— Factually accurate and verified by Dr. Clayton J. Stitzel. Last updated on May 13, 2020.
Bracing Is Becoming an Outdated Option in the Rapidly Expanding and Innovative Field of Scoliosis Treatment
Full-time scoliosis bracing is an outdated treatment that needs to be limited to a very narrow range of scoliosis cases (very early stage growth (Risser sign 0-2) with curves greater than 25 degrees, but less than 40 degrees).
Scoliosis brace treatment has existed for more than 450 years, yet its success is still controversial. Full-time bracing often causes more problems for the person wearing it, such as pain that didn't exist before, breathing problems, and weakened muscles. It hasn't been consistently proven to prevent scoliosis surgery, either.
So... why does it continue to be the most recommended treatment for scoliosis?
Bracing is typically recommended for children in early-stage growth with a scoliotic curve between 25 and 40 degrees. The "hope" is that bracing will delay or halt curve progression, since the condition is progressive. One major problem with braces — including hard plastic braces, metal braces, and even softer dynamic braces — is they cause muscles to weaken. When you don't use your muscles, they atrophy. For example, when your arm is broken and casted, the muscles inside the cast become small and weak. This is what happens when your child wears a brace for the recommended 18-23 hours a day.
It also explains why the curve rapidly worsens once the brace is removed. In a brace, your child's spine becomes stiff. Joints don't get necessary movement and they often develop more degenerative issues. Bracing also puts stress on the ribs and typically causes a rib hump. Doctors almost always recommend removing the brace when they see this negative change using 3D x-rays, yet the additional damage may have already been done.
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Scoliosis Braces Constrict Breathing and Bone Growth
Another serious issue with bracing is that bones cannot grow properly without intermittent pressure. The theory behind bracing is that it will open the inside of the curve (the concavity) by removing pressure, and encourage growth on the concave side of the curve (the convexity). But you need intermittent pressure on bones to stimulate growth, and the concavity needs to grow. You cannot "guide" bone growth by squeezing the ribs and bending them laterally while the wearer sleeps or sits.
Even if bracing was proven successful, studies suggest that children only wear them 10 percent of the recommended time. They say bracing hurts, is embarrassing, and handicaps their lives. Full-day bracing doesn't prevent surgery, so they aren't inclined to follow the protocol.
In addition, braces like the most common thoracolumbar-sacral-orthosis (TLSO) brace squeeze the chest wall and abdomen. A Norwegian study of the TLSO found it significantly decreases pulmonary functions, including breathing capacity, oxygen, and CO2 exchange ratios. Breathing impacts hormone regulation, muscle and fat composition, and cognitive performance. One study showed that children who wore a hard brace had a 30 percent decrease in vital capacity (VC) and a 45 percent decrease in expiratory reserve volume (the air you can push out after a normal exhale). These decreases in pulmonary function are identical to those typically found in long-term smokers! Respiratory distress causes headaches, anxiety, sleep disturbances, nightmares, and cognitive dysfunction (memory, perception, and problem solving). The risks associated with scoliosis braces are demonstrable.
Why Are We Still Using Full-Time Scoliosis Braces?
Possibly, doctors and chiropractors still prescribe scoliosis braces because they continue to view the condition as purely spinal, rather than primarily a neuro-hormonal condition resulting from a genetic predisposition. The condition is primarily caused by the brain not being able to maintain normal spinal alignment during periods of rapid adolescent growth spurts. In children, the brain doesn't recognize that the spine is out of alignment, so it doesn't trigger auto-correction mechanisms to fix the curvature. For whatever reason, the natural alarm bells don't sound in the hindbrain, so the brain doesn't realize there is a problem to fix.
Scoliosis exercise treatment needs to create a "stimulus" — or new message — that helps the brain recognize something is going wrong! The brain will then "reflexively respond" to correct spinal alignment automatically. Exercises need to stimulate this involuntary reaction, and only specialized exercises can accomplish this.
