When it comes to a progressive and incurable condition like scoliosis, the chosen treatment path is crucial. From traditional to alternative, current treatment strategies have evolved to combine the benefits of multiple modalities. Scoliosis bracing has been around since the condition’s early days, and while there are many different braces to choose from, not all are created equal. The big difference is whether or not a brace is designed to ‘hold’ or ‘correct’ the scoliosis.
If you or someone you love has recently received a recommendation to wear a scoliosis brace, there is a lot of information to wade through. In an effort to better understand the pros and cons associated with different types of scoliosis braces, please continue reading so you can make the most informed decision possible.
Bracing is a common facet of scoliosis treatment in children and adolescents; this is because bracing only works if a spine is still growing. It’s most often prescribed for patients with a Cobb angle measurement of 20 or 30 degrees.
As a progressive condition, a large part of any treatment strategy is controlling the level and rate of progression. With many of the traditional bracing options, the purpose of the brace is to reduce the likelihood of the scoliosis worsening and avoid the need for spinal-fusion surgery. The theory behind bracing is that if pressure is placed on the parts of the spine with bad curves, that pressure will stop those bad curves from growing, controlling their progression.
Depending on condition severity, treatment approach, and the type of brace being used, some braces require constant wearing, others are worn at night, and some are worn for large portions of the day. Considering the age group most commonly diagnosed with scoliosis, adolescents 10 to 18 years of age, you can see how compliance can be a challenge.
Before we move on to the differences between individual braces, I want to draw attention to the biggest overarching difference that impacts efficacy: the difference between a brace that ‘holds’ the scoliosis and a brace that ‘corrects’ the scoliosis.
If you’ve done your homework, you’ve likely come across the two terms ‘holding’ and ‘correcting’ when reading about scoliosis treatment options. While they might seem similar, in terms of treatment efficacy, they mean very different things.
The idea behind a lot of traditional bracing and invasive spinal-fusion surgery is to ‘hold’ the spine in a straighter alignment. In terms of making a crooked spine straighter, these methods can be considered successful, but what I want to caution patients and their families about is that a straighter spine held in position can come at a cost; that cost is the spine’s overall strength and flexibility.
The other thing I’d like to point out is that holding the spine in a straighter alignment is doing little to address the actual underlying cause of the deformity and is, instead, just addressing the curvature as a symptom of it.
The difference between holding and correcting is significant. When a crooked spine finds its way back to a straighter alignment through corrective means, the spine’s been manipulated to move in the ways we want it to.
Whether this is accomplished through chiropractic adjustments, corrective bracing, scoliosis-specific exercises and therapy, or a combination of everything, the end result is a spine that’s experienced a correction through natural and functional means; it’s not being held in a better position through artificial means.
Manipulating the spine to move into a corrective position means the spine doesn’t lose its natural strength and flexibility, as it does when it’s simply being held in position.
Because children and adolescents are still growing, they face the highest risk of progression, and also because they’re still growing, their spines can respond favorably to scoliosis bracing as a means of preventing progression from getting worse.
If you’ve done some reading about scoliosis, you’ve likely stumbled across the term ‘early detection’. As a progressive condition, it’s in the very nature of scoliosis to worsen over time; as an incurable condition, treatment efforts are aimed at controlling its progression so that patients can live their best lives throughout treatment and beyond.
When it comes to treating children and adolescents with scoliosis, we want to monitor them closely to see how growth affects their progression. As the number one trigger for progression, growth is obviously not something we can stop from happening, but we can certainly make every effort to counteract the condition’s natural tendency to worsen along with it.
Scoliosis bracing is a common treatment option for kids because they’ve yet to reach skeletal maturity, meaning their spines can still be manipulated to varying degrees. For moderate-to-severe conditions, or when rapid progression is a concern, bracing can be recommended as a means of slowing down progression.
Through a three-point pressure system, traditional braces put pressure on parts of the curvatures we don’t want to keep growing. That squeezing effect, in theory, can slow down progression.
Again, this isn’t doing anything to actually correct the curvature, only to hold it in a corrective position. While bracing is more commonly recommended for younger patients, scoliosis bracing for adults also has its place.
Scoliosis bracing for adults is less commonly prescribed as they’ve already reached skeletal maturity. Another reason is that as growth is no longer a factor with adult patients, rapid progression is not as much of a concern.
When it comes to bracing for adults, if recommended, it’s for different reasons than with younger patients. In younger patients, bracing is mainly recommended to limit progression; in older adults, it’s most often prescribed to reduce pain and limit the need for medication.
