Lower back pain and sciatica are a real trouble for many. Particularly in cases where guidance and rehabilitation has been either incorrect, lacking or both, the desire to do something to take the pain away can be tempting. This is commonly the reason people turn to the use of supports, aids, painkillers, surgery, injections and belts. All of these are often a short term attempt to provide some degree of relief from what can be a severe, quality of life limiting, pain. When it comes to support belts for lower back pain, are these really worth it or are you making a mistake relying on these tools?
Today we’ll cover two specific types of belt, firstly, a lumbar support that would aim to work directly on the lower back. Secondarily we’ll be taking a look at a sacroiliac belt that is worn around the hips and pelvis. We’ll be asking what they’re supposed to be doing, critiquing their effectiveness, as well as offering our recommendations on whether you should consider support belts for your lower back pain or not.
Why you might consider a lumbar support belt for your low back pain
Whether it is a lumbar support or sacroiliac support belt, that matters little at this stage of analysis. The why is an important consideration we must make. Often people will not immediately turn to these devices at the first sign of injury, primarily because the first sign of back pain is often ignored. This is simply the reality of things, and therefore it is reasonable to suggest that most who are considering lower back support have had back pain for some period of time. This would mean that most looking at supports, perhaps like yourself, would come under the category of chronic lower back pain, as covered in the podcast episode on the topic, this means there are a variety of factors present every day which are irritating the lower back. This could be specific activities, the habitual ways you move, weaknesses and more. Most of which you’re unaware of.
Overlaying a belt on such practices invariably makes the situation worse rather than better. Just like using painkillers to mask the pain, or spinal injections for back pain relief, if we do not evaluate the pro’s of con’s of each we cannot hope to effectively apply these tools for long term relief.
The phrase springs to mind: when you’re a hammer, everythings a nail. That is to say, often we’re understandably motivated by pain and look for something to just take it away, even if this means applying these tools in a way that makes things worse. This is why we put huge amounts of time and effort into these detailed podcasts and articles every week.
Our biggest goal with the podcast in general, is to help you as the reader, with back pain, sciatica or some amalgamation of the both, to have a better understanding of tools, if they’re relevant at all, and if so, how they can be deployed to help your long term recovery and injury resolution.
The types of belts and supports for your lower back pain or sciatica
There are two main belts that people will work to use, the lumbar support belt which is often a larger device, somewhat like a corset, that sits atop the pelvis and spans the lumbar spine. The second is an SIJ belt or sacroiliac belt, this works at the level of the pelvis and is placed lower down as we’ll discuss later. Both of these belts aim to add stability to the body. They aim to provide control to an area of the body to limit movement, and therefore the propensity for injury to take place. The difference is merely in the location they’re applied.
It might be helpful for a moment to consider the use of a knee sleeve or elbow support for comparison. Both of these are designed, much like the above supports, to provide compression and competence to a joint by adding a degree of stiffness to the joint. Why stiffness? Because when you injure a joint, it is the ligaments that you’ve injured in most cases, possibly with the additional injury to some of the cartilage. In either case, the integrity and tension of the joint has been compromised because the structures that maintain the tension through the joint have been injured. The external use of the compression straps around the specific joint that’s injured provides that extra protection while healing takes place amongst other things. The important point to remember here is that the compression occurs…
AT THE JOINT THAT IS INJURED!
As we will discuss later on, you wouldn’t put the knee support around the middle of your lower leg or thigh and expect it to protect your knee would you?
Lower back injuries at the root cause of back pain & sciatica
For a moment let us turn to the injuries that are most commonly at the root cause of lower back pain. We’ve discussed many of the specific diagnosis that can arise as causes for lower back pain on previous podcast episodes but here are a few:
- Herniated discs (including bulges and slipped discs
- Degenerative disc disease
- Spinal Stenosis
These are just some of many, but the thing that’s important is the precise location they are occurring. The overwhelming majority are at L4/5 and L5/S1 in the lower back, the last 2 mobile segments of the spine. This is incredibly important when it comes to the consideration of a belt, regardless of which you choose. The L4/L5 and certainly the L5/S1 are set deep within the pelvic girdle as you can see in the image below:
Just take a moment to think back to our discussion about the elbow and knee supports. Does it look as though our belt could provide the same compression and support to this region when, as is certainly the case for L5/S1 and likely the case for L4/L5, either belt cannot possibly cover this level?
The issues with the belts are similar, but important to discuss.
Lumbar support belts for back pain
The first option is the lumbar support, which would be the “corset” style mentioned earlier, regardless of whether it is a thick corset, or a thinner belt akin to a weightlifting belt, the same truth remains.
They feel good to wear!
We make no point of denying this, if you put on these supports they do feel great. The compression feels lovely while you’re standing up, your core is held tight and it’s a good feeling.
The problem is however, you’re not compressing the right level! And it is nothing like the compression offered the knee or elbow options in terms of specificity or accuracy. Not to mention, in most cases the center point of the support is likely to be the point at which maximum protective compression is being exerted. In the case of some of these lumbar support belts, you’re talking about supporting the L1/L2 or L2/L3 level of the spine.
