Patent Publication Number: US-2021177638-A1

Title: Back support belt

Description:
The invention relates to a back support belt system, in particular a back orthosis or reclination orthosis for the treatment and prevention of back problems. The system comprises a pelvis strap and two independent left and right shoulder straps extending therefrom, those shoulder straps crossing each other in the back and ribcage region and being connected to the pelvis strap via tension straps, for simultaneously tensioning the pelvis strap and the shoulder straps. 
     Back support belt systems are used to straighten the upper body, i.e., for the treatment and correction of bad postures and curved spines, for example, in the case of osteoporosis. Known back support belt systems and orthoses essentially consist of a pelvis strap, which can be closed under tension over the pelvis or hip of a patient, or generally a wearer, and which is then intended to form a basis for the application of force on the back. Known systems also contain straps or support rails which extend from the pelvis strap and which are intended to reposition or support the shoulders in spatial relation to the spine or the upper spine portion in relation to the lower spine portion through a targeted application of force. Through the interaction of these elements, the spine of the wearer is supposed to be mechanically stabilized and, above all, straightened in the region of the shoulder and the upper thoracic spine. The more the shoulder straps are tensioned, the more the shoulders are supposed to be pulled back, by means of which the upper body can be straightened. 
     Back support belt systems are also intended to help reduce stress on the back when lifting and carrying loads, in particular avoiding excessive stress, in that the forces generated especially in the region of the shoulders are purposefully absorbed and distributed. When lifting and carrying loads, support belts are intended to introduce the forces acting primarily on the upper body via arms and shoulders directly into the pelvis or the torso. In this way, the spine is supposed to be bypassed and relieved. In addition, a back support belt system is intended to remind the wearer to assume a harmful, burdensome relieving posture in the case of an excessive poor posture of the upper body, and to convey a feeling of safety and stabilization. Back support belt systems are thus also intended for the occupational safety of healthy people. At the same time, the back support belts are supposed to guide and limit the movement in a controlled manner in order to avoid bad postures unfavorable for the back when lifting or carrying loads. This is expedient in occupational safety, rehabilitation and certain sporting activities. 
     The disadvantage of known back support belt systems or back orthoses of this type is the complex structure, which makes it difficult for the wearer to apply and why incorrect use can hardly be ruled out. The mostly rigid design of known bandages with support elements and straps helps to achieve a support effect, but an individual adaptation to the specific indication situation, to the specific therapy requirement and/or to the anatomical circumstances of a wearer is not possible to a sufficient extent. Particularly a movement of the user results in certain movement phases, in the case of particular stress or even when tensioning the back support belt system during application or afterwards, in an unwanted slipping of the support belt system on the body (migration) to a position that greatly affects the wearing comfort and can render the orthosis essentially ineffective. In particular, patients with restricted mobility find it difficult in practice to apply such belt systems and to generate the necessary tension on the support elements and on the pelvis strap even after they have been applied. It can also be difficult to apply an orthosis that has already been set up for the purpose of sufficient support, i.e., a pretensioned orthosis, under said tension. Pretensioned shoulder straps can pull a pelvis strap, to which they are connected, unfavorably upwards, particularly into the upper waist portion in the direction of the lower ribcage, even during application, so that a functional fit on the pelvis can no longer be achieved. 
     Therefore, the technical problem addressed by the invention is that of improving such back support belt systems or back orthoses, such as reclination orthoses, which are based at least on a basic structure containing a pelvis strap frame with force-introducing shoulder straps extending therefrom, so that it is easier to apply them to the wearer and in addition, a migration of the system, especially of the pelvis frame, is effectively prevented as soon as it is applied or during use, especially during a movement of the wearer. As a result, the support and relief effect of such systems is supposed to be improved and can also be maintained over the entire duration of wear. 
