Should you brace yourself against pain?

Watched a strapped-up Venus Williams demolish her opponents this year at Wimbledon? Despite a sore left knee, she stormed into the finals, where sister Serena got the better of her. The knee support she wore helped keep her in the game. “That’s the life of an athlete. Tape and ice and all,” she said, as she soldiered on through the pain.

Closer home, we see cricketers strap on elbow guards, thigh supports, knee pads, back braces and so on, more often in expectation of injury rather than just after it.

For sportspersons, using such supports as protective gear is almost second nature, just as sprains and injuries are an inevitable part of their careers.

But can belting up prevent injuries? A plethora of lumbar belts, posture braces, knee pads and wrist wraps now carry claims of prevention on the Net, in ergonomic office equipment stores and on teleshopping channels. And software workers, desk-job holders, frequent travellers and golfers are the target audience.

A small 2003 pilot study by the department of industrial engineering and management, Ming-Chi Institute of Technology, Taipei, Taiwan, had people perform data entry jobs for an hour while wearing or not wearing a new type of back belt. The researchers’ conclusion: “The new belt seemed to provide support for the back by the counter-supporting force from the knees. The results suggest that (it) may be useful in seated tasks because of its maintenance of lumbar lordosis and erect trunk.” In other words, it may aid posture.

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Brace for occupational safety

In the early 1990s, several companies in the US, from grocery store chains to kindergartens, braced their employees for tasks involving bending and lifting by investing in wide elastic belts fastened by Velcro. The assumption: Additional support would protect them from back injuries. The most famous instance was home improvement retailer Home Depot’s back support use policy. A 1996 University of California, Los Angeles, School of Public Health study of 36,000 Home Depot workers found lower back injuries reduced by 30% after it mandated the belts.

This reversed the findings of a 1994 study at the US National Institute for Occupational Safety and Health (Niosh), which concluded that “the effectiveness of using back belts to lessen the risk of back injury among uninjured workers remains unproven”. Niosh continued its studies till 1998, though, and stuck to its guns.

Through the 1990s, the debate on braces focused mostly on non-white-collar jobs. Now, braces are back in the news as a preventive measure for sedentary white-collar employees (read software workers and bankers). The claims: that a back brace can prevent strain while driving, lifting weights in the gym or swinging a golf club; that “executive” back supports ensure correct posture at the desk; that a soft neck collar prevents neck strain while travelling; and that an overnight wrist splint can prevent soreness and repetitive stress injury from long hours of typing.

Some companies appear to buy these claims. Recently, a US-based software giant reportedly ordered belts for its developers. However, doctors and ergonomic consultants are reluctant to endorse braces. Some see these as exoskeletal accessories that can compensate for weaknesses or undue stress in the right circumstances. While most specialists agree that braces can support your back and shoulders, improving your posture, there is no consensus that they do much more than immobilize an injured limb. And doctors are quick to point out the risks in using them as preventives.

There’s no denying that everyday living takes a huge toll on our spinal system and joints. Prolonged sitting and standing, bending, twisting, lifting, ill-designed furniture, non-ergonomic transport, ill-fitting clothes, even sports and leisure activities can give rise to back and joint strain, says K.N. Krishna, consultant neurosurgeon, Wockhardt Hospital, Bangalore. However, as Bharati Jajoo, occupational therapist and co-founder, ErgoWorks—which has several major software companies in Bangalore as clients—says: “People cannot rely on gadgets for prevention. What is needed is awareness and proactiveness.”

Worn too long, braces can make “hibernating” muscles slack. “The brace is artificially doing the same job your muscles should be doing,” says Rajat Chauhan, a practitioner of sports and exercise medicine and musculoskeletal medicine, who runs the Back 2 Fitness chain of clinics.

US-based Mayo Clinic’s prescription: “Limit use to intermittently several hours a day.”

Shyam Pingle, president of the Indian Association of Occupational Health, warns that these “supportive” products could lull you into a false sense of security. If you wear a brace instead of adopting lifestyle correction techniques, you will still be in for trouble.

