— Factually accurate and verified by Dr. Clayton J. Stitzel. Last updated on October 1, 2018.
The Disadvantages of Treating Only the Symptom & Not the Underlying Condition
Full-time scoliosis bracing is an outdated treatment that needs to be limited to a very narrow range of scoliosis cases. 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 scoliosis 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. Scoliosis 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 done.
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Scoliosis Braces Constrict Breathing and Bone Growth
Another serious issue with scoliosis 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 brace (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 physical rather than neuro-hormonal with genetic predisposition. Scoliosis is primarily caused by the brain not being able to maintain or restore posture and balance. In children with scoliosis, 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's a problem to fix.
Scoliosis exercise treatment needs to create a stimulus that helps the brain recognize that something is wrong. The brain will then work to correct spinal posture. Exercises need to stimulate a subconscious trigger, and only specialized exercises can accomplish this. A routine of sit-ups and pelvic exercises won't create the needed trigger.
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 scoliosis.
How Does the ScoliSMART Approach Compare to Bracing?
Success rates, differentiators, exercises.
Alternatives to Bracing for Scoliosis
At the 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 scoliosis case is unique. Larger curves require more extensive treatment, especially in children whose spines are still growing. Curves that measure over 25 degrees have a 68 percent chance of progressing in adulthood, as well. Our innovative equipment and Auto Response Training helps minimize the "coil down" effect of scoliosis. 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. This allows your child to avoiding 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."
Related: Is ScoliSMART Right For My Child?
Proactive Scoliosis Treatment
Children with mild or moderate scoliosis benefit most from the 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.
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.
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.
Nutritional and Hormone Testing
The chemicals your brain uses to talk with the rest of your body are called neurotransmitters. 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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