If an adult with scoliosis is in severe pain, some doctors will prescribe a scoliosis back brace to help reduce their patient’s spinal movement and provide them with support. Depending on the cause and severity of the patient’s condition, bracing recommendations will vary significantly.
That being said, there are two common types of scoliosis braces recommended for adults:
Younger adults sometimes opt for a rigid brace to improve their spine’s overall appearance.
These are sometimes used for their rehabilitative potential in strengthening the body’s posture for long-term relief.
Now that we’ve looked into the different ideologies behind scoliosis bracing in general, and scoliosis bracing for children and adults, let’s explore some of the defining features of the most popular braces: TLSO Boston brace, Milwaukee brace, Charleston Bending brace, and the ScoliBrace®.
TLSO (thoracic-lumbosacral-orthosis) braces are corset in style and are most often pre-made out of rigid plastic. It focuses on the mid-to-lower spine in order to stabilize the lateral bend of a scoliosis curvature.
The brace comes in small, medium, and large, and the most common TLSO brace design is the Boston brace; this is the most common scoliosis brace used in the United States. It wraps around the patient’s rib cage, hips, and lower back and has to be worn virtually all day: 18-23 hours.
As you can imagine, wearing a Boston brace isn’t comfortable. In fact, it’s designed to be uncomfortable, in part, so that the patient’s body stops the progression.
This is where compliance can become an issue. Imagine a 15-year-old girl wanting to wear a rigid brace all day that restricts her range of motion and can also impair lung function. Let’s also keep in mind that the brace only fits under clothing that’s baggy enough - not exactly in line with the day’s big fashion trends.
Often, once teenagers get to school, that brace comes off and goes in the locker. If the brace isn’t worn the way it's supposed to be, success rates drop significantly.
Known as a CTLSO (cervico-thoraco-lumbo-sacral-orthosis) brace, the Milwaukee brace resembles a bulky plastic body jacket and is most often used for treating high thoracic (middle back) curves.
It functions in the same way that many lower-back braces do, with the exception of having a neck ring. The neck ring’s held in place through vertical bars that are attached to the main body of the brace.
This type of brace is most effective for curves in the thoracic spine and is regarded as particularly effective when it comes to kyphosis (an excessive outward curve).
The Milwaukee brace should be worn for 23 hours a day to decrease the likelihood of curvature progression, and there are also braces that are designed to be worn only at night.
The Charleston Bending brace is designed to be worn at night so that adolescents can reduce their thoracolumbar curves while sleeping. Developed in the 1970s, this brace makes a decent attempt at addressing the compliance issue that sabotages many bracing treatment attempts.
However, the flip side of that is the brace is only designed to be used while in a lying-down position, and many question just how effective it can be when worn only in that one position for a limited amount of time a day.
The Charleston bending brace is molded so that it will conform to the wearer’s body while they’re bent towards their curve’s outward bulge.
The other big issue with this is that it only addresses the bending associated with the scoliosis, not the rotation, and we know that as a 3-dimensional condition, any effective treatment plan has to treat the curvature on all three planes: frontal, coronal, and sagittal.
Treating scoliosis as a 2-dimensional condition, rather than 3-dimensional, is a major shortcoming of traditional scoliosis bracing in general.
As mentioned earlier, scoliosis braces are still one of the most common forms of treatment for the condition. While some people would take that as evidence of their efficacy, this is where it’s important to do your own due diligence.
The aforementioned braces don’t address the condition’s nature as 3-dimensional; instead, they treat it as 2-dimensional.
In fact, traditional braces such as the Boston and the Milwaukee can do a fair amount of harm due to their squeezing designs.
As the braces are designed to squeeze the spine so that it slows down the bad curve’s progression, that pressure can cause a gradual weakening of the spine.
Anything that weakens an already deformed spine isn’t good in the long-term.
There’s also a growing concern amongst experts that the Boston brace can actually increase the spine’s overall rigidity.
In addition, as most of the squeezing pressure from the brace comes from the sides, rib deformities that are already characteristic of scoliosis can worsen.
Of course, there are also the financial costs associated with getting a scoliosis back brace, and depending on budget, this factor alone could decide whether or not a scoliosis back brace is a viable treatment option.
When considering different paths of treatment for scoliosis, financial cost should also be considered. When it comes to bracing, the average cost of a traditional scoliosis back brace can vary depending on the design.
Most often, traditional braces will range in price from $5,000 to $10,000. It’s important to remember that this is solely the cost of the brace; this doesn’t include the cost of having the brace fitted, X-rays taken, and any other associated fees. For the more current and innovative ScoliBrace®, the average cost is $4,600.