If the brace fits…

Dr Chauhan says an additional problem is that many people are choosing the wrong product or wearing it incorrectly. He’s even seen patients wear their braces back-to-front or upside down, besides keeping them too tight or too loose. The soft neck collar that many spondylosis sufferers choose (often out of cosmetic considerations) gives only 5% relief, while a rigid collar offers more relief. Also, quality customized braces are a far cry from cheap ones, which could be unscientifically designed.

Such supports do aid rehabilitation from back pain, sprains, and tennis or golf elbow by restricting motion. But, as Dr Chauhan says, “They work like Sellotape and stick temporarily...they are really not fixing anything at all. They provide relief in the short term, and help during the healing process; for (a) permanent cure, you need to get at the root of the problem.”

The medical consensus appears to be that braces act as a preventive only where there is a history of damage, that too only if correctly fitted by a doctor or physiotherapist (also see Treat and Surf, below).

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SUPPORT OPTIONS

Soft foam collars (often wrongly used for pain relief) can be used occasionally for preventive care—to relieve muscle tension during travel or watching TV. Do not wear for more than 30 minutes to 1 hour, and leave off for double that time before putting it on again.

Forearm support: It is used in preventive care for those at risk of, or with a history of, tennis elbow.

Back brace/support: There are at least four-five different types, depending on which region you want to protect (lumbo-sacral, dorso-lumbar, cervical, etc.). An executive back support, for instance, supports the lumbo-sacral region, helping maintain proper posture while sitting at a desk or travelling. More flexible back supports for golfers are meant to be strapped on when executing long drives, and similar ones are recommended for weightlifters or industrial workers lifting heavy objects, even new mothers repeatedly picking up and putting down toddlers, etc.

Wrist wrap: This breathable elastic band offers mild compression over the wrist joint. It is indicated for preventive care during sports activities, driving and jobs involving repetitive wrist movement.

Wrist splint: This rigid but light metal splint holds the wrist in a neutral position. It can help manage carpal tunnel syndrome. It should be used at night or while the wrist is at rest.

Knee support: It can help prevent mild strain during games such as tennis or while using a treadmill.

Ankle wrap: It is used in sports such as cycling, football, etc.

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CONNECT

Bed rest is bad for back pain

Don’t rest that bad back. Contrary to popular belief, rest is not always the best solution for back pain, say doctors. Almost all specialists say bed rest is the worst way to deal with “uncomplicated” back problems (lower back pain, sciatica, etc). Unfortunately, this is what most people tend to do when their back hurts: Rub on muscle relaxants or heating ointments, pop a few painkillers and lie back. Two weeks of bed rest will make the muscles lazy, deplete calcium and lead to unnecessary workdays lost, points out Vijay Sheel Kumar, neurosurgeon, pain specialist and honorary chairman and co-founder of Doctor Kares Hospital, Delhi. Unless you have a slipped disc or ruptured tissues, an active exercise programme is more likely to lead to sure and speedy recovery. CHITRA NARAYANAN

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Monsoon = dehydration= fatigue!

Even as water drips from the skies, your body can actually be parched.

Why it happens: “Excess sweat (thanks to humidity) leads to loss of not just water but salts too,” says Nalin Nag, consultant, internal medicine, Apollo Hospital, New Delhi. Sweat does not evaporate, your body doesn’t cool as well, so it tries harder to lose heat with more sweat. “Muscles need a good electrolyte-water balance. Even mild dehydration, as little as a 1-2% loss of your body weight, can sap your energy,” adds Dr Nag.

Heed the signs: “Dry lips and tongue, headache, nausea and muscle cramps and most often, extreme fatigue, are telltale signs,” he adds. And as we’ve said before, by the time you’re thirsty, you’re already dehydrated, so avoid waiting till then to drink. KAVITA DEVGAN

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Contraceptive pill increases the risk of blood clots fivefold

Doctors should prescribe birth control pills that are least likely to cause blood clots, say researchers in a study published in the ‘British Medical Journal’ in August. Oral contraceptives containing levonorgestrel and a low dose of oestrogen were associated with the lowest risk of blood clots in the leg or lungs, researchers at Leiden University Medical Center, Netherlands, found. Desogestrel, cyproterone acetate or drospirenone carried about 1.5-2 times the risk. But any kind of contraceptive pill increases the risk of blood clots fivefold, the authors said, confirming earlier studies. BLOOMBERG

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