     The technical problem is completely solved by the new type of back support belt or back orthosis design according to the claims. Said back orthosis or back support belt system comprises at least the following elements: An at least in portions stretchable pelvis strap to be applied around the pelvis of a wearer, having a middle portion that can be positioned in the lumbar/sacral region in the applied state and left and right side portions that extend laterally therefrom and pull ventrally when applied, a right shoulder strap loop which, according to the invention, extends solely from said left side portion of the pelvis strap to be applied over the right shoulder of the wearer, and a left shoulder strap loop which, according to the invention, extends solely from said right side portion of the pelvis strap to be applied over the left shoulder of the wearer. It is therefore provided that both ends of a shoulder strap loop begin on the opposite (contralateral) pelvic strap side, i.e., they cross the torso of the wearer on both the back (dorsally) and in the abdomen or chest region of the wearer. In this case, it is particularly provided that the right shoulder strap loop and the left shoulder strap loop cross each other in the applied state in a dorsal central upper crossing point, in a dorsal central lower crossing point in the applied state and particularly also in two lateral crossing points in the applied state, particularly in the region of the ribcage or the waist. 
     According to the invention, said two shoulder strap loops are each connected at their at least one end to the pelvis strap via a, preferably inelastic, tension strap that, via at least one first deflection element, runs to the respective side portion of the pelvis strap and is deflected, so that it runs along on or even in the pelvis strap in a sliding manner to the respective pelvis strap end, i.e., to the ventral portion when the orthosis is applied. The tension strap—and thus the respective shoulder strap loop connected thereto—can be tensioned and, in particular, can be fixed at the respective pelvis strap end. 
     Therefore, in a first aspect of the invention, a back orthosis is provided, comprising: a stretchable pelvis strap to be applied to the pelvis of a wearer, having a middle portion that can be positioned in the lumbar/sacral region in the applied state and a left side portion extending laterally therefrom with a left pelvis strap end and a right side portion extending laterally therefrom with a right pelvis strap end, wherein the pelvis strap ends are connectable to each other under tension for application; a right shoulder strap loop to be applied over the right shoulder of the wearer, which is connected via both its first end and also its second end alone, i.e., exclusively, to the left side portion of the pelvis strap; a left shoulder strap loop to be applied over the left shoulder of the wearer, which is connected via both its first end and also its second end alone to the right side portion of the pelvis strap; wherein the right and left shoulder strap loop are each connected at least at their respective first ends to the pelvis strap via a first tension strap, and wherein the first tension strap of the right shoulder strap loop runs via at least one first left deflection element which is arranged on the left side portion and runs along on or in the pelvis strap towards a pelvis strap end in a sliding manner, where it can be tensioned and fixed thereto, and wherein the first tension strap of the left shoulder strap loop runs via at least one first right deflection element which is arranged on the right side portion and runs along on or in the pelvis strap towards a pelvis strap end in a sliding manner, where it can be tensioned and fixed thereto. 
     For this purpose, it is provided in a first embodiment that the first tension strap of the right shoulder strap loop runs via at least a first left deflection element which is arranged on the left side portion, crosses the middle portion and runs along on or in the right side portion of the pelvis strap towards the right pelvis strap end in a sliding manner, and wherein the first tension strap of the left shoulder strap loop runs at least via a first right deflection element on the right side portion, crosses the middle portion and runs along on or in the left side portion of the pelvis strap towards the left pelvis strap end in a sliding manner. 
     In a further embodiment alternative to the first embodiment, it is provided that the first tension strap of the right shoulder strap loop runs via the at least one first left deflection element, which is arranged on the left side portion, and runs from the first left deflection element in the direction of the middle portion to at least one second left deflection element arranged on the middle portion and from there, runs along the left side portion towards the left pelvis strap end, and wherein the first tension strap of the left shoulder strap loop runs via the at least one first right deflection element, which is arranged on the right side portion, and runs from the at least one first right deflection element in the direction of the middle portion to at least one second right deflection element arranged on the middle portion and from there, runs along the right side portion towards the right pelvis strap end. 
     According to the invention, “tension strap” primarily refers to an essentially inelastic, i.e., tensile-resistant, flexible strap in the form of a woven belt. Functionally equivalent designs, such as chain or link belts, straps made from solid material of flexible polymers and metal bands are also included herein. Alternatively, it also refers to tension ropes or tension cords, individually or in a combination of parallel or interwoven cords. In particular, it is provided that the tension straps, particularly in comparison to the shoulder straps, are not stretchable, i.e., essentially inelastic and tensile-resistant. 
