Introduction

The use of back or kidney belts as a personal protective device against back injury and to reduce back pain has been the subject of a long ongoing debate and much controversy. The existing scientific evidence or lack of it on the one side of the argument is challenged by the beliefs of users and vendors of these devices who reference almost as many positive studies and anecdotal evidence to prove the effectiveness of the belts.

The belts are usually used during manual lifting activities and sold as a protective device to offer support of the spinal column and "strengthen the back by supporting the muscles of the back whilst lifting heavy loads". The mechanism by which these devices are supposed to protect a worker have been the subject of their own controversy with some claiming that the intra-abdominal pressure increase as a result of the pressure exerted by the belt on the abdomen helps to support the back and vertebral column, others claim it could act as a reminder to workers during manual lifting not to lift too much and to keep their back in mind when lifting so as not to injure it. Others have said that the warming effect of the belt may aid in keeping the muscles of the back warmed and ready for work whilst lifting, thereby offering more supple muscles which are not as easily injured. Most scientific studies carried out to date have shown that either no evidence can be found as to their effectiveness or ineffectiveness. Some however indicate the belts have an adverse effect on worker health especially when they stop wearing them, and increase the prevalence of back injuries, perhaps due to a false sense of security when wearing them, or a weakening of the back muscles that make them more susceptible to injury.

The controversy regarding manual lifting and back belts rages on around the world where they are sold and used in many countries overseas and in South Africa.

In South Africa it has become more and more common to find forklift and other drivers using these devices as a protective device against whole-body vibration in order to prevent lower back pain and other musculo-skeletal effects. This practice is not followed in any other country as far as is known for industrial purposes, and may be unique to South Africa.

The devices are also called back belts, lifting belts, abdominal belts or back support belts in various countries when they are used for lifting activities in the workplace. A different type of lifting belt may be used for sports weight -lifting usually made of leather. They are however also known internationally and locally as kidney belts when used by sportsmen usually in off-road motorcycle riding such as motor-x or enduro racing or off - shore boat racing and snow mobiles. This has sometimes led to confusion when the terms are used inter-changeably, even though the devices and their use differ from country to country and application.

The devices themselves, vary in design, but are generally manufactured from layers of elasticised material, with Velcro ends for attachment and adjustment, and may or may not have vertical support stays for additional support. The belts are usually thicker at the back and narrower at the front and are stretched around the person's lumbar region and waist area and fastened by Velcro at the front or side. This then is claimed to offer support to the lumbar area, by increasing the intra-abdominal pressure and supporting the spinal column, and surrounding organs.

The kidney belts are used as a kidney support device in motor sport applications, such as off road motorcycle racing, and apparently help to hold the kidneys in place during rough terrain riding, and is supposed to prevent kidney bruising and blood in the urine, and are also non-specifically said to reduce pain. Reference is made to reports in the motor-cycle magazines as to the effectiveness of the kidney belts in reducing or eliminating low-back and kidney pain, supporting the kidneys, and internal organs. These are however personal opinions of commercial vendors of these belts and specialist off-road motorcycle magazines and offer no posting of scientific evidence to support these views or findings.

In South African industry today it has become common practice amongst many forklift drivers to rely on kidney/ back belts as a back support device to "prevent" lower back pain and injury.

It is not known why or where the use of these belts by forklift drivers first originated in South Africa, but it can be surmised that they could have originally been used as a device that crossed over from their original use in motor - cycle off road sport.

This type of use is on the increase in industry today, and drivers request these devices from employers more frequently. The main guiding principle of occupational hygiene hazard control is one of engineering controls first and personal protective equipment as a last resort. This fact is largely ignored in industry in deference to other types of

personal protective equipment from ear protection to respirators and other devices. Adopting the "cheap", quick fix solution often seems the best and are usually the major control measure considered first by employers, or requested by employees. Back and kidney belts should be used with caution until further scientific and conclusive proof is available as to their effectiveness, and special care should be taken with workers with compromised cardio-vascular systems due to the increase in blood and intra-abdominal pressure that may add further stress to the system.