Last updated on January 7th, 2023 at 10:22 am
Time and time again, parents sit across from me in my office describing the gut-wrenching experience they endured during their child’s first brace fitting. Watching their child meltdown in tears, complain about not being able to breathe, and seeing the panic in their eyes when the doctor tells them they have to wear it 23 hours a day for the next 2-3 years. I also feel how disturbed these parents felt at that very moment because they almost always seem to be looking straight through me as they tell the story, and I can’t help but to think “we need a better way”.
The impact of back bracing for scoliosis
The very thought of having to wear an uncomfortable, hot, and socially embarrassing back brace 20 hours a day through some of the informative teenage years is a living nightmare for most adolescent patients. The current standard of care requires brace treatment recommendation for curves 25-40 degrees with a Risser sign of 2 or less; however, more and more parents are choosing to ignore these guidelines.
Kids and teens recommended for bracing are often more concerned about the social impact of looking and feeling differently than other kids their age.
- What do scoliosis braces look like?
- How long do you wear a brace?
- Will wearing a brace really prevent spinal fusion?
- Will an in-brace x-ray be necessary?
- What types of spinal braces are available?
- Is this the only treatment for scoliosis in teenagers?
Full time bracing is intolerable for most kids
Thankfully, most of us have never had the “pleasure” of being fitted or having to wear a rigid scoliosis brace (most often named after a city like Boston, Milwaukee, Charleston, etc.). The sear thought of being forced to wear something that severely restricted my motion, breathing, and any type of physical activities the patient may have once enjoyed. Part of the irony is full-time rigid bracing can decrease breathing capacity (one of the most concerning aspects of severe scoliosis) by as much as 30%, which are levels often seen in populations of chronic smokers! Also, advanced imaging of patients in brace vs. out of brace indicates the pressure on the rib cage will increase the rib cage deformity and make the rib hump worse! I had an “off the record” conversation with a top Orthopedic scoliosis specialist, and he said he always resists parents requesting braces because “the kids just “wilt” away emotionally, physically, and psychologically.”
Scoliosis Braces for Children and Teens
Most kids with scoliosis don’t get diagnosed until they’re approaching their teen years. Most will never reach the surgical threshold, even without a brace for a child. When the curves show a rapid progression or reach a certain threshold, doctors typically prescribe a brace for kids whose spines haven’t matured. About one in five patients with scoliosis end up wearing a back brace in hopes that it will slow the progression and allow them to avoid surgery.
Most begin wearing a brace between the ages of 11 and 14, and many continue the treatment until they stop growing at around 16 or 17. Because this is a socially awkward time for kids — particularly for girls, who are eight times more likely to be diagnosed with scoliosis than boys — wearing a brace can take its toll on a teenager’s self-esteem. In one study, half of the adolescents who wore a brace showed clear signs of negative body image. The embarrassment and shame that often accompanies scoliosis bracing prompt many teens to refuse to wear them.
To alleviate the discomfort and embarrassment associated with bracing, specialists have designed a variety of braces for teenagers and children to make patients more comfortable. Below is a list of the most commonly used scoliosis braces for children and teens.
Full-Time Scoliosis Braces
- Rigid orthosis bracing — Hard plastic braces are generally not recommended for adult patients because they cause the muscles to atrophy, which can accelerate degeneration. However, younger adults who are concerned about the cosmetic impact of scoliosis may use a rigid brace to improve the spine’s appearance.
- Pediatric scoliosis brace — Also referred to as METHA Casting by an orthotist.
- Milwaukee Brace — As the first modern TLSO brace developed to treat scoliosis, it’s also one of the bulkiest. Today it’s used only occasionally, replaced by more comfortable and form-fitting braces with straps. The Milwaukee brace stories are the things of horror from many decades ago.
- Boston Brace — Also known as a TLSO brace, this rigid plastic orthotic with straps is one of the most commonly used scoliosis braces for kids today because of its “off the shelf” non-customized design. The TLSO is intended to be virtually unnoticeable under loose clothing but still uncomfortable for the patient. It’s typically worn 23 hours a day.
- Rigo-Cheneau Brace — Considered a “hypercorrection” style brace, which means it is applied to the patient in a very aggressive manner with tight straps. It targets spinal rotation rather than just pushing on the apex of the spinal curve.
- Spine Cor Brace — This “flexible” brace is an effort to make full-time brace wear more tolerable; however, independent studies have not been able to duplicate the same treatment success as the manufacturer claims, and patients report even lower wear satisfaction than traditional types of braces. Many doctors also recommend the Schroth method with this back brace.
- Flexible back supports — Some adult patients wear flexible braces for support and temporary palliative relief during certain activities, such as exercising at the gym or physical therapy.
- Charleston Bending Brace — Made for nighttime use, this model applies extra force to the spine so it can be worn for only eight to 10 hours a day while the patient sleeps.
- Providence Brace — Also designed for nighttime wear, this brace aims to achieve maximum correction with minimal discomfort. It’s mostly prescribed for smaller curves and is often used in conjunction with the Boston Brace.
Wilmington Brace- They’re designed to properly align the spine in the brace and are constructed to fit a kid’s frame. They incorporate unique shaping and padding. Each kid’s brace is custom molded to fit, and it closes in the front.