     According to the invention, “deflection element” refers primarily to an eyelet or ring for a strap or a rope to be guided through, but also to a mounted roller or roller block. An anti-slip or a slip-improving coating can be provided, depending on the focus of the application and the specific tension strap guide (see below). 
     In the present case, “wearer” refers to a person who applies and uses, i.e., wears, the belt system according to the invention, for example, as part of occupational safety measures in order to prevent excessive stress or poor posture when working, especially when carrying loads. It also refers to a patient who applies and uses, i.e., wears, the belt system according to the invention, for example, as part of therapeutic measures in order to counteract excessive stress or incorrect posture of a previously damaged, diseased musculoskeletal system or to allow for a targeted movement guidance in the sense of therapy for the diseased musculoskeletal system. 
     According to the invention, the tension straps are guided on or in the pelvis strap along its longitudinal extension such that the shoulder strap loops can be tensioned, i.e., respectively facilitated by said tension straps, when the pelvis strap is stretched, in particular while the orthosis is applied to the wearer or afterwards. It is particularly provided that, when they are in the applied state, the shoulder strap loops can be tensioned separately on the pelvis strap via the tension straps. 
     It is also provided that, by tensioning the shoulder straps on the pelvis strap, i.e., the respective tension straps connected to the shoulder strap loops, in particular while the orthosis is applied to the wearer or afterwards, the pelvis strap itself is also tensioned, i.e., can also be tensioned further. 
     According to the first embodiments, the pelvis strap is advantageously also tensioned together with the tensioning of the shoulder strap because the two lateral and central deflection points move towards one another due to the tension on the tension strap. In the second embodiment, the pelvis strap and the shoulder strap can be tensioned separately. This is especially also possible for elderly patients with restricted mobility. Since particularly the ends of the tension straps of the shoulder straps can each be fixed directly to the pelvis strap, for example, by means of Velcro elements and/or can be tensioned there by separate tensioning devices on the side portions, a quick and easy adjustment of the shoulder strap tension is possible even while the back support belt system according to the invention is worn. 
     If the pelvis strap is applied under tension around the pelvis or hip of the wearer by closing the two pelvis strap ends, especially in the region of the abdomen of the wearer, the pelvis strap, according to this aspect of the invention, can be tensioned or tightened further in that tension is applied to the tension straps of the shoulder strap loops guided along the pelvis strap according to the invention in order to tension the shoulder straps. It has been shown that the tension of the pelvis strap can increase proportionally to the increase in shoulder strap tension, which results in a better fit and a better hold of the pelvis strap. An unwanted migration of the pelvis strap when tensioning the shoulder straps can thus be avoided. 
     For this purpose, it is particularly provided that the tension straps each have free tension strap ends which can be fixed directly to the respective pelvis strap ends for tensioning. This can be achieved in an inherently known manner using releasable connecting elements. Hooks and eyelets or, alternatively or additionally, Velcro hooks, in particular on the side of the free tension strap ends, and Velcro counter elements, especially velour, in particular on the side of the pelvis strap end, are preferred. A location-variable positionability of the tension strap ends at or on the pelvis strap ends is preferred in order to make the tension and direction of tension individually adaptable. This is achieved in particular by means of large surfaces formed on the pelvis strap ends, having Velcro counter elements, or by a plurality of surfaces spaced apart from one another. 
     The invention thus particularly allows for a practically two-step tensioning when applying or using the orthosis: Once the pelvis strap ends are closed, possibly under initial tension, the pelvis strap can be tightened further in a first tensioning process using the free tension strap ends; in this first step, the tension introduction preferably first leads to a tension that runs radially around the hip or the pelvis of the wearer, thus applying the pelvis strap in a better and tighter manner. In a second step of the tensioning process, the two shoulder strap loops can be re-tensioned via the two other laterally lying free tension strap ends. Both tensioning processes can be carried out simultaneously in one tensioning step, or in several separate tensioning steps that can be distinguished noticeably by exertion of force and/or tensioning effect on the pelvis and shoulder straps, in particular on the basis of the specific arrangement and guidance of the tension straps and the deflection elements on the pelvis strap and on the basis of the static and sliding friction conditions of the fixed or running straps on the deflection elements and along the pelvis strap. 
