps people from correctly using a brace.

How often should you wear a back brace? It depends on whether they are in pain and what activities you are doing. The more pain you have, the more frequently you will want to use the brace.

It is very impractical to wear a brace all day long. The only time you should wear a brace for extended periods of time is if you are currently in pain. The pain can be acute (meaning new onset and strong), or it can be chronic pain in which the back hurts most of the time. A back brace can help you get through the day, even if you aren't lifting much. Fortunately, acute pain doesn't last too long. Once you are in a lower level of pain (or, perhaps pain-free), you will be able to use the brace less often.

After the acute pain has passed, use the brace "as needed." It should be used when you are going to ask a lot of your back. Understandably, one wants to wear a back brace all day. Most jobs, even physically intensive ones, do not require constant lifting. There are breaks in the action or changes in job requirements. An "on-again, off again" approach keeps you from getting tired of wearing the brace.

Most braces are tightened with two steps. First, there is usually a Velcro strap to secure the brace across the waist. Second, there are usually two side straps and that can be cinched tightly. You can tighten these cinching straps when lifting and loosen them once exertion activity is complete. This strategy targets the use of the brace and thus increases how effective it will be.

Under what circumstances should you wear the brace? Once you're out of acute pain, the brace should be worn just with bending or lifting activities, or sitting in a bad chair. If you do not have a physical job, you may not need to wear a brace very often, but may need it when working around the house.

One very common misconception surrounds the use of back braces. My patients always ask me: "Won't a back brace weaken my back over the long-term?" The truth is no! Let me explain. This misperception stems from people falsely assuming that when they use back braces they aren't using the muscles of their back and that those muscles will slowly weaken.

An extreme but helpful example of this muscle weakening is the "disuse" atrophy a person develops when wearing a cast. We all have seen people whose arms or legs have lost strength (and size) after wearing a cast for a prolonged period of time. Why did the arm or leg get skinny? It is because without the ability to move and contract, muscles weaken and lose size. (With muscles, it's a case of "use it or lose it.") Over a period of six to eight weeks of complete disuse, there is enough weakening to easily see the difference. So muscles weaken - or waste away with disuse.

But there is a difference between wearing a cast on a broken arm and wearing a back brace on a strained back: muscle contraction. There is little or no use of the muscles trapped in an orthopedic cast. However, with a back brace the back muscles still contract just as much as they would without the brace. In other words, the muscles still continue to work. As a result, our back muscles aren't resting and won't waste away. So don't worry about a back brace weakening your back. It simply doesn't happen - even with prolonged use.

So what value is the back brace adding? It is supporting the injured muscles of the back by clamping down on them when they are in use. This support helps keep the muscles from going into spasm and causing pain. It is the same principle a tennis player employs by wearing an elbow support while playing. Firm support helps an injured muscle not to go into spasm.

As we can see, wearing a back brace can be a very important pain-prevention strategy for those with acute or chronic back pain. People without a past history of pain should also use a back brace to support their back during heavy exertion as a preventive measure.

Occasionally, a patient will claim it hurts more to wear a brace when they are in acute pain. If this happens, then the brace may not be for you at this time. Don't be afraid to try it again when you are at a different pain level.

One last thought: don't let the back brace lull you into a false sense of security and encourage you to lift with bad technique or lift more that usual. You must wear the brace and use proper lifting technique to achieve the greatest protection from injury.