The foregoing information indicates a somewhat mixed bag of evidence - some in support of back belts and some in opposition. Evidence supporting use of back belts includes some restriction in end-range motion of twisting and side bending, clinical evidence of a decrease in lost-time back injuries among those with prior back injuries, and a suggestion of increased trunk stiffness which may be of some benefit. Evidence in opposition of back belt and a "false sense of security" that may lead workers to overstrain their backs. This review of the literature indicates that the following approach to use of back belts be followed (following McGill, 1993): 1. Back belts should be treated as prescription item and should be provided only to individuals having had a previous back injury. These workers should be weaned from the belts as soon as it is appropriate. 2. Back belts should not be universally distributed to all workers at a worksite, given the lack of demonstrated effectiveness among uninjured workers and potential increased risk of injury after discontinuation of use. 3. Individuals considered for a back belt prescription should be screened for cardiovascular risk, due to the increased blood pressure associated with belt use. 4. Individuals using back belts should be required to participate in a mandatory exercise program, and should continue in the program after being weaned from the belt during the period of increased back injury risk. 5. Workers using back belts should be exposed to a mandatory education program, to ensure that the back belts are used properly. 6. A full ergonomic assessment of the workplace should be performed to reduce any physical hazards that may increase the incidence of back injuries. The evidence presented in this paper suggests that back belts have a rather limited role to play in controlling the costs and incidence of back injuries. Reliance on back belts as a sole method of combating this problem clearly does not provide an effective solution. Effective back injury control programs tend to emphasize job redesign, where the worker's job is changed to reduce the amount of manual lifting that has to be done (or the lifting that must be done is made easier). Methods of job redesign applicable to the mining industry are contained in the Bureau of Mines Information Circular 9235 (Gallagher et al., 1990). Employers who are interested in keeping the cost of back injuries down are encouraged to focus on job design as a primary method of injury control, and if back belts are to be used, careful consideration should be given to the factors discussed above.