     Due to the dynamic force distribution of the shoulder straps on the pelvis strap, which is made possible in particular due to the slidingly guided tension straps of the shoulder straps, the tension force can advantageously be distributed dynamically in the back orthosis depending on the state of movement of the wearer, without resulting in local excessive tension and thus unwanted migration of the back orthosis. In particular, the arrangement according to the invention allows for the tensioning force, which holds the pelvis strap through static friction on the pelvis or iliac crest of the wearer, to be in an appropriate and always adjusted relationship with the tensioning force of the shoulder straps, whereby excessive tension of the shoulder straps, which reduces the holding force of the pelvis strap (static friction), can be effectively avoided. As a result, an unwanted migration of the pelvis strap and thus the back orthosis is prevented. 
     In this case, it is advantageously also made possible that, when applied to the wearer, the elastic pelvis strap is stretched for tensioning and closing the two side portions, whereby the tension straps, particularly in the form of tension belts and/or tension ropes or tension cords, which run along the pelvis strap, particularly between the respective side portion and the central pelvis strap portion, are simultaneously also stretched on both sides, so that the shoulder straps are automatically tensioned in relation to the pelvis strap when the pelvis strap is applied and the two strap ends are closed under tension, whereby the necessary tension is easily generated, which allows particularly for the force introduction on the shoulders required for reclination. 
     Each tension strap is individually guided on or in the pelvis strap between at least one central deflection element in the region of the dorsal middle portion of the pelvis strap and at least one lateral deflection element which is arranged in the lateral region located further towards the front (ventrally) of the respective side portions. For the dynamic tensile force distribution according to the invention in the orthosis, the course and arrangement of the tension straps on the pelvis strap are particularly decisive for the desired function of the belt system in the orthosis. It can be selected on the basis of the intended use, therapy objective or requirements of the wearer. In one case, a particularly relieving effect of the shoulder straps, for example, when used in the field of occupational safety, is intended, and in another case, an effective and easily appliable reclination orthosis is desired for osteoporosis patients with restricted mobility. The present invention therefore comprises several variants and designs of the tension strap guides. 
     In a first variant, the tension strap that comes from the dorsal first end of the right shoulder strap loop runs from a first left deflection element positioned to the left of the middle portion along the left side portion to the left pelvis strap end, and the tension strap that comes from the dorsal first end of the left shoulder strap loop runs from a first right deflection element positioned to the right of the middle portion along the right side portion to the right pelvis strap end. This means that the incoming tension strap of the opposite shoulder strap loop is guided directly towards the front (ventrally) solely via a lateral deflection element. 
     In another variant, said tension strap, coming from the dorsal first end of the right shoulder strap loop, runs from a first left deflection element at a distance further from the middle portion along the left side portion in the direction of the middle portion to a second left deflection element at a distance closer to the middle portion and from there, runs along the left side portion towards the left pelvis strap end, and the tension strap, coming from the dorsal first end of the left shoulder strap loop, runs from a first right deflection element at a distance further from the middle portion along the right side portion in the direction of the middle portion to a second right deflection element at a distance closer to the middle portion and from there along the right side portion towards the left pelvis strap end. 
     This means that each tension strap is guided between the at least one central deflection element and the at least one lateral deflection element. In a first variant, the tension strap coming in a traversing manner from the shoulder strap loop of the opposite body half is guided on the lateral deflection element in the direction of the middle portion of the pelvis strap and from there onto the deflection element located closer to the center. From the more central deflection element, the tension strap is guided towards the front (ventrally) on the same side of the pelvis strap. In another variant, the incoming tension strap is guided back and forth several times in a direction-changing manner on a plurality of lateral deflection elements and at least one more centrally located deflection element, particularly in the manner of a waist, wherein the deflection elements form the blocks and the tension strap each forms the runner. 