This is why using braces by themselves to guide bone growth doesn't make sense. Neither does "waiting and watching" for a curve that measures less than 25 degrees, which is the common management approach in the early stages of the condition.
How Does the ScoliSMART Approach Compare to Bracing?
Success rates, differentiators, exercises.
Alternatives to Bracing for Scoliosis
At ScoliSMART Clinics, we teach your child an exercise training routine that creates new muscle memory to hold the spine straighter. Our Early Stage Intervention and ScoliSMART BootCamp programs halt scoliosis progression, reduce curvature, and improve your child's breathing. We also decrease each child's curve rigidity so they can move more easily.
Every case is unique. Larger curves require more extensive treatment, especially in children whose spines are still growing. Curves that measure over 30 degrees have a 68 percent chance of progressing in adulthood, as well. Our innovative equipment and "reflexive response" training helps minimize the "coil down" effect. This is when the spine twists from the top to the bottom, kinking in the middle like a rubber band. The spine needs a chance to be free of this coil down effect to improve the chances of stabilizing or reducing the curvature.
Opportunities for Combined Treatment
Many children are at a high risk for curve progression based upon their age, skeletal maturity, and curve measurement at diagnosis. In these cases, it may be beneficial to combine ScoliSMART treatment with conventional nighttime bracing. A nighttime brace, such as a Providence brace, does not cover the torso like a typical TLSO brace, allowing for better breathing and comfort. It also takes advantage of the guided growth principle known as the Hueter-Volkmann principle. And because this brace is only used during sleep, there is less concern for torso muscle atrophy due to the fact that the child is not using it while upright during the day, fighting gravity.
This combined approach can be advantageous in juvenile idiopathic scoliosis or progressive adolescent idiopathic scoliosis. It allows your child to avoid wearing the brace to school, or to athletic practices and events, while still providing supportive, guided growth during sleep. Our patients who have used this combined approach consistently tell us that this brace is more comfortable than the TLSO counterpart. It also gives parents peace of mind knowing that they are using all of the non-surgical therapies available to them.
Caution must be used, however, when electing to use nighttime bracing only, as some studies suggest that nighttime bracing by itself does not produce a significantly different outcome than just "watching and waiting."
Progression factor is a calculation that attempts to predict how progressive a child’s curve might be, and hence how aggressive treatment should be at that time. This progression factor is based upon your child’s age, bone maturity, and current curve measurement. This progression factor helps the ScoliSMART doctors develop the most appropriate treatment plan for your child, thus minimizing unnecessary treatment and avoiding under-treatment.
Related: Is ScoliSMART Right For My Child?
5 of the Most Common Questions Parents and Patients Have About Scoliosis Bracing
What Are the Different Types of Braces for Scoliosis?
There are many different types of back braces for scoliosis. Some patients and parents would say there are "too many" to choose from, but each has different attributes that may seem more beneficial or desirable in some way. One source of confusion for many is the tradition of naming the brace after the city where it was developed. This is how we get brace names like "Boston Brace," "Wilmington Brace," and "Charleston Bending Brace." Only recently have newer scoliosis back braces taken on more "marketing style" names like "SpineCor Brace" (short for Spine Corporation) and "ScoliBrace." Given this is a very broad and significant topic, please see our blog article on the topic for detail information on types of scoliosis braces.
What Is the Best Brace for Scoliosis?
Scientific research has determined there is no "best back brace for scoliosis" because using a spinal brace for scoliosis should only be considered one part of a patient's overall scoliosis treatment strategy and effort, and only for scoliosis in children who are at high risk for a moderate curve getting worse (very early stage growth (Risser sign 0-2) with curves greater than 25 degrees). The Boston Brace and Wilmington Brace are two of the most popularly recommended braces for scoliosis in teens, but that doesn't necessarily make them "the best." Regardless of which brace is recommended, it must achieve at least a 50% in-brace improvement without making the spinal rotation worse, and the patient will need to wear the brace for the prescribed amount of time.
