Trapped inside a scoliosis brace for 20 hours a day over two years, young Leah LaRocco suffered both physical and emotional scars. Now, as she looks back at that time in her life, she calls the contraption a “modern-day straight jacket for teenage girls” and compares spinal braces to “medieval torture devices.”

“Wearing this shell … was a living nightmare for an introverted, active teen who played a sport and loved being outdoors,” she said. “The shocking thing is that, 20 years later, the treatment options for scoliosis remain the same: back brace or scoliosis surgery.”

looking for an alternative to a back brace

It’s a common misconception that bracing and spinal fusion are the only ways to stop curve progression. Clinical studies have raised significant doubt about the effectiveness of bracing as a scoliosis treatment. Yet doctors continue to fall back on this outdated treatment method year after year. It does beg the question, “How effective is bracing for idiopathic scoliosis?”

For parents who don’t want to subject their child to the pain of scoliosis bracing, there are better alternatives out there. But first, it’s important to learn why some types of scoliosis braces aren’t as effective as medical science seems to believe.

How do different types of scoliosis braces work?

While some studies suggest that some types of scoliosis braces can stop curves from progressing to 50 degrees, others are inconclusive. Researchers compared the outcomes of patients who wore braces against those who didn’t conclude that both groups ultimately had the same chances of being recommended for surgery.

Bracing may seem to work in the short term, contorting the spine into what looks acceptable in X-rays. Still, any positive effects will often reverse once the bracing stops—even if the spine has reached skeletal maturity. One patient who stopped wearing a brace at age 19 showed a 10-degree scoliosis curve progression over six years.

Part of the problem with hard braces is that they treat adolescent idiopathic scoliosis like a spinal issue when it’s a neuro-hormonal problem rooted in genetic predisposition. It treats only the symptom (the curve) rather than addressing the underlying dysfunction. What’s worse, braces for scoliosis can inflict more harm than benefit causing. Some patients even refer to bracing torture and claim brace scars physically and psychologically.

Weakened muscles. If back bracing works at all, it’s by forcing the spine straighter, but once the bracing stops, nothing keeps the curves from worsening again. In the meantime, muscles and nerves in the back have atrophied, possibly sustaining permanent damage, leaving the spine even less capable of realigning itself than before. The resulting muscular weakness often causes further deterioration.

Scoliosis Xray

Lack of compliance. One of the reasons scoliosis bracing often proves ineffective is because the trauma of wearing one often prevents children from complying with their treatment, compromising its effectiveness. In some studies, kids with braces wore them the recommended number of hours only 10 percent of the time, while six in 10 said they felt handicapped by them.

Breathing problems. A study of one of the most common orthosis for idiopathic scoliosis, the Boston brace, found that the device squeezes the chest wall and abdomen, significantly diminishing breathing capacity, oxygen levels, and other pulmonary functions. Another study of children wearing hard braces showed a 30 percent loss of vital capacity and a 45 percent decrease in the amount of air released during normal exhalation—changes similar to what you might expect in a long-term smoker. Such respiratory distress can cause anxiety, headaches, cognitive dysfunction, and sleep disturbances.

An Alternative to Different Scoliosis Braces

Fortunately, there are better scoliosis treatment options out there. Since the spinal curvature stems from a neuro-musculoskeletal imbalance, the most effective long-term treatments involve re-educating the brain to correct the spine’s alignment.

Scoliosis curves develop when the brain recognizes that the spine is misaligned. However, specialized exercises that trigger the body’s automatic responses can alert the brain that something is wrong and help the body adjust itself naturally—without the external force of a brace.

Identical Twins Scoliosis Success Story

ScoliSMART’s doctors recommend a multifaceted scoliosis treatment program that includes:

For decades, doctors have fallen back on the same scoliosis treatments: bracing and surgery. It’s time we put an end to the practice of forcing the spinal curve into midline alignment. There are better and more effective ways to stop curves from progressing. Doctors prescribe different types of scoliosis braces for one in five adolescents who have the condition. As a result, an estimated 30,000 children with scoliosis are wedged into mounts each year. But to what end?

Even though scoliosis bracing has existed for centuries and has been considered the standard surgery prevention tactic since the modern brace was invented in the 1940s, there is little evidence to support its effectiveness.

Although a 2013 study on the effects of bracing concluded that bracing was more likely to prevent the need for surgery than the alternative “watch-and-wait” method, it also found strong evidence that many back braces are prescribed unnecessarily. Nearly half of all patients in the watch-and-wait group never progressed to the point of needing surgery even without a brace, and the same is true for more than 40 percent of the kids who were prescribed braces for moderate scoliosis, but rarely wore them.

To further complicate the picture, many different types of back braces have evolved over the past several decades, and each type works differently. There is a lot of conflicting data about the success rates of the different types of scoliosis braces, making it difficult to get a clear picture of how they compare and their health risks.

Full-Time Scoliosis Brace Types:

TLSO Brace

This is the most common scoliosis brace treatment in the United States and sometimes confused with the Wilmington Brace. In the study mentioned above, 68 percent of brace-wearing patients used one, especially for curvatures in the thoracic spine. It is typically made of rigid polyethylene plastic and worn around the rib cage, lower back, and hips to apply pressure at three points along the spine.