     With the applied pelvis strap, the place of introduction of the tension straps of the shoulder straps lies in the back/dorsal region of the pelvis strap but always between the middle portion and the aforementioned lateral portion. For this purpose, the deflection elements are guided on or in the region of stretchable (elastic) portions of the pelvis strap such that an active change in length of the pelvis strap through pull or tension leads to pull or tension on the tension strap, thus effectively shortening its length. In a particularly preferred embodiment, the tension strap is in this case guided back from a lateral pelvis strap portion to a more central pelvis strap portion and from there guided back again in the direction along the lateral pelvic portion. With this “Z”-shaped deflection of the tension straps, a force/length transfer is achieved in the manner of a single or possibly multiple pulley. Simply pulling on the shoulder strap, for example, when bending, results in a two-fold or manifold increase of the tension on the pelvis strap. Conversely, the pull on the pelvis strap when applied leads to a dual or multiple effective shortening of the shoulder strap. The latter is particularly advantageous for applying the back strap system according to the invention because particularly the shoulder straps can at first be applied loosely and then shortened to an expediently large extent by the tensioning when the pelvis strap is applied in order to achieve the intended support function. 
     In preferred embodiments, it is additionally provided that the first, outer starting point of the shoulder strap end is positioned in the region of the iliac crest, preferably exactly on the iliac crest ( crista iliaca ), when the pelvis strap is in its applied state. This advantageously ensures that the second end of the respective shoulder strap loop attached to the pelvis strap, i.e., in the anatomical frontal plane of the body of the wearer or user, does not experience any significant passive change in length when moving, especially when bending the back. In combination with the specific course of the shoulder straps according to the invention on the body, a “neutral point” is achieved which prevents unwanted additional transverse forces during movement, which could additionally cause the migration of the pelvis strap. The front point of introduction of the tensile force of the respective shoulder strap loop in the pelvis strap lies therefore preferably in the anatomical frontal plane. The belt system thus retains its tension even during bending. 
     In a first variant thereof, the second end of the right and left shoulder strap loops is each connected at left and right lateral anchors, respectively, to the respective side portions, wherein, in the applied state of the pelvis strap, the left and right lateral anchors are each located on or in the region of the left and right iliac crest of the wearer. Said second ends of the shoulder strap loops can be connected to said anchors either directly or indirectly via, in particular length-adjustable, stationary tension straps. For this purpose, such tension straps can be guided in an inherently known manner through eyelets serving as anchors and be clamped with themselves in a buckle for the purpose of length adjustment. 
     In another variant thereof, the second end of the right and left shoulder strap loops is connected to the pelvis strap via a second tension strap, wherein the second tension strap of the right shoulder strap loop runs slidingly via at least one left lateral deflection element along the left side portion towards the left pelvis strap end, and the second tension strap of the left shoulder strap loop runs slidingly via at least one left lateral deflection element along the left side portion towards the left pelvis strap end, and wherein the left and right lateral deflection elements in the applied state of the pelvis strap are each located on or in the region of the left and right iliac crest of the wearer. 
     In preferred embodiments of the invention, at least one end of the shoulder strap loop, which forms the transition between the shoulder strap and the associated tension strap, is designed as a particularly elastic strap portion. 
     According to the invention, “elastic strap portion” refers primarily to an elastic band, i.e., a flexible band, particularly in the form of a woven belt, that can be stretched by tensile stress. Functionally equivalent designs, particularly elastomer strips, preferably made of rubber, silicone rubber, polyurethane, and the like, are thus also included. Alternatively, this also refers to elastic tensioning ropes with inserts made of elastomeric fibers. It is provided that said elastic strap portions, particularly in comparison to the other portions of the shoulder strap loops, are more elastic, i.e., they can be stretched further under tensile stress. In a preferred variant, said elastic strap portions are the only components of the shoulder straps that are stretched, i.e., lengthened, under the tensile forces that can occur when the orthosis is used properly, especially when bending the back. The elastic strap portion preferably has a force-expansion range at a longitudinal expansion of +60% from 7 N to 55 N, in particular from 20 N to 40 N. 