Alternatives to Bracing
Some parents believe the health risks of scoliosis bracing aren’t worth taking, especially considering its lackluster performance in effectiveness studies. The problem is that most braces for kids attempt to physically force the spine into compliance instead of getting to the root of the problem.
Through a combination of specific exercises performed while wearing the ScoliSMART™ Scoliosis Activity Suit, kids can retrain their muscle memory to align and stabilize their posture. Addressing this underlying neurological discoordination ultimately treats the curvature more effectively than a brace. To set young patients on a path toward long-term improvement, ScoliSMART offers a Scoliosis BootCamp for kids with advanced curves as well as a Small Curve Camp for early intervention physical therapy.
To learn more about how to treat the whole scoliosis condition and not only the curve, connect with our passionate providers at ScoliSMART. To explore a non-brace/ non-surgical treatment for your child’s scoliosis problem, you may schedule a no-cost Zoom or phone consultation with a ScoliSMART doctor. Please get in touch with us today!
The ScoliSMART approach is more effective than bracing
The doctors of ScoliSMART published their first “end-of-growth and skeletal maturity” success rate study in January of 2017. The retrospective study included patients who started the ScoliSMART program only at Risser 0-1 and reached skeletal maturity (Risser 5) with the curvature LESS than 50° (surgical fusion threshold). The results were remarkable. While the Bracing Adolescent Idiopathic Scoliosis Treatment study published in 2014 boasted a 72% success rate after two years of data collection, it did not account for the 27% of patients who dropped out of treatment during that time. Thus artificially elevating the success rate.
In contrast, the ScoliSMART success rate was an incredible 97.3% over 2.5 years, with only a 13% patient dropout rate. Both studies were conducted under Scoliosis Research Society guidelines, thus making the result comparable. The statistical data favored the ScoliSMART approach over scoliosis bracing in success rate and patient dropout over a more extended period.
ScoliSMART keeps your child doing what they love
As parents, we all want our children to one day to be able to reflect on the memories they created during their childhood fondly. We fully understand the freedom of childhood is a particular time when kids can pursue dreams and activities without the consequences or responsibilities of adulthood. Unfortunately, perhaps the cruelest aspect of full-time bracing is how it robs children of the opportunity to make those valuable, lifelong memories. There is no way kids can fully engage in cheerleading, gymnastics, basketball, swimming, or almost any other active lifestyle with bulky hard rigid braces restricting their torso. The detriment of full-time bracing on a teen’s social life goes without saying.
Utilizing the ScoliSMART approach to treatment, teens with scoliosis have little or no restrictions on their social or physical activities during the treatment sessions and even the period of home rehabilitation after the in-office treatment protocols. We firmly believe the memories kids make at this age are valuable and should be considered when making treatment decisions.
A Scoliosis Braces for Adults
Scoliosis manifests in adults for a variety of reasons. Some develop degenerative scoliosis due to wear and tear from aging. Other adults who had scoliosis as children may now suffer from pain or leg numbness.
An estimated 6 percent of Americans over the age of 50 have some degree of scoliosis, as do about 15 percent of those over 60 with lower back pain. The actual rates are probably even higher; a 2010 study of MRI scans found that 39 percent of participants over 60 had scoliosis in their lower backs that had previously gone undetected. Doctors rarely prescribe braces for scoliosis in adults because such treatment cannot improve the condition of a patient who has reached skeletal maturity. When a brace is recommended, the treatment goal is typically to provide pain relief and reduce the need for medication. Some doctors believe scoliosis braces for adults may help reduce spinal motion and give much-needed support to those in severe pain. Many adults with scoliosis pain have found the ScoliSMART Activity Suit a more more effective way to treat scoliosis pain and spinal curve progression on their own. The best part is that it’s not a back brace, it’s your own personal rehab system for scoliosis!
Final thoughts word on bracing for scoliosis
Bracing is a relic and remaining product of the growing gap in treating scoliosis. The clinical application of bracing simply isn’t accurately reflecting the ever-growing body of knowledge regarding adolescent idiopathic scoliosis. In short, the continued use of scoliosis braces in most cases results from the growing gap between what we know about idiopathic scoliosis and how we treat idiopathic scoliosis.
This growing gap is one of the driving motivations behind ScoliSMART’s efforts to “find a better way” to treat scoliosis. The ScoliSMART approach to treating scoliosis is more effective than bracing because it can reduce the spinal curvature, keep kids involved in their social and activities, and doesn’t harm your child emotionally or physically in the process.
Online consultation scheduling is available!
Now it’s even easier to connect with ScoliSMART. Schedule your no-cost, no-obligation phone or Zoom consultation online with a ScoliSMART physician. Visit the ScoliSMART BootCamp page and click the “Schedule Online” button at the top of the page. Then select the best date and time to connect with a physician. Schedule your consultation right here!
ScoliSMART Clinics is committed to treating the WHOLE scoliosis condition, not only the curve. Genetic & clinical testing with targeted nutrient therapies, expert in-office treatment programs, and the world’s only ScoliSMART Activity Suit provides patients of all ages with the most comprehensive, most effective, and least invasive treatment options available worldwide.