Over the past several months, we have received many inquiries pertaining to the effectiveness of "back belts" and the wisdom of issuing these belts to employees who, as part of their job, are required to perform a lot of lifting. It would seem that the answer to such a question would be quite simple in that back belts would seem to be a very proactive approach to avoiding employee back injuries. We as safety professionals, however, must consider all possible ramifications before making any recommendations concerning the use of these devices to our clients. The fact that these belts are relatively new as a common piece of equipment in the workplace prompted us to research the effectiveness, the benefits, and the hazards of issuing belts to employees. We contacted health and safety professionals from many different agencies including The National Institute of Occupational Safety and Health, The American Conference of Governmental and Industrial Hygienists, and the Bureau of Workers' Compensation Division of Safety and Hygiene. In addition, we obtained many articles from scientific journals and other sources as well as discussing this issue with companies that are presently using these belts in the workplace. We've done some homework and here is what we have found.

HOW THE BELT WORKS

There are many different styles and brands of lifting belts on the market, but all of them function on one or a combination of the following principles. Many belts are designed with a rigid lumbar support, that makes it very uncomfortable for the wearer to bend at the waist. If worn property, bending becomes almost impossible and the wearer is forced to squat in front of the load and lift from the legs rather than placing any stress on the spine. As we know, bending to lift a load is the main cause of back injury. In addition to forcing the wearer to lift properly, many belts are also designed to be tightened around the waist to increase the intra-abdominal pressure. The effect of this feature is to inflate the abdominal cavity so that it supports part of the load, and this helps relieve the pressure on the spine as well as the back muscles. Most belts use one or a combination of both principles to protect the wearer against back injuries. In theory, this idea is a simple solution to a serious problem. When one takes into consideration that approximately thirty-one percent of all workers' compensation cases are related to back injuries, the $35-$60 that a company spends on each belt seems well worth the investment. Since the main objective, however, is to assure the safety of the worker, we must make sure that our good intentions are not just a "band aid" and that we do not actually worsen the problem, or create another, because we were searching for the proverbial "quick fix".

ON THE POSITIVE SIDE

Many industries currently using the belt are pleased with the results. They believe that the lumbar and abdominal support offered by these belts prevent over-stretched muscles and encourage squat lifting. Dr. Richard Schwartz, chair and associate professor of occupational therapy and director of the industrial injury prevention lab at the University of Texas Health Science Center in San Antonio, has conducted a number of studies on back supports and concludes that back supports can be effective. Schwartz says, "What we have found when back supports are given to people following training in proper body mechanics and how to properly wear the belts, is that they lead to significant reduction in lost time compared to true controls. We found that there were no adverse effects that we could measure in terms of constriction of abdominal muscles." Jerry Hipp, corporate safety director for Pure Grow, an agricultural chemical company in California says, "My belt project may be more of a placebo than anything else, but I don't care, because it works." Bethlehem Steel is such a firm believer in back-support belts that they encourage their employees to wear them both on and off the job.¹

Many ergonomists feel that wearers of back support belts mistakenly are lead to believe that they can lift heavier loads when wearing the belt---the "Superman Syndrome". A 1992 study using 652 airline baggage handlers concluded that lifting-belts should not be worn for this type of activity. Several researchers have concluded that prolonged use of the belts actually cause dependency and reduction in the abdominal muscle strength and/or endurance.^2,3 Consequently, there is reason to believe that this dependency may actually increase the chances of back injury when the belt is not worn. A few researchers have also indicated that the increased intra-abdominal pressure caused by using the belt can lead to increased systolic blood pressure impeding blood flow to the heart.

Sanitation also becomes an issue when dealing with back belts. It is advisable that employees not share belts unless the belts have been properly sanitized. It is most desirable, however, to have one belt issued to each employee.

SUMMARY

It is obvious that there is still much research that needs to be done in this highly controversial area. At the very minimum, everyone agrees that lifting belts alone will not eliminate back injuries. Even proponents of lifting belts agree that a successful program is dependent upon employees receiving proper training in lifting techniques and instruction on the proper use of the belt.¹ Since this is a relatively new concept in back injury prevention, it may be years before enough data is gathered to determine whether these belts actually are warranted as a routine piece of personal protective equipment in the workplace. Moreover, the Bureau of Workers' Compensation Division of Safety and Hygiene's official position paper does not endorse lifting belts as "legitimate ergonomic means in the long-term prevention of low back disorders.⁴ We have Included a copy of this position paper along with the National Institute for Occupational Safety and Health's findings for your information. It is our recommendation, therefore, that the employers, begin to address the problem by attacking the cause of these injuries-----improper lifting technique. This can be accomplished through a comprehensive training program. Once this has been successfully accomplished, employers can then begin to study the feasibility of a back belt program to supplement this training. It is our hopes that this approach will allow employers to begin a program to reduce back injuries while more research is done on the effectiveness of back belts. We hope that this newsletter has provided you with some answers to questions that you may have had on this controversial subject. We will continue to follow the research in this area and work with you in you efforts to reduce back injuries.