     This elastic strap portion is preferably arranged at the end of the shoulder strap loop that pulls upwards over the rear upper back to the shoulders. Since the change in length when the back is bent is particularly pronounced in this region of the body, the particularly elastic strap portion located in said region can reduce excessive tension on the straps, i.e., compensate for it through its intrinsic stretching during bending. Due to its elasticity, the elastic strap portion is used to limit the tensile force of the tension introduced into the pelvis strap by the shoulder straps, which prevents the pelvis strap from migrating. In addition, the change in length of the back during bending can also be compensated, which holds the shoulder straps in position on the shoulder, provides freedom of movement and increases the wear comfort and effectiveness of the back belt system. 
     In a variant thereof, said elastic end portion is additionally provided with a separately formed mechanical expansion limiter that is guided parallel to the elastic portion. The expansion limiter can be designed as at least one less elastic or inelastic band which is connected to the respective ends of the elastic portion. Depending on the desired therapy objective or intended use of the system, this can be used for a controlled motion control during bending. In particular, excessive bending of the back is supposed to be prevented, which may be indicated therapeutically, for example, in postoperative rehabilitation or in the field of occupational safety when lifting loads, for reclination and postural improvement and the resulting improvement in load transfer in the back. 
     In a further embodiment, the support belt system according to the invention is guided in separate cross guides at least at the crossing points of the shoulder strap loops. This is used in particular to simplify the application of the back orthosis to the wearer or user because the cross guides hold the intersecting shoulder straps in the correct positions. At least one such cross guide is preferably provided in the upper, central, rear crossing point. 
     The back support belt system according to the invention allows for the wearer to be reminded in the case of an incorrect posture of the upper body, i.e., in particular: Greatly forward bent torso and in the worst case additional rotation of the back in the bent position, to adopt a gentler posture, i.e., in particular: an upright posture. When lifting loads with a curved spine, the load is shifted to the front part of the ventral pillar of the vertebral body; by straightening the spine and lifting from the knees (upright posture), the load is advantageously distributed over the entire region of the ventral pillar. The upright posture can be assumed by the wearer particularly when said wearer experiences an increased pull via the shoulder strap system according to the invention when the upper body is bent forwards. In this case, the pelvis strap acts as an “anchor” and establishes the central fixed point which is used to generate a force from the movement on the shoulders in the dorsal direction via the belt system. A further side effect of the tightly fitting, tensioned pelvis strap of the back support belt system according to the invention is the conveying of a feeling of safety and stabilization to the wearer of the system. 
     In a particular embodiment, the back support belt system according to the invention is therefore fitted onto an elastic vest or jacket, wherein the shoulder straps and/or the pelvis strap are fixed at least in portions to the vest or jacket. The subject matter of the invention is therefore also protective clothing, particularly in the form of a vest or jacket, containing a stretchable vest or jacket and the herein described back support belt system according to the invention. 
     In the simplest case, the back support belt system is sewn to the vest or jacket. In an alternative variant, the support straps are guided in loops on the vest or jacket. The design on a vest or jacket allows for a simplified application and removal, which is very useful particularly for short-term and recurring use of the back support belt system, for example, in the field of occupational safety. The vest or jacket used is made of elastic fabric or knitted fabric. Alternatively, flexible vests, such as those inherently known as safety vests, can be fitted with the back support belt system according to the invention. 
     Finally, the subject matter of the invention is also the use of the back orthosis according to the invention or the protective clothing according to the invention for protection against adverse stresses on the back. 
    
    
     The invention is illustrated in more detail by the following specific embodiments, wherein said embodiments are not meant to be limiting. 
