Does a back support have a positive biomechanical effect?

The influence of weightlifting belts and wrist straps on deadlift kinematics, time to complete a deadlift and rating of perceived exertion in male recreational weightlifters: An observational study

Both weightlifting belts and wrist straps are commonly used weightlifting training aids but their effects on deadlift kinematics and performance were still not known. This study examined the effects of weightlifting belts and wrist straps on the kinematics of the deadlift exercise, time to complete a deadlift and rating of perceived exertion (RPE) in male recreational weightlifters.This study used a repeated-measures, within-subjects design. Twenty male healthy recreational weightlifters (mean age ± standard deviation = 23.1 ± 2.5 years) were recruited from 2 local gyms and the Education University of Hong Kong between January and April 2021. All participants used various combinations of belt and straps during a conventional deadlift. The hip and knee flexion, cervical lordosis, thoracic kyphosis and lumbar lordosis angles and time to complete a deadlift were measured using video analysis software. RPE was also recorded.Wearing both a belt and wrist straps was found to reduce knee flexion angle (P < .001), but not hip flexion angle (P > .05), during the setup phase of the deadlift compared to wearing no aid. Wearing straps alone exaggerated thoracic kyphosis in the lockout phase of the deadlift compared to wearing a belt alone (P < .001). No changes were seen in cervical and lumbar lordosis angles when using any or both of the weightlifting aids. Additionally, the participants completed deadlifts faster when wearing both a belt and straps (P = .008) and perceived less exertion when wearing a belt and/or straps (P < .001).Weightlifting belts and wrist straps, when using together, have positive effects on the kinematics of deadlift, time to complete a deadlift and RPE in male recreational weightlifters. Trainers should recommend the use of a belt and straps together, but not straps alone, to recreational weightlifters when performing deadlift training.

Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature

BACKGROUND

Wearing lumbosacral orthosis (LSO) is one of the most common treatments prescribed for conservative management of low back pain. Although the results of randomized controlled trials suggest effectiveness of LSO in reducing pain and disability in these patients, there is a concern that prolonged use of LSO may lead to trunk muscle weakness and atrophy.

PURPOSE

The present review aimed to evaluate available evidence in literature to determine whether LSO results in trunk muscle weakness or atrophy.

STUDY DESIGN

This is a systematic review.

METHODS

A systematic search of electronic databases including PubMed, Scopus, ScienceDirect, and Medline (via Ovid) followed by hand search of journals was performed. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the effect of lumbar orthosis on trunk muscle activity, muscle thickness, strength or endurance, spinal force, and intra-abdominal pressure in healthy subjects or in patients with low back pain, were included. Methodological quality of selected studies was assessed by using the modified version of Downs and Black checklist. This research had no funding source, and the authors declare no conflicts of interest-associated biases.

RESULTS

Thirty-five studies fulfilled the eligibility criteria. The mean and standard deviation of the quality score was 64±9.7%. Most studies investigating the effect of lumbar orthosis on electromyographic activity (EMG) of trunk muscles demonstrated a decrease or no change in the EMG parameters. A few studies reported increased muscle activity. Lumbosacral orthosis was found to have no effect on muscle strength in some studies, whereas other studies demonstrated increased muscle strength. Only one study, which included ultrasound assessment of trunk muscle stabilizers, suggested reduced thickness of the abdominal muscles and reduced cross-sectional area of the multifidus muscles. Out of eight studies that investigated spinal compression load, the load was reduced in four studies and unchanged in three studies. One study showed that only elastic belts reduced compression force compared to leather and fabric belts and ascribed this reduction to the elastic property of the lumbar support.

CONCLUSION

The present review showed that the changes in outcome measures associated with muscle work demands were inconsistent in their relation to the use of lumbar supports. This review did not find conclusive scientific evidence to suggest that orthosis results in trunk muscle weakness.

Are There Abnormalities in Peripheral and Central Components of Somatosensory Evoked Potentials in Non-Specific Chronic Low Back Pain?

Chronic low back pain (CLBP) was shown to be associated with longer reflex response latencies of trunk muscles during external upper limb perturbations. One theoretical, but rarely investigated possibility for longer reflex latencies might be related to modulated somatosensory information processing. Therefore, the present study investigated somatosensory evoked potentials (SEPs) to median nerve stimulation in CLBP patients and healthy controls (HC). Latencies of the peripheral N9 SEP component were used as the primary outcome. In addition, latencies and amplitudes of the central N20 SEP component, sensory thresholds, motor thresholds and nerve conduction velocity were also analyzed in CLBP patients and HC. There is a trend for the CLBP patients to exhibit longer N9 latencies at the ipsilateral Erb’s point compared to HC. This trend is substantiated by significantly longer N9 latencies in CLBP patients compared to normative data. None of the other parameters showed any significant difference between CLBP patients and HC. Overall, our data indicate small differences of the peripheral N9 SEP component; however, these differences cannot explain the reflex delay observed in CLBP patients. While it was important to rule out the contribution of early somatosensory processing and to elucidate its contribution to the delayed reflex responses in CLBP patients, further research is needed to find the primary source(s) of time-delayed reflexes in CLBP.