¹Tomecek, S., "Shop Smart to Help Your Workers' Backs", Safety and Health November 1992, pp 30-33.

²Reddell, C.R., Congleton, J.J., Hutchingson, R.D., and Montgomery, J.F.,"An evaluation of a weight lifting belt and back injury prevention training class for airline baggage handlers". Applied Ergonomics Vol 23 No. 5 (1992) pp 3l9-329.

³Holmstrom, E., and Morttz, U., "Effects of Lumbar Belts on Trunk Muscle Strength and Endurance: A Follow-Up Study of Construction Workers", Journal of Spinal Disorders Vol. 5 No. 3 (1992) pp 260-266.

⁴Bureau of Workers' Compensation Division of Safety and Hygiene "Lifting Belts/Back Supports/Back Braces" Official Statement of Position

Bureau of Worker's Compensation

Division of Safety and Hygiene

POSITION:

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.

RATIONALE:

(1) Back belts in no way eliminate a worker's exposure to the hazard. While there is lifting, there are compression and sheer forces on the spine and stresses on the supporting muscle groups.

(2) There is no direct scientific evidence to validate that spinal compression forces are reduced by increases in inter-abdominal pressure. At this point, there are only hypotheses. ¹

(3) There is growing evidence that with prolonged use of these devices, the lifting structures of the trunk may weaken. Subsequent lifting without the belt has resulted in increased injury rate which may imply physical dependency.^2,3

(4) 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.

(5) Just because supports are provided does not mean they are being used properly if at all.²

(6) The support received from the device may resist "improper bending" and limit motion of the trunk. Whether good or bad, this raises the question "how will the less capable thoracic spine without support react to casual reaches, twists and postures formerly taken on by the more sturdy lumbar spine as the pivotal point of motion?"

(7) Other significant concerns are the increased blood pressure associated with belt wearing and the implications of this for those who may have a compromised cardiovascular system.⁴

(8) The promotion of these devices may lead an employer to overlook sound ergonomic principles. "The ergonomic approach to workplace design must be recognized as the most effective and is the first choice for controlling sources of workplace stress."⁵

NOTES:

The ergonomic approach strives to fit the task to the person, rather than force the person to adapt to the task. Ergonomics through engineering controls treats the cause of the problem, rather than the symptoms. By designing the task such that heavy lifting and bending is eliminated, a greater part of the working population can perform the job at less risk. Administrative controls, such as training and job rotation should not be viewed as primary methods of control. Medical devices, such as lifting belts, are not considered PPE by OSHA⁶ and are to be used only under special circumstances as prescribed by a health care professional.

REFERENCES:

1 McGill, M.S. "The Effect of an Abdominal Belt of Trunk Muscle Activity and Intra-Abdominal Pressure During Squat Lifts." Ergonomics, Feb 1990, pp. 147-160.

2 Reddell, C. "An Evaluation of a Weight-Lifting Belt and Back Injury Prevention Training Class for Fleet Service Clerks." Unpublished masters thesis, Texas A&M University Department of Industrial Engineering.

3 Do Back Supports Work? National Safety Council, 1988.

4 Hunter, et al. (1989). "The effects of a weight training belt on blood pressure during exercise." Journal of Applied Sport Science Research. (3(l), 13-18.

5 OSHA Instruction CPL 2.78, Directorate of Technical Support Appendix A-4.

6 OSHA Meatpacking Guidelines

BACKBRAC.DOC 6/21/93

NIOSH INFORMATION

NIOSH Finds Scientific Evidence Insufficient to Support Use of Back Belts

In response to the increasing number of workers relying on back belts to prevent injury during lifting, NIOSH decided to evaluate the evidence of their effectiveness. After an extensive review of the scientific literature, NIOSH has concluded that there is inadequate scientific evidence that back belts actually reduce the risk of back injury. Moreover, because workers think they're protected, they may attempt to lift even more with a belt than they would have without it, subjecting them to even greater risk.

Rather than relying solely on back belts, the Institute recommends that employers and workers minimize their risk of back injury by developing and implementing a comprehensive ergonomics program. A program of this nature would focus on prevention and:

1. include an assessment of all work activities to ensure that tasks can be accomplished without exceeding the physical capabilities of the worker;

2. incorporate on-going, comprehensive training for all workers on lifting mechanics and techniques;

3. provide a surveillance program to identify potential work-related musculoskeletal problems; and

4. include a medical management program.

September 17, 1994

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