       FIG. 1  is a perspective front view of a first embodiment of the back orthosis according to the invention. A left shoulder loop  24  that can be applied over the left shoulder is attached to a pelvis strap  30  with a rear middle portion  31  on the right side portion  34  of the pelvis strap  30 , and a right shoulder loop  22  that can be applied over the right shoulder is attached to the left side portion  32  of the pelvis strap  30 . The (dorsal) end  25  of the left shoulder strap loop  24 , which, in the applied state, runs on the back, is connected via an elastic strap portion  80  to an essentially inelastic tension strap  54 . The tension strap  54  runs via a right deflection element  64 , designed in this embodiment as an eyelet, a ring or a simple buckle, to the right of the middle portion  31  on the pelvis strap  30  and, crossing the middle portion  31 , is guided towards the front along the left side portion  32  of the pelvis strap  30  where it ends in a free end  55 . In this case, the free end  55  of the tension strap  54  can be fixed to the left pelvis strap end  32 . Correspondingly symmetrical thereto, the rear end  23  of the right shoulder strap loop  22  runs via an elastic strap portion  80  to a tension strap  52 , which runs via a corresponding left deflection element  62  to the pelvis strap  30 , also crosses the middle portion  31  and runs along the right side portion  34  to end in a free end  55 . The free end  55  of the tension strap  52  can be fixed to the right pelvis strap end  35 . The respective other ends  26 ,  27  of the shoulder strap loops  22 ,  24  are firmly connected in the illustrated embodiment to a region of the side portions  32 ,  34 , which lies further to the side, i.e., further away from the middle portion  31 . For this purpose, the second end  26  of the right shoulder strap loop  22  is firmly connected to the left side portion  32  of the pelvis strap  30  at a left anchor  72 . Said left anchor  72  is positioned in a region of the left side portion  32 , which, when the orthosis is applied to the wearer, lies on or above the left iliac crest of the wearer. The second end  27  of the left shoulder strap loop is also firmly connected to the right side portion  34  of the pelvis strap  30  via a right anchor  74 . Said right anchor  74  is also positioned in a region of the right side portion  34 , which, when the orthosis is applied to the wearer, lies on or above the right iliac crest of the wearer. Due to the positioning, according to the invention, of the fastenings of the ends  23 ,  25 ,  26 ,  27  of the shoulder strap loops  22 ,  24  on the pelvis strap  30  on the opposite side of the body, the shoulder strap loops cross each other at four crossing points: a rear central upper crossing point  41  and a rear central lower crossing point  43  and in a left lateral crossing point  42  and a right lateral crossing point  44 . On the upper portions of the shoulder straps which, when the orthosis is applied to the wearer, run in the region of the clavicle and the shoulder blade, additional, in particular partially elastic and/or padded, shoulder straps  28  are optionally formed. 
       FIG. 2  is a perspective rear view of another embodiment of the back orthosis according to the invention in the open state. Deviating from the components corresponding to the features shown in  FIG. 1 , the embodiment according to  FIG. 2  has, in addition to otherwise corresponding components, an alternative tension strap guide: The tension straps  52 ,  54  of the right and left shoulder strap loops  24 ,  22  enter the pelvis strap  30  in first lateral left and right deflection elements  62  and  64 , respectively. From there, they are first deflected in the direction of the middle portion  31  and there, they enter second left and right deflection elements  63 ,  65  positioned centrally, i.e., closer to the middle portion  31 . There, the tension straps  52  and  54  are deflected and subsequently pull in the direction of the left and right pelvis strap end  33 ,  35 , respectively. In addition to the embodiment of  FIG. 1 , adjustable second tension straps  56 ,  57  are provided in the embodiment according to  FIG. 2  for fastening the respective second end  26 ,  27  of the shoulder strap loops  22  and  24  at the anchor points  72  and  74 , each of which is in this case clamped with itself in buckles  58  in order to achieve a length adjustment of the shoulder straps. 
       FIG. 3  is a perspective rear view of the back orthosis according to  FIG. 2  in a form applied to a wearer. It is also shown that the first deflection elements  62 ,  64  are arranged in the region of the elastic pelvis strap  30  on a stiffening element  36  and particularly directly connected to it. The middle portion  31 , designed as a stiffening element, of the pelvis strap  30 , on which the second deflection elements  63 ,  65  are arranged and to which they are particularly directly connected, can also be seen. 
       FIG. 4  is a perspective front view of the embodiment according to  FIG. 1  in the state applied to the wearer; the reference signs apply accordingly. 
