I only recently began to carry back braces. Prior to this point, I would simply order one when a patient came to me complaining of acute lower back pain.

The turning point came when a patient came to me after injuring her low back while packing her house for a move across the country. She was antalgic, in moderate-to-severe pain, and frantic because the movers were coming in 1 week. She feared she wouldn't be ready as she couldn't pack anymore due to the pain.

I suspected a sprain/strain of the iliolumbar ligament due to overuse, and treated her accordingly. After treatment, I recommended she rest and ice for the rest of the day despite the fact that she felt substantially better after treatment. She protested, and I worried she was going to attempt to pack anyway due to her time constraint.

I voiced my concern, explaining that it was important she not continue bending and lifting boxes, and suggested a back brace to support her when she resumed packing. The problem was that it was Friday; the brace wouldn't arrive until Monday.

Therefore, I suggested she pick one up at a local drugstore in the event that she couldn't wait through the weekend. I explained that a brace would stabilize her lumbar spine, as well as support her when she needed to bend, limiting the amount of movement in her low back so she wouldn't further aggravate the problem, and this would allow it to heal. She took my advice and picked one up at a drugstore for $20.99.

Fitting In

I ordered a back brace from Meyer Distributing. I chose a Criss Cross Lumbosacral back brace, meaning you pulled one side around your belly from the back, then the other side, and it Velcros at the middle of your belly. I chose it for the price. It cost $13.99, and I would sell it for $20 plus shipping. I got one small and one medium in case the sizes weren't accurate; the small is for a 28- to 32-inch waist. The medium was for a 32- to 36-inch waist. The measurement is taken at the widest point—your hips. I chose a lumbosacral brace over a cheaper Sure Fit Lumbar Brace because her injury was to the L5–S1 area, and I wanted to limit movement at this level completely.

This means if she tried to bend over, the brace would limit her movement in the lumbar spine and the sacrum. The ilio-lumbar ligament goes from the ilium to the lumbar spine at L5. A sprain to this area means the ligament has been taxed, pulled to the point where it is peeling from the bone.

In an effort to understand how they worked, how they should be worn, and to make sure she got the right size, I tried them both on myself. I put the small on first; it felt super tight, the amount of effort needed to pull it around my waist resulted in the need to brace oneself, as it was a very tight fit. This wasn't a problem for me. However, I imagined it would be a problem for someone with acute low back pain.

I assumed it ran small and tried the medium. This was much easier to get around my waist, and I didn't have to brace myself so much to pull it from each side. I wore it for about 30 minutes to get a feel for it and decided it wasn't tight enough. Although it initially felt more comfortable, it allowed too much movement. I settled on the small. The intention is to limit movement. It needed to be tight. The patient arrived for her appointment complaining again of moderate back pain, she was also antalgic once again.

Back to the Store

On my request, she had brought the drugstore brace in with her. I asked her to put it on; I was interested to see if it supported her well enough. I realized that it was generic in that it only supported her lumbar spine. It did not extend to her sacrum. She stated she had a 30-inch waist, so I handed her the small. Her instinct was to wrap it around her waist, rather than her hips. I explained the proper way to wear it. I noticed that I had been correct in my assumption that she would exacerbate her pain in her attempt to pull it around each side of her waist; she winced while pulling each side around her waist. She felt it was too tight. Although she liked the way the medium felt better, she agreed that it allowed too much movement and not enough support. She went home with the small.

Body Sport's two-pull lumbosacral support brace allows the patient to wrap the brace around his or her waist first, then provides two pulls, one on each side.

She came in one more time that week feeling much better. She was no longer antalgic and her pain had decreased, despite the fact that she had been packing all week. She stated she had worn the brace as instructed, and she had returned the other brace to the drugstore. She said the difference between the one she purchased and the one I purchased was remarkable.

The experience taught me several things. First, I now carry a small inventory of back braces. I have each size available. Also, I understand that buying a back brace in a drugstore is not comparable to a back brace ordered from the doctor. I have switched to using back braces by Body Sport. The company sells a two-pull lumbosacral support brace that allows the patient to wrap the brace around his or her waist first, then provides two pulls—one on each side—that draws it up tight.

Sharon Ihlefeld, DC, practices in Los Gatos, Calif. Contact her at .