The back brace, re-engineered to make it more comfortable and effective, is rebounding. A handful of new braces have been introduced in the previous a number of months, with more anticipated this year. The braces are made to relieve the stress on vertebral disks that are usually the source of lower-back pain.
The brand-new braces are a much cry from the conditional and heavy back braces offered a decade ago. The aged designs were created to limit motion and immobilize the spine. Not just were the braces impractical to use, they typically resulted in intense weakening of abdominals, creating a variety of new health and wellness troubles.
The new models are made of lighter-weight, flexible materials. Instead of immobilizing the back, the new braces are designed to "unload" the pressure on a disk while still allowing patients to maintain a normal range of movement.
Such innovation is helping spur renewed interest in braces. Meanwhile, physicians are becoming increasingly disillusioned with current treatments for the 20 million people affected by back pain each year in the United States. Injection treatments, disk-heating procedures and back fusion surgery have posted disappointing results in clinical studies as well as the real world. Although the procedures are still a good option for certain patients, doctors increasingly believe many more patients could benefit from trying less-invasive options, like braces, first.
"Because we have a lot of 'failed-back syndrome' and people who don't do well, you really want to exhaust nonoperative treatments," says Daniel Lee, orthopedic spine surgeon in Las Vegas.
"Patients have very good results," said Linda Dean, certified prosthetist and orthotist and owner of Dean Prosthetic and Orthotic Services in Evanston.
The braces aren't a cure-all. Even a 2-pound lightweight brace can be too heavy for a frail 80-year-old, Dean said. And wearing a brace might reduce patients' willingness to take more active steps to relieve pain, like exercising and losing weight, said Dr. Richard S. Rabinowitz, an orthopedic spinal surgeon in Hoffman Estates and Elk Grove Village.
Others say the devices can provide a respite that helps interrupt pain signals and allows patients to begin physical therapy and muscle-strengthening exercises.
Nicholas Pellegrino, a 72-year-old semiretired mortgage banker, began wearing a new brace just over a week ago. Before the treatment, the Lynbrook, N.Y., man found it difficult to even take a few steps. "On a scale of one to 10 for pain, I was a 10," Pellegrino says. "After the brace, I'm about a four. It's difficult to put it into words, I feel so much better."
The brace used by Pellegrino, the Disc Unloader from Corflex of Manchester, N.H., wraps around the abdomen and is cinched tight using Velcro straps. The 2-pound brace eases the pressure on the disks by shifting the burden of back support to the abdomen. The brace has been shown to reduce disk pressure by 41 percent. Pellegrino says wearing the snug brace isn't entirely comfortable and makes him look about 10 pounds heavier, but it's a small price to pay to ease his back pain.
The Unloader brace and others like it generally are worn for a few hours at a time, depending on how much relief is needed. They are available only by prescription, because long-term use can still lead to some weakening of the abdominal muscles so patients must do daily abdominal strengthening exercises. Pellegrino has begun pedaling a stationary recumbent bike to boost his strength.
Doctors say that in addition to providing short-term pain relief, use of the braces manly can help break the psychological cycle of back pain, which often leads to depression and inactivity, which in turn, exacerbates the back problem.
"It's a crutch to reduce the pain and to get people into sound exercise regimens," says Vijay Vad, sports-medicine specialist at Hospital for Special Surgery in Manhattan who designed the Corflex brace and receives royalties from sales.
The Orthotrac Pneumatic Vest, made by Orthofix International of Huntersville, N.C., also "unloads" pressure from the disk. But instead of shifting back support to the abdomen, the Orthotrac device, introduced last year, transfers the weight to the hips. The vest, which weighs about five pounds, uses an inflation device to push "lifters" up against the rib cage and down against the pelvis. It sounds odd, but the gentle pressure is likened to a tight belt, and patients say it's mild compared with the discomfort of back pain.
"It does restrict your activity but it makes the difference between having pain and not having pain," said David Zeiger, a Chicago osteopathic doctor who prescribes the vest for patients and has used it himself.
According to early clinical trial results presented to the North American Spine Society in December, patients using the Orthotrac device reported significant pain relief compared with an older- style brace.
Rabinowitz said he'd like to see more thorough randomized, blinded studies showing the new devices are effective for treating lower-back pain caused by pressure on spinal disks. Meanwhile, he said, using a brace is a low-risk strategy for some patients.
"Is it possible it may be of benefit? Yes. Is there a huge down side? No. If it doesn't work, take it off," he said.
Typically, patients whose pain is caused by pressure on spinal disks are candidates for the braces. Patients with other types of back pain or those who can't stand up straight because of the pain might not be good candidates for braces, which typically are covered by insurance.
Benedetta Riccardo, a 46-year-old retired baker from Utica, N.Y., has suffered for three years from herniated disks. In June, she began wearing the Orthotrac device. She's not entirely pain- free, but no longer needs pain pills. She concedes the device is a bit awkward, but worth it.
"At least I can pick up my grandchildren, which I couldn't do before," Riccardo says. "I can walk a little bit. I can go shopping, which I couldn't do before. I can do normal things."
- Daily Herald Features Editor Anna Madrzyk contributed to this story
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