How Much Does a Scoliosis Brace Cost?
The actual "out of pocket" cost of a brace will vary greatly and depend on many factors. Obviously, insurance coverage and deductibles are policy-specific, but there are many other "hidden" costs to getting a brace; for example, multiple orthopedic doctor visits and potential physical therapy. Some "soft" brace options like the "SpineCor Brace" are not covered by insurance and often cost upwards of $5,000.
Can Braces Correct Scoliosis?
No, the sole purpose of a brace is to keep the curve from getting worse. Scoliosis back support devices like the Boston Brace and Wilmington Brace are "intended" to work under the "theory" of guided growth. When a patient begins to develop the condition, their spine become unevenly loaded, putting slightly more pressure on the inside of the curve vs. the outside of the curve. This unequal pressure may cause the vertebrae to grow in a slight wedge shape, possibly contributing to some further curve progression. The published research data on wearing a brace, hours per day, and combination with physical therapy is very inconsistent and unclear.
How Long Do You Have to Wear a Brace for Scoliosis?
Assuming the brace achieves at least a 50% in-brace correction without making the spinal rotation worse in a child still in early stage growth with a curve 25 to 40 degrees, most orthopedic doctors recommend at least 18 hours of daily wear to help, and many doctors insist on 23 hours of wear to help it from getting worse. The number of hours needed to help seems to be an unanswered question and scientifically unclear.
Most doctors recommend patients wear a brace from early stage growth (age 9-12) until skeletal maturity (age 15-16 in females).
Proactive Scoliosis Treatment
Children with mild or moderate scoliosis benefit most from ScoliSMART exercises because their muscles are not yet deformed by months or years of compensating for abnormal twisting and bending of the spine. In addition, we use proactive treatment solutions such as genetic testing, nutritional testing, and our ScoliSMART Activity Suit. All kids who have large spinal curves started out with small curves first!
ScoliSMART Activity Suit
The activity suit and exercises work with the natural torque pattern of the body to create new muscle memory. The new muscle memory helps the spine unwind, stabilizes asymmetrical muscles, and reduces curvature without pressure or pain. The ScoliSMART Activity Suit is used in combination with the Scoliosis "BootCamp" program for patients under the age of 18, but is also available to adult patients looking for back support for scoliosis to help relieve back pain (without wearing a brace or making their spinal muscles weaker)!
Genetic, Neurotransmitter, and Hormone TestingScoliSMART Labs has pioneered scoliosis genetic testing, as well as clinical testing (neurotransmitter, hormone, and bone metabolism) as a way of treating the whole scoliosis condition, in addition to the spinal curve.
Genetic variant testing can identify the exact "blips" in the patient's genetic record that lead to the hormone and neurotransmitter imbalances that lead to the inability to coordinate spinal alignment during periods of rapid adolescent growth! Identification of these variants is critical to identifying the most "at risk" patients for severe curve progression, and allows for highly specific nutritional interventions to provide the critical components patients need to "stay ahead of the curve."
Neurotransmitters are the chemicals your brain uses to talk with the rest of your body. We test neurotransmitters for imbalances that contribute to the development or progression of idiopathic scoliosis. Imbalances can be corrected with supplements and dietary changes. Normal neurotransmitter levels help your child benefit from ScoliSMART exercises. Abnormal neurotransmitter or hormone levels can also create abnormal bone growth patterns. It is well known, for example, that adolescents with idiopathic scoliosis tend to have lower bone density than their peers. These biochemical abnormalities need to be addressed to ensure optimal response to any scoliosis therapy, whether it is exercising, bracing, and/or even surgery.
If a scoliosis brace has been recommended for your child, you deserve a second opinion. Our programs can replace bracing and surgery, or be combined with standard nighttime bracing treatment — and allow your child to be a child.
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