Back Belts Ineffective, Study Finds
Those ubiquitous back belts--however effective they may look--do nothing to prevent back injuries, according to a study of more than 9,000 Wal-Mart workers.
The study, published in today’s Journal of the American Medical Assn., found that workers who wore the belts regularly while lifting were just as likely to report lower back pain and to file workers’ compensation claims as those who wore the belts rarely, if at all.
Perhaps, back experts say, it’s time to relegate the garments to the fashion category.
“It’s not really surprising to me that [back belts] didn’t make a difference,” said Dr. James Weinstein, an osteopath and professor of surgery and community and family medicine at Dartmouth Medical School in Hanover, N.H. “The pressure makes you feel better--that’s why we do it. But that probably doesn’t prevent you getting injured.”
Researchers at UCLA, however, question the study’s findings. Their own back belt study--conducted with 36,000 Home Depot workers and published in 1996--reported that back belts could reduce back injury rates by about one-third.
Lower back pain is the second most common reason for visits to the doctor, after flu and colds. It is an enormously expensive problem: In 1995, for instance, workers’ compensation claims for lower back pain totaled an estimated $8.8 billion, 23% of the total amount of payments for that year.
The causes of most cases are mysterious. To try to deal with the problem, many employers--and employees--have chosen industrial back belts of various styles. The rationale is that they provide support to the lower part of the back.
To study back belts, James T. Wassell and co-workers at the government’s National Institute for Occupational Safety and Health teamed with Wal-Mart Stores, headquartered in Bentonville, Ark. They interviewed 9,377 employees--based at 160 new Wal-Marts in 30 states--whose job included some merchandise lifting. At some of the stores, workers lifting heavy objects were required to wear back belts. At others, back belts were available but optional.
Back belts come in various styles; the belts used in this study were made of stretchable nylon and fastened into place with adjustable Velcro straps.
At the start of the study, workers--whose jobs involved receiving, moving and arranging stock in the stores--were asked about their back belt-wearing habits and past problems with back pain.
Six months later, they were asked again about their belt-wearing habits and whether or not they had experienced four or more episodes of lower back pain in the last six months. More than 6,300 workers completed both interviews.
The researchers also examined all workers’ compensation claims that involved the back, screening them for key words such as “strain,” “sprain” and “lifting.”
Those who had worn the belts, the scientists found, were statistically just as likely to report back pain and file workers’ compensation claims as those who wore them rarely or never--implying that the belts didn’t help.
What’s more, back belts appeared useless at preventing injury, regardless of whether a person had a prior back injury and among people whose jobs involved particularly heavy lifting.
But Douglas Landsittel, one of the study’s authors, said there may be some people for whom the belts are helpful: “We’re not saying, ‘Don’t wear back belts,’ ” he said. “We don’t have enough information to make that statement in all cases.”
Other back experts say they are not surprised by the findings.
“For 50 years, we’ve assumed that when we have a back that hurts when we do a particular task, that the task probably caused the backache,” said Dr. Nortin Hadler, professor of medicine at the University of North Carolina at Chapel Hill. That’s not necessarily true, he said: Back pain, in most cases, may just be an unavoidable consequence of getting older, one that back belts will do nothing to prevent.
And although back belts might provide useful support, one study from the 1960s suggests that you need an inflatable kind--blown up to almost unbearable tightness--to achieve that, Hadler said.
In another study, in 1998, 24 men and women were outfitted with back belts and their muscles were measured while they performed lifting tasks. The back belts didn’t slow muscle fatigue, the authors found.
Hadler said the more important issue is how we deal with back pain. There’s plenty of evidence, he said, that people who work in jobs they dislike, for employers who don’t treat them well, are far more likely to experience debilitating back pain than those who work in sympathetic work environments.
But there are some problems with this most recent study, said David McArthur, an epidemiologist at UCLA and an author of the 1996 study that concluded belts could reduce injury rates. For instance, he says, the National Institute for Occupational Safety and Health researchers simply asked the workers if they had experienced back pain, instead of getting doctors’ reports. Such “self-reports” are far less accurate, he said.
The institute, headquartered in Washington, is the government body responsible for researching workplace illnesses and injuries, and makes recommendations based on those findings. The agency doesn’t recommend back belts because--in a 1994 review of the research literature--it concluded that there wasn’t sufficient evidence to show they worked.
Some workers Tuesday came to the belts’ defense.
“It does help,” Adolfo Gutierrez said of the belt he wore as he unloaded a delivery truck in Los Angeles. “It’s helping me right now.”
The owner of a hardware store in Los Angeles, Jose Magallon, said he also believes belts help prevent injury to his workers. Besides, he said, “the insurance companies make you make all the employees wear them.”
But at a Home Depot in Los Angeles, 32-year-old cashier Stephanie Alvarado said that despite company policy, “I never wear them. They are uncomfortable and make my back hurt more.”
The belts aren’t the only back pain remedy to receive a drubbing lately. Bed rest, according to a review article published recently in the journal Spine, does nothing to alleviate lower back pain--and may even prolong recovery time.
“Today we know that resuming your normal activities as soon as possible is the way to get better faster,” said Weinstein of Dartmouth.
Weinstein is heading a large national study--the Spine Patient Outcomes Research Trial, or SPORT--which physicians hope will provide more answers about causes of and treatment for back pain. (Those who wish to participate can call [888] 794-BACK.)
“People have been using corseting, traction, poking-and-pulling and girding up the loins for hundreds of years” to try to ease and prevent back pain, Hadler said. “Now, finally, we have the science to start to test some of these remedies.”
(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)
Back Pain and Belts
The cause of most lower back pain is a mystery. Workers often wear belts or braces, such as the one below, to help protect their lower backs from injury during heavy lifting. But a new study suggest that the belts may not help.
*
The Spine
The backbone is a stack of 33 vertebrae separated by sponge-like disks, all wrapped in muscle. It surrounds and protects a dense corridor of nerves that reach all parts of the body. The spinal column consists of three main sections: the cervical, or neck section; the thoracic, or upper back; and the lumbar, or lower back.
