Although this figure is obtained from conjecture – as there is no substantial evidence dating the use of such therapeutic devices – we can safely assume that humans have been subject to lower back pain for as long as humans have existed. In more recent times in our history, our European ancestors may have known about the relief of lower back pain by using lumbar supports of various types.
The Voyageurs (the great canoe men) of the North West Company during the Canadian fur-trade era were faced with the challenge of carrying 40-kilogram bales of neatly packed furs to bring back to Eastern Canada bound for the Old World. The Voyageurs of the North West Company had to also carry the 40-kilogram bales of supplies from Quebec west, as far as the Pacific and the Athabaska region of north-western Canada. All the Voyageurs wore elegant, family-designed sashes around their wastes. Some were definitely intended for Sunday use, but most sashes were worn for the additional strength these provided the lower back and for heavy lifting. Some Voyageurs are said to have been able to carry up to three bales (121 kilograms) during the many portages encountered on the canoe trips to and from Montreal.
The sash came from France along with the first French settlers and was made of strong woven materials, such as wool or cotton, used as belts to secure the lower spine. The sash was positioned between the trochanters and the Iliac crests and secured tightly. These men were usually short with wide shoulders and small buttocks that enabled them to fit among the bales of merchandise in the long Montreal canoes.
Being in practice since 1966 has allowed me to have substantial experience using the trochanteric belt and the classic lumbar corset regularly in cases of lower back pain. For many years, as part of chiropractic care, I utilized the classical lumbar corset support to stabilize the lower back to relieve back pain. While the lumbar corset seemed to relieve many aspects of lower back pain, I found ultimately that the trochanteric belt worked just as well, in many cases. It was when I finally combined what I learned while studying motion palpation under Dr. Henri Gillet and my subsequent training as a board certified chiropractic orthopedist, that I became an ardent user of the trochanteric belt, as opposed to the lumbar corset.
I will explain why I believe that, in most instances where lower back support is required, the trochanteric belt is far more efficient than the classical lumbar corset for the L4-L5-S1 area. I am not discounting the use of the corset for higher lumbar or dorso-lumbar problems, however.
The trochanteric belt is also called the sacro-iliac belt because of its positioning over the sacro-iliac joints (SI) slightly above the trochanters, stabilizing or limiting the peculiar movements between the innominates and the sacrum. Any inspection of the joint surfaces of the SI joints will create the impression that the pockmarked appearance serves to stabilize the articulation to provide the strength and rigidity to support the entire spine and its relationship to the coxa.
While this is true on one hand, these abundant, mogul-like protuberances also allow the multi-faceted motion typically seen on motion testing of the SI joints to create amazing flexibility with great strength.
For example, applying pressure on the lateral side of the pelvis will cause the entire pelvis to shift to the opposite side. Motion palpation of the SI joints, by having the patient flex the knees on the thighs, will cause the posterior superior iliac spine (PSIS) to descend inferiorly. Actually, the SI joints are capable of the entire range of movement possible because the SI joints are completely gyroscopic in function. The hundreds of tiny moguls serve to allow all possible movements within a very tiny space. This also says a lot about the versatility of movements of the pubic joint, the L5 – S1 spine and the coxa as these joints act in concert with all the SI movements.
Palpating the SI joints while wearing the trochanteric belt (in the standing knee flexing position) still has the diminished characteristic movements of the PSIS. The overall effect of the SI belt is to significantly limit the movement of the lumbo-sacral joint while allowing the coxa and the pubic joint to compensate for the lack of the full excursions of the SI joints. This is especially important in any L-S facet syndrome and any L4-L5-S1 disc syndromes – especially disc protrusions.
Understanding the function of the trochanteric belt allows practitioners to decide which lumbar support will work best for patients. Probably the best overall lumbar support would be one where the SI joints are stabilized for the L-S spine and the mid- and upper lumbar vertebrae are supported by the abdominal corset by intra-abdominal pressure against the anterior lumbar spine and secondary support of the posterior lumbar spines between the pelvic crests and the lower ribs. This would be an ideal lumbar support system that covers all bases.
However, the best lower lumbar support, in my opinion, is still the classic trochanteric belt.