Effects of a new industrial lifting belt on back muscular activity, hand force, and body stability during symmetric lifting

This work investigated how wearing a new design of back belt affects erector spinae activity, hand force, and body stability. The belt was first tested with static holding tasks and found to significantly decrease the back muscle activity. Actual lifting tasks were further carried out to test the effect of the belt. Ten male subjects performed a symmetric lifting task of low-lying loads (11 and 16 kg) at natural toting velocity, using either a squat or stoop lifting posture, both with and without a belt. The study measured various independent variables using electromyography (EMG), load cells, and motion capture device. The results demonstrated that the belt reduced the load on the erector spinae, as well as the triceps brachii and biceps brachii. The overall mean values of the peak (hand) force did not appear significantly affected while wearing the belt, but the force peaks appeared postponed. The belt did not alter body stability while lifting. From the present findings, the belt effectively changed the force distribution during lifting, at least reducing the muscle load on the back. The belt may be a potentially useful device for symmetric industrial lifting tasks.

The effects of lumbosacral orthoses on spine stability: what changes in EMG can be expected?

Antagonistic trunk muscle activity is normally required to stabilize the spine. A lumbosacral orthosis (LSO) might reduce the need for this antagonistic activity by providing passive stiffness to the trunk and increasing spine stability. The maximum reduction in trunk muscle EMG and in the resultant spine compression force due to the LSO was estimated using a biomechanical model. The lumbar spine stability was first quantified for the average trunk muscle EMG recorded from 11 male subjects performing various isometric trunk exertion tasks. Subsequently, the spine-stiffening effects of the LSO were implemented in the model and trunk muscle forces were reduced iteratively until the original level of spine stability without the LSO was achieved. The upper bound estimates of the reduction in trunk muscle EMG due to LSO ranged from 0.6% to 14.1% of the maximum voluntary activation depending on the task and the muscle. The resultant spine compression force averaged across all tasks decreased by only 355 N. A much larger variance of the experimental data precluded the detection of these effects at statistically significant levels. However, the small effects size does not necessarily exclude the possibility of functional benefits of slightly reducing muscle activity in patients with low back pain.

Effect of a Back Belt on Reaching Postures

OBJECTIVE

The present study investigated the effect of a back belt on reach actions.

SUBJECTS

Sixteen undergraduate college students (8 male students, 8 female students) ranging in age from 18 to 22 years. Thirteen subjects were included in the final analysis.

SETTING

The Department of Psychology at Miami University, Oxford, Ohio

METHODS

Using a well-established set of procedures developed in our laboratory for studying reaching, seated adult participants reached for and retrieved an object placed at various distances from them. Reach distances included values both closer than and farther than each subject's maximum seated reach. The reach task had 2 conditions: picking up and retrieving a small block and skewering and retrieving a small bead with a needle. For each task condition, each subject either wore the belt or did not use a belt.

RESULTS

Results indicate that when subjects wore the belt while reaching, they tended to have initial transition points (sitting to nonsitting) closer to their bodies than while not wearing the belt. That is, for a distant object, subjects were more likely to raise their bodies out of the chair rather than perform an extreme seated reach, possibly acting to preserve a greater margin of safety.

CONCLUSIONS

The back belt consistently modified reaching postures by limiting extreme ranges of motion during a task that required enhanced stability. Furthermore, the methodology and analysis presented in this article when applied to chiropractic will allow us to begin thoughtful investigation of the effects of chiropractic adjustments on postural transitions and margin of safety.

Effects of the abdominal belt on muscle-generated spinal stability and L4/L5 joint compression force

The goals of this study were (1) to determine the effects of abdominal belts on muscle-generated active lumbar spine stability, (2) to determine their effect on the subsequent joint compression force at L4/L5 and (3) to determine whether the effective stability of the spine could be predicted by the active spine stability and belt condition. Electromyographic (EMG) and trunk stiffness data from a previously reported experiment in which 10 subjects performed quick-release tasks (perturbation) with and without an abdominal belt were used as inputs to biomechanical models to estimate the active spine stability and effective stability of the spine, respectively. The subjects exerted isometric trunk flexion, extension and lateral bending trials at 0 and 80% of maximum intra-abdominal pressure when the resisted force was suddenly released. Wearing an abdominal belt had no significant effect on either the muscle-generated lumbar spine stability or the L4/L5 joint compression force in any direction. The effective stability of the spine was adequately predicted by the active spine stability and the effect of the belt, which accounted for approximately 34% of the effective spine stability. The study demonstrated that the abdominal belt contributed to the passive stability of the lumbar spine and did not change the active stability for tests performed within the same experimental session.