For people weighing the pros and cons of various forms of treatment, in addition to considering the efficacy of traditional scoliosis bracing, there is also the financial cost and the emotional and physical challenges associated with wearing a brace that can be uncomfortable and cumbersome.
A big problem with traditional scoliosis bracing is that they’re not custom fit to each and every patient. While certain adjustments can be made and most braces have size options of small, medium, and large, those standardized sizes most certainly can’t be considered custom.
Considering that the braces have to be worn for most of the day, imagine how something that’s not tailored to your body could make you look and feel. Now, also imagine you’re an insecure tween or teenager dealing with all the rigors and emotional upheaval of day-to-day life, plus a progressive and incurable spinal deformity.
Basically, they see their curvature continuing to worsen and, more importantly, they feel it. That pain and discomfort, paired with how they look and the mobility restrictions they’re faced with, often simply becomes too much. If the brace is considered too painful, uncomfortable, embarrassing, or limiting, many patients refuse to wear it.
Much like teenagers who get their orthodontic braces yanked off too soon because they can’t see the end result through the challenges, regardless of how effective a treatment option is, if it’s not sustainable, it ends up wasting time and resources.
Now, after reading all this, you might be thinking there’s little point to even considering scoliosis bracing as a treatment option. I’m here to tell you that there’s a new brace for a new era of scoliosis correction, and you’re going to want to read all about it.
When it comes to modern scoliosis correction technology, I have to point out that the vast majority of traditional scoliosis braces were designed in the 70s. While some tweaks have been made over the years, the overall design remains the same; this is a major shortcoming.
It’s not the theory behind scoliosis bracing that I take issue with; it’s the many shortcomings of the actual braces that I feel are unnecessary. I felt there had to be a better approach to scoliosis bracing, one that could actually improve the condition, rather than just ‘hold’ it.
Here at the Scoliosis Reduction Center, we wanted to give our patients another option that could deliver positive results through curvature reduction and functional improvement.
I touched on it earlier, but the big difference between traditional scoliosis braces such as the Boston and the Milwaukee and the ScoliBrace® is this: the former treats the condition as if it’s 2-dimensional, while the latter addresses its true 3-dimensional nature.
A true scoliosis doesn’t just bend, it rotates, and that’s why it’s considered a 3-dimensional condition; any treatment strategy that doesn’t address it as such will fall short.
The other big difference between traditional bracing and the over-corrective ScoliBrace® is that the ScoliBrace® is classed as ‘ultra-corrective’ bracing, meaning it’s designed to actually reduce the scoliosis while it’s being worn.
The ScoliBrace® is custom manufactured and 100-percent bespoke to each and every patient. Picture shelling out big bucks for a finely-made Italian suit. The tailor measures each and every inch of your body, and the care and intricate detailing that goes into the final measurements results in a suit that’s 100-percent customized to suit your body type and all of its curves; our custom ScoliBrace® is much the same.
We’ve taken the very best corrective principles from other bracing designs and combined them with BraceScan: an advanced and modern 3D imaging software. With BraceScan, we take multiple scans of the patient’s body and spine to ensure a completely customized fit for each and every ScoliBrace®.
My treatment plans don’t always necessitate the use of scoliosis bracing, but when a patient’s condition dictates that necessity, the corrective ScoliBrace® is by far the best choice.
Combined with other forms of treatment such as chiropractic adjustments and scoliosis-specific exercise and therapy, the ScoliBrace® represents a new era for scoliosis treatment: one I’m very excited to be a part of.
Scoliosis is a complex condition. From causation to progression, it’s a condition that often has the medical community scratching its head in search of answers and understanding.
Although we might not understand every variable that affects its development and progression, we’ve come up with a solid foundation from which to develop the best possible scoliosis treatment plans.
When it comes to bracing as a form of scoliosis treatment, there have been a lot of advancements made from the early designs, and those advancements have culminated in the ultra-corrective ScoliBrace®.
The ScoliBrace® uses the ideology behind traditional bracing and addresses its shortcomings by treating the condition as 3-dimensional and making the brace more comfortable, customized, and corrective.
Rather than just holding the spine in a corrective position as the traditional braces do, the ScoliBrace® actually works to move the spine into a corrective position while it’s being worn.
When combined with other forms of proactive treatment, the ScoliBrace® can have impressive results in terms of controlling progression and correcting a curvature without compromising the spine’s natural strength and flexibility.
Nalda, Tony - Scoliosis Hope