The issue here is two-fold:
- What little support you are offering, is at the wrong level: meaning you’re completely missing the mark and likely stopping a more healthy joint from moving correctly.
- Your limitation in movement at the L1 to L3 levels will mean that the lower levels of the lumbar spine (that are unstable) will have to move more!
This means that the lower lumbar injury and instability that needs more support and protection is going to have to be MORE involved in movements of the body rather than less! The exact opposite of what you want.
Ok, but what about the sacroiliac belt?
Sacroiliac belts for lower back pain and sciatica
These belts will typically be worn around the pelvis, and so the theory is that they provide compression to the sacroiliac joint to aid in stability of the region. Which they do effectively. At least these variations can more logically address the area they’re designed for, relatively effectively if worn properly. However, In our experience, looking at the imaging of thousands of patients over the years, the majority of people with lower back issues, including those that might involve the sacroiliac joints, will find that they have a reduced lumbar curve.
Why is this relevant you might be wondering?
We discussed the sacroiliac joints’ role in lower back pain in a dedicated podcast, but the short version is as follows: flattening of the lumbar curve posteriorly tucks the pelvis and relatively disengages the sacroiliac joints. Instead of providing compression, focusing on the realignment of the lumbar lordosis will have the effect of restoring integrity to the sacroiliac joints in the standing position and will provide a much superior long term fix. Not to mention the fact that the sacroiliac joint is almost never the “primary injury” it is usually a secondary strain to a lumbar spine issue, usually at L5, S1, and so as we will see next, using a sacroiliac belt may well compress the joints effectively, but it comes at a cost.
The main flaw in the sacroiliac support belt is that its use places huge additional force on the lumbar spine, this happens in two ways. Firstly, it simply is not providing any support or protection for the lower back by virtue of its position, it is also preventing the sacroiliac joints from participating in movement, although movement at the SIJ is very negligible.
The more significant issue is the way it affects the hips. In order to have the belt do its job, it needs to be tight, and in doing so, it will create compression on the gluteal musculature. This compression will have the effect of limiting the movement at the hips. The reduction in hip movement will be compensated by the next mobile region, the lower lumbar spine. If your injury is at L5,S1, for example a disc bulge, this is a real issue!
The main reasons these support belts make back pain worse
Fundamentally the two belts are the same in terms of their critique, we’ve covered the particular nuance of each above. Below are some of the issues common to both belts and belts in general.
Belts & supports do not address the problem
Your lower back injury is a weakness that you must work to compensate for and rebuild, belts do neither of these things and not only that, they actually focus more strain to the most common origins of lower back issues by virtue of them not being able to act on the L4, L5 and L5, S1 segments. Regardless of the precise diagnosis, they cannot target their support to these injured regions in the same way a knee brace might help your recovery from a medial collateral ligament strain in your knee.
Support belts feel nice and are used as a disabling crutch
The simple truth is that you’re “told” that they are great for back pain so they are used as a crutch for so many, in spite of testimonial to the contrary. They end up being used excessively and you feel a certain conditioning that you cannot manage without them, plus, they do feel nice to wear when you put them on!
Belts and supports wear out over time
A result of the former issue is that the belts are overused and the elastic in them wear out over time, resulting in the need for a new belt or just lackluster support of your old belt. We’ll discuss what gets stronger over time shortly.
Belts weaken your lower back and make back pain worse
Of course this is a little hyperbolic, but there is some truth to the reality of belt use, you relax your core as the belt is engaging for you. Reliance on this as a crutch means that your core muscles have lost what little conditioning stimulation they did have, compounding the issue furthering your perceived reliance on the belt.
What about a special support belt for your lower back?
The simple truth is that we’re all built with our own innate and dynamic support mechanism for the lumbar spine, one that can provide support and protection for the entire lumbar spine! One that actually gets stronger with time instead of wearing out. Relying on external supports prevents you looking within for support and recovery and prevents you working on your own bodily mechanics. Bad movement habits’ effects on your back injury will only be enhanced through the use of the external belts mentioned above, allowing you to get worse faster.
Instead, commit to learning to brace and engage your own corset and lumbar support mechanism. This will provide lumbar and pelvic support that is long lasting and dynamic. Learn to isolate the hip movement from lower back movement for short to medium term movements preventing the lumbar spine region that’s injured from having to participate in as much movement. This has the effect of reducing the likelihood and frequency of injury. This takes time but it is time well invested.
From there you can move on to rebuild strength in the hips and back musculature to continue the rehabilitative process and build your custom, self-made lumbar support belt. One that you can switch on at a moment’s notice, one that doesn’t get sweaty, one that doesn’t rub, one that works.
If you need help doing this, check out membership to the Back In Shape Program where we walk you through doing this from the ground up in the safest way! Building your support belt and the conscious control of it starts immediately as it is so vital to your prospects of back pain recovery. You might need to unlearn a few prior bad habits, but it will be your best route to long term relief and lasting results.