Effect of belt pressure and breath held on trunk electromyography

STUDY DESIGN

This study examined the effect of a belt on ventilation and trunk muscle activities during repetitive lifting tasks with a control of breathing type and belt pressure.

OBJECTIVES

To evaluate the effect of the lifting belt on the trunk muscle electromyography (EMG) and to parse out potential interaction between ventilatory changes and lifting belts.

SUMMARY OF BACKGROUND DATA

Although both tensed thorax and compressed abdomen are considered to assist transferring the force from torso to pelvis in lifting, there has not been any consideration of the interaction between the two chambers in most published analyses.

METHODS

Eleven male study participants participated in the study. They performed five minutes of paced repetitive squat lifts at frequencies of one or three lifts per minute, with loads of 10 or 25 kg. Belt pressure was set at 0 (no belt), 10, and 20 mm Hg. Study participants lifted with inspire-hold and expire-hold for a period of 5 minutes. Lift ventilation data and trunk muscle normalized electromyography (NEMG) (including rectus abdominis, external oblique, latissimus dorsi, and erector spinae) for the final lift were collected for analysis.

RESULTS

The results indicate that the ventilation demand for lifting was not different with or without use of a belt. The prelifting erector spinae NEMG was 8-11% maximum voluntary contraction (MVC) lower and the latissimus dorsi NEMG was 15-21% MVC lower than that without belt. This is also the case in the lifting phase. The rectus abdominis NEMG was increased by 4% MVC and the external oblique NEMG was increased by 3-5% MVC while lifting with a belt.

CONCLUSIONS

These data do not lead to a statistical effect of lifting belt pressure on ventilatory behavior. It appears that the use of a belt in lifting significantly decreased the back muscular activation yet increased the abdominal muscular activation. Thus, claims of benefits derived from the use of a belt in lifting remain controversial. The simultaneous controls of the air volume held and pressure of the belt during the moment-controlled lifting tasks allowed this presentation of belt effects on trunk muscle NEMG unique from that in most of the literature.

Mechanisms of action of lumbar supports: a systematic review

STUDY DESIGN

A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities.

OBJECTIVE

To summarize the evidence bearing on the putative mechanisms of action of lumbar supports.

SUMMARY OF BACKGROUND DATA

A restriction of trunk motion and a reduction in required back muscle forces in lifting are two proposed mechanisms of action of lumbar supports. Available studies on these putative mechanisms of action of lumbar supports have reported contradictory results.

METHODS

A literature search for controlled studies on mechanisms of action of lumbar supports was conducted. The methodologic quality of the studies was assessed. The evidence for the two proposed mechanisms of action of lumbar supports was determined in meta-analyses.

RESULTS

Thirty-three studies were selected for the review. There was evidence that lumbar supports reduce trunk motion for flexion-extension and lateral bending, with overall effect sizes of 0.70 (95% confidence interval [CI] 0.39-1. 01) and 1.13 (95% CI 0.17-2.08), respectively. The overall effect size for rotation was not statistically significant (0.69; 95% CI -0. 40-4.31). There was no evidence that lumbar supports reduce the electromyogram activity of erector spinae muscles (effect size of 0. 09; 95% CI -0.41-0.59) or increase the intra-abdominal pressure (effect size of 0.26; 95% CI -0.07-0.59).

CONCLUSION

There is evidence that lumbar supports reduce trunk motion for flexion-extension and lateral bending. More research is needed on the separate outcome measures for trunk motion before definite conclusions can be drawn about the work conditions in which lumbar supports may be most effective. Studies of trunk motion at the workplace or during specified lifting tasks would be especially useful in this regard.

Effect of lifting belts on trunk muscle activation during a suddenly applied load

The National Institute for Occupational Safety and Health suggests there is insufficient biomechanical or epidemiological evidence to recommend the use of back belts in industry. From a biomechanical perspective, previous work suggests that lifting belts stiffen the torso, particularly in the frontal and transverse planes. To determine whether lifting belts stiffen the torso and alter the trunk muscle response during a sudden loading event, we tested the hypotheses that (a) lifting belts alter peak muscle activity recorded with electromyography (EMG) during sudden loading and (b) lifting belts have a larger impact on trunk muscle response when sudden loads are applied asymmetric to the torso's midsagittal plane. A sudden load was delivered to 10 men and 10 women without history of low back disorder via a cable attached to a thoracic harness; motion was restricted to the lumbar spine. Results indicate that gender was not a significant factor in this study. The lifting belt reduced the peak normalized EMG of the erector spinae muscles on average by 3% during asymmetric loading, though peak normalized EMG was increased by 2% during symmetric loading. Lifting belts have been shown to slightly reduce peak erector spinae activity during asymmetric sudden loading events in a constrained paradigm; however, the effects of lifting belts are too small to provide effective protection of workers. Actual or potential applications include the assessment of lifting belts as protective devices in workers based on the effects of lifting belts on the trunk muscle activity.