There are a variety of braces. The most popular rigid braces, the Boston orthosis, originated in 1972 at the Boston Children’s Hospital. Developed by Dr. John Hall and William Miller, it was the first back brace to eliminate the need for a metal superstructure (like the Milwaukee brace), making it less noticeable beneath clothing. (Compliance has always been a challenge in scoliosis treatment, and doctors hoped the added comfort would entice patients to wear their braces more often).

The Boston back support can create adverse health problems for kids despite its popularity. Children suffer a significant loss in breathing capacity and other pulmonary functions when the rigid plastic squeezes the chest wall for 18-23 hours each day. In one study, wearing the brace caused a 30 percent drop in vital capacity, residual volume, functional residual capacity (FRC), total lung capacity, and forced expiratory volume.

Scoli Fact-4

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SpineCor Brace

To encourage patient compliance with correctly and continuously wearing scoliosis braces, some doctors have resorted to flexible bracing systems that allow partial movement and adjust to accommodate a child’s growing body. Note: This is not related to other flexible scoliosis braces like the Sparthos back brace.

The most widely recognized “flexible” brace, the SpineCor brace, is based on a theory that scoliosis stems from three main factors: postural disorganization, muscular dysfunction, and unsynchronized spinal growth. In 1998, pediatric surgeons from Sainte-Justine Hospital in Montreal hypothesized that their dynamic brace could prevent and even improve spinal abnormalities by influencing these factors through controlled movement.

It is not an entirely new concept. Soft braces were used to treat scoliosis as early as 1876 but became obsolete with the invention of the rigid brace just 26 years later. Today’s versions are less likely to infringe on a patient’s quality of life than their hard plastic counterparts, which makes it easier to tolerate wearing them for 20 hours a day.

Quality of life may come with a tradeoff, however. Conflicting data makes it difficult to assess the success of the SpineCor brace, but past studies suggest that the SpineCor brace is even less effective than a hard brace. More recently, researchers using standardized criteria developed by the Scoliosis Research Society found no significant difference in success rates between the SpineCor and TLSO braces. Since even dynamic braces allow children’s developing muscles to atrophy — causing the curve to worsen once the brace is removed rapidly — the risk may not be worth the reward.

Is a Scoliosis brace runing your child life

Types of Scoliosis Braces : Nighttime braces

Charleston Bending Brace

Nighttime braces offer another solution to patient compliance with consistently wearing scoliosis braces. Some orthopedic surgeons have modified traditional brace designs to apply stronger corrective force, reducing the wear time to just 8-10 hours — the length of a good night’s sleep.

The Charleston bending brace became the first side-bending nighttime treatment in 1979. In a collaboration between Dr. Frederick Reed of South Carolina and his colleague, orthotist Ralph Hooper, the Charleston bending brace fixes the patient in an over-corrected position to stretch the spine farther than a traditional CTLSO brace. By wearing it only at night, they reasoned, patients could avoid the social anxiety and negative self-image issues that often accompany scoliosis bracing (especially in adolescent girls).

The Charleston brace still suffers from compliance issues despite the reduced wearing time. Patients find the overstretching uncomfortable when trying to sleep, and some report morning soreness that can last up to three hours. In some patients, aggressive stretching can cause back pain and worsen the secondary curves of the spine. Most doctors consider this brace effective only in specific and limited situations.

Providence Brace

The latest evolution of the nighttime brace aims to achieve maximum curve correction with minimal discomfort. Instead of bending the spine, the Providence brace applies direct, opposing forces to straighten abnormal curves.

In 1992, creators Charles d’Amato and Barry McCoy of the Children’s Hospital of Rhode Island stumbled upon the design for their brace while developing a preoperative spinal X-ray method for patients about to undergo scoliosis surgery. Although it is less effective than the Boston brace for treating large curves, researchers recommend it for less pronounced curves, and some doctors prescribe a combination of both braces.

There is no reliable data on whether the improved comfort of the Providence scoliosis brace makes patients more likely to wear it, partly because they sometimes accidentally remove it in their sleep. One common complaint about the Providence scoliosis brace is that the tilt of the shoulders and rotation of the torso make standing and walking difficult when patients need to get up at night.

Rethinking Types of Scoliosis Braces

These various types of scoliosis braces share a critical commonality for all their differences: They all attempt to correct a neuro-hormonal problem with only a physical treatment. Most braces merely tackle the symptoms without addressing the underlying problem even when successful. The brain doesn’t recognize that the spine is out of alignment, so the body’s posture-correcting mechanism doesn’t kick in.

Instead of forcing correction, building new muscle memory helps the spine unwind naturally by reducing asymmetrical muscle firing. That is the guiding principle behind the ScoliSMART™ Activity Suit, an exercise program combined with outpatient care to hold the spine straighter without causing pressure or pain. The suit uses active resistance and the patient’s natural locomotion pattern to return the spine to a more neutral position.

This latest innovation in scoliosis treatment has been a long time coming. For more than 400 years, braces have been the predominant method for halting the progression of spinal curvature, despite their uninspiring success rates, high social costs, and significant health risks. The more we learn about how this condition works, the more obvious it is that it is time to approach adolescent idiopathic scoliosis differently.