Back Belts and Workplace Back Injury Prevention: Evidence Review

Introduction and Background

Over the past year and a half, there have been a high number of recordable and reportable back injuries in warehouse and production areas. To address the issue and reduce or eliminate back-related injuries, an investigation into preventive measures — including the use of back belts — was conducted. Several studies have been reviewed, and the findings are consistent: there is no evidence to support the claim that back belts prevent back injuries. Even NIOSH declined to recommend back belts as a means of reducing or eliminating workplace back injuries. In fact, some evidence suggests they may increase the number and severity of work-related back injuries (Youngstown State University, 1997). Most studies recommend training and ergonomic awareness programs as the most effective means of reducing or eliminating back injuries.

How Back Belts Work

There are different types of back belts and supports, but generally they function by forcing an individual to squat rather than bend over when lifting heavy objects. Some are designed with a hard insert, similar to a corset. Others are designed to apply pressure that inflates the abdomen, which in turn lessens the pressure exerted on the spine by the load (Youngstown State University, 1997).

Manufacturer Claims and Disclaimers

ITA-MED Co., a manufacturer of back supports, states in its advertising that the use of back supports will help to "maintain correct posture, and avoid injury even while lifting heavy loads" (ITA-Med Co., 2009). It is not clear exactly how the supports are meant to "avoid injury." Notably, there is a prominent disclaimer at the bottom of the same advertisement which states: "Reminder: Any back support is only a supplement — so train yourself to practice safety habits, especially when lifting heavy loads; Do warm-up and stretching exercises to strengthen back muscles, and use proper lifting techniques to avoid injury" (ITA-Med Co., 2009). It is not a coincidence that even the manufacturer emphasizes the need for additional care when lifting heavy objects.

Official Position on Back Belt Use

A number of studies have examined the effectiveness of back belts, and as a result of their findings, the Ohio Bureau of Workers' Compensation Division of Safety and Hygiene has taken the position that "back braces, supports, or 'lifting belts' are not endorsed by the Division of Safety and Hygiene as tools for the prevention of back injuries. Although they may be useful in some instances of rehabilitation or as prescribed by a physician, these devices are not considered a legitimate ergonomic means in the long-term prevention of low back disorders" (Ohio Bureau of Workers Compensation, 1993).

The rationale supporting this position is as follows: back belts do not eliminate a worker's exposure to the hazard. While lifting occurs, compression and shear forces act on the spine and stress the supporting muscle groups. There is no direct scientific evidence to validate that spinal compression forces are reduced by increases in intra-abdominal pressure — at this point there are only hypotheses. Furthermore, there is growing evidence that with prolonged use of these devices, the lifting structures of the trunk may weaken (Ohio Bureau of Workers Compensation, 1993).

Back supports may not only fail to prevent injury — they might actually increase the risk of injury. Specifically, "subsequent lifting without the belt has resulted in increased injury rates, which may imply physical dependency; a reported increase in support perceived by the user may translate into a false sense of security, hence fostering the potential for additional risk taking; just because supports are provided does not mean they are being used properly, if at all; the support received from the device may resist 'improper bending' and limit motion of the trunk" (Ohio Bureau of Workers Compensation, 1993).

Conclusion and Recommendations

Consistent with the above review, the findings of the National Institute for Occupational Safety and Health are nearly identical (CDC, 2002). NIOSH goes a step further by listing specific actions companies should take to increase safety and reduce the risk of back injury. NIOSH recommends that organizations administer ergonomic programs that focus on prevention and that include an assessment of all work activities to ensure tasks can be accomplished without exceeding the physical capabilities of the worker. Programs should also incorporate ongoing, comprehensive training for all workers on lifting mechanics and techniques; provide a surveillance program to identify potential work-related musculoskeletal problems; and include a medical management program (Youngstown State University, 1997).

Based on the above information, the use of back belts should be strongly discouraged due to the lack of evidence that they help and the possibility that they may actually contribute to instances of back injury and possibly other health problems, such as cardiovascular stress. It is imperative that an ergonomics program be immediately incorporated into the workplace, following the plan provided by NIOSH above. The evidence is clear that the only proven prevention is adequate training with regard to lifting, combined with making the workplace safer through sound ergonomic design and environmental improvements.