       FIGS. 5A and 5B  each show alternative variants of the embodiment according to  FIG. 2 or 3 , wherein the first deflection elements  62 ,  64  can be fixed or are fixed on the stiffening elements  36 , and the second deflection elements  63 ,  65  can be fixed or are fixed to the middle portion  31  of the pelvis strap designed as a stiffening element in variable positions, resulting in an alternatively configured arrangement of the respective tension straps  52 ,  54  guided in said deflection elements on the pelvis strap  30 .  FIG. 5A  shows a first arrangement of the first deflection elements  62  and  64  on the upper edge of the pelvis strap  30  and that of the second deflection elements  63 ,  65  at middle height on the middle portion  31 .  FIG. 5B  shows an alternative arrangement of the first deflection elements  62 ,  64  in the central region of the pelvis strap  30  and that of the second deflection elements  63 ,  65  in the lower region of the middle portion  31 . 
       FIG. 6  shows a further alternative embodiment of the back orthosis in a front view analogous to the representation in  FIG. 1 . Deviating from the embodiments according to  FIG. 1  and also from the alternative embodiment according to  FIG. 2 , in this depicted variant of said embodiments, it is additionally provided that the free second ends  26  and  27  of the two shoulder strap loops  22 ,  24  are each guided in left and right lateral deflection elements  66 ,  67 , and wherein the second end  26  of the right shoulder strap loop  22  ends in a second tension strap  56  and the second end  27  of the left shoulder strap loop  24  ends in a second tension strap  57 . They can also each be fixed to the left and right pelvis strap ends  33 ,  35  via their free tension strap ends  55 . In this embodiment, both ends  23 ,  25 ,  26 ,  27  of the respective shoulder strap loops can thus be tensioned separately via individually assigned tension straps  52 ,  54 ,  56 ,  57 . 
       FIG. 7  shows a further embodiment of the back orthosis according to the invention according to  FIG. 1  in a representation analogous to the representation in  FIG. 2 . The same reference signs denote the same or functionally identical elements. 
       FIG. 8  shows a further embodiment of the invention as protective clothing: A back support belt system analogous to the embodiment according to  FIG. 2  is fitted onto an elastic vest  90 . At least in portions, the right and left shoulder strap loops  22 ,  24  and the pelvis strap  30  are firmly connected to the vest  90 . The back orthosis can thus be applied directly and immediately together with the vest  90 . 
     LIST OF REFERENCE SIGNS 
     
         
         Right shoulder strap loop ( 22 ) 
         The first end ( 23 ) of the right shoulder strap loop 
         Left shoulder strap loop ( 24 ) 
         The first end ( 25 ) of the left shoulder strap loop 
         The second end ( 26 ) of the right shoulder strap loop 
         The second end ( 27 ) of the left shoulder strap loop 
         Shoulder strap ( 28 ) 
         Pelvis strap ( 30 ) 
         Middle portion ( 31 ) 
         Left side portion ( 32 ) 
         Left pelvis strap end ( 33 ) 
         Right side portion ( 34 ) 
         Right pelvis strap end ( 35 ) 
         Stiffening element ( 36 ) 
         Central upper crossing point ( 41 ) 
         Left lateral crossing point ( 42 ) 
         Central lower crossing point ( 43 ) 
         Right lateral crossing point ( 44 ) 
         The first tension strap ( 52 ) of the right shoulder strap loop 
         The first tension strap ( 54 ) of the left shoulder strap loop 
         The second tension strap ( 56 ) of the right shoulder strap loop 
         The second tension strap ( 57 ) of the left shoulder strap loop 
         Belt buckle ( 58 ) 
         First left deflection element ( 62 ) 
         Second left deflection element ( 63 ) 
         First right deflection element ( 64 ) 
         Second right deflection element ( 65 ) 
         Left lateral deflection element ( 66 ) 
         Right lateral deflection element ( 67 ) 
         Left anchor ( 72 ) 
         Right anchor ( 74 ) 
         Elastic strap portion ( 80 ) 
         Jacket ( 90 )