A back support and compression vest includes a garment made of a compression-like material with a fabric panel arranged about the abdomen designed to receive an adjustable back support belt. The fabric panel includes a right and left fabric panel cooperating to form a slot opening about the lower middle back and spaced generally about the middle front abdomen of wearer. The fabric panel is sufficiently wide to allow the belt to be properly positioned. The garment includes a pair of shoulder pad holders for receiving removable shoulder pads. The shoulder pads are sufficiently shaped to cover the wearers shoulder while also extending rearward across a portion of the wearers back and forward across a portion of the wearers chest. The shoulder pad holders include a fabric envelope having an opening arranged generally on the inside portion of the garment along the arm aperture.
