Intensive corset use can aggravate GERD, especially if wearing it when people are sitting. If people are sitting a lot they should consider using a taller chair to make the corset more comfortable.
The second symptom is unusual pressure points from the stays in the corset. Because an appropriate corset has metal stays and some plastic stays, sometimes these can irritate people who are short-waisted.
Notes: The metal stays in the back rarely irritate, can be bent away from the spine, and can be easily smoothed to fit the exact location in the center of the spine. The plastic stays in the front sometimes need to be removed but do not decrease the function and stability of the brace.
Muscle atrophy has been described but is rarely a problem. If patient is without pain, is walking and doing core exercises then increased strength follows. Patients are frequently stronger than they were prior to having the disc injury after doing this program for several months.
CORSET USE AND FITTING
In the acute patient, the corset is best fitted with a patient in the supine position where they are more comfortable and the brace can be fit. The choice of brace should be made primarily on the criteria that it has metal stays, is made with elastic and that it can firmly wrap around the abdomen. Because, in the supine position, the intradiskal pressure is 0, putting the corset on when the patient is lying down prevents a rise in intradiskal pressure when they stand up since the corset reduces the intradiskal pressure by 30% when the patient stands up. This and the immobilization primarily ensures that the nerves start feeling better almost immediately after a corset is placed.
The patient should be fitted with a brace and walked around to make sure it feels good and that it fits. Patients should be told that walking with the brace is the very best activity they can do. They should be told that because nerves take three times longer to heal than simple muscle injuries, a corset may need to be worn for six to twelve weeks to protect the nerves and strengthen the muscles.
The corset should be worn 100% of the time while they are up in patients who are in the acute condition. As time goes on, and when they become more chronic, they can be used only for activity which will bring on pain, such as standing in the kitchen, gardening, tennis, and other outdoor activities. Sitting in low chairs is contraindicated with the back brace. Sitting in a higher chair is an effective way to keep intradiscal pressure reduced.
How to Fit a Corset
More Corsets - Less Opioids
The More Corsets/Less Opioids Program was begun for the Family Practice residents at the Contra Costa County Regional Medical Center in Martinez, California, a San Francisco Bay area city, in 2011. Inspiration for the program came from two directions: 1) the frustration of residents with many patients unnecessarily taking regular addicting doses of hydrocodone and 2) the lack of good options for other pain management in a County setting. The powerful New England Journal of Medicine perspective “A Flood of Opioids, a Rising Tide of Deaths” (November 18, 2010) pointed out to all of us that something must be done about this epidemic. A professor of Pain Management at UC Davis, in commenting about the use of hydrocodone in low back pain, said in 2011 “ This experiment in pain management has been a disaster.”
The CCCRMC has a long history of conservative care in orthopedic spine issues including staff physicians who used to prescribe corsets before Modern Pain Management told us “back braces don’t work" and "they make your muscles weak”. With a 40 year history of successful use of corsets in relieving low back pain, the Family Practice Residency has, since 2011, had yearly reviews of the More Corsets, Less Opioids Program for all residents.
The residents now feel they have a “biomechnical pain reliever” instead of a potentially lethal narcotic Rx. As you might suspect, corset use has risen dramatically from 2011-2015. The residents are happier and the patients are at little risk at addiction.