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Scoliosis Braces:
Are They Outdated & Ineffective


Dr. Clayton J. Stitzel


March 30, 2024

Table of Contents

Adolescent idiopathic scoliosis, a spinal condition characterized by abnormal curves, affects millions of people worldwide. One of the treatment options for scoliosis is bracing. Bracing aims to halt curve progression and promote spinal alignment. In this comprehensive guide, we will explore the different types of braces, understand the principles behind how bracing works, and delve into the impact of bracing on daily life. Additionally, we will discuss the process of getting fitted for a brace, offer tips for parents supporting their child through bracing, compare scoliosis bracing to physical therapy, and address important considerations, such as brace wear hours and alternative treatments.

What is a scoliosis brace and how does it work?

A scoliosis brace is a device used to correct or prevent the progression of spinal curvature in individuals with adolescent idiopathic scoliosis. It works by applying pressure to the spine, helping to straighten and align it. The brace is typically worn for several hours a day, depending on the severity of the condition.

Be aware of brace wear and its pitfalls

Full-time scoliosis braces often cause more problems than they solve. Pain that didn’t exist before, breathing problems, weakened muscles, spinal deformities and even psychological scarring. Most shockingly, back braces for adolescent idiopathic scoliosis aren’t proven to prevent scoliosis surgery, either.

Who is the right patient for scoliosis brace?

Full-time back bracing is an overused conservative treatment method that needs to be limited to a very narrow range of adolescent idiopathic scoliosis cases:

  • Very early-stage growth (Risser sign 0-2)

  • Curves greater than 25 degrees, but less than 40 degrees on x-ray

Scoliosis Research Society notes that adolescent idiopathic scoliosis progresses most often in patients who are growing and have curves which are above 20 degrees.


Scoliosis back brace treatment has existed for more than 450 years. Yet its success is still controversial. Much of the research conducted on back braces for adolescent idiopathic scoliosis reveals mixed and contradictory results. Studies have demonstrated the negative physical, emotional, and psychological effects scoliosis back bracing treatment has on children and teens. It has become clear that a better way for treating scoliosis, an effective treatment, needs to be developed based on the latest science and technology.

Even if bracing was successful, studies suggest that children only wear them 10 percent of the recommended time noting bracing hurts, is embarrassing and handicaps their lives. Moreover, full-day bracing doesn’t prevent surgery, so they are not inclined to follow the protocol. 


What are the different types of braces for adolescent Idiopathic scoliosis ie boston brace?

There are many different types of back braces for scoliosis. Some patients and parents would say there are “too many” to choose from. 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 came from. This is how we get brace names like “Boston Brace,” “Wilmington Brace,” “Milwaukee Brace” , Willand “Charleston Bending Brace”. Only recently have newer scoliosis back braces from privately owned orthotists taken on more “marketing style” names like “SpineCor Brace”, “WRC brace” and “ScoliBrace”. These back braces claim to work better, because of their custom-fit process. The Boston Brace 3D, a type of Boston Brace developed at Boston Children’s Hospital in the 1970s, is one such example of a back brace that has evolved with technology to its present form with three-dimensional spinal correction.

Here are some commonly used scoliosis braces:

  • Boston brace for Idiopathic scoliosis: This brace, also known as a thoracolumbosacral orthosis (TLSO), is a rigid brace that covers the torso from the armpits to the hips. It applies corrective pressure to the spine, aiming to prevent curve progression and promote spinal alignment.

  • Milwaukee brace for Idiopathic scoliosis: This brace is a full-torso brace that includes a neck ring and a pelvic girdle. It is primarily used for the treatment of cervicothoracic curves and aims to correct the curve while allowing normal growth.

  • Charleston bending brace: This brace is a specialized nighttime brace that is worn while the patient sleeps. It focuses on the curve correction by applying bending forces, specifically designed for certain types of scoliosis curves.

  • Nighttime Idiopathic scoliosis brace: This type of brace is worn only during the night and is often recommended for moderate scoliosis curves. It provides a degree of flexibility for the patient during the day while still offering the necessary support during sleep.

  • The Wilmington Brace is a scoliosis brace that has gained recognition for its design, treatment effectiveness, and patient comfort. It features a unique open-back construction, providing ventilation and comfort during wearing.

  • Regardless of the type of brace prescribed, it is important to note that skin irritation can be a potential side effect of wearing any scoliosis brace. Regular monitoring of the skin and proper care of the brace can help mitigate the risk of skin problems. The care team, including orthotists, can provide guidance on how to address any discomfort or skin issues that may arise.

What sets WCR and Rigo-Cheneau Braces apart?

The WCR brace, also known as the Wilmington brace, offers a more flexible approach for moderate Idiopathic scoliosis curves. This brace design provides optimal support and allows for a degree of mobility, which can be beneficial for patients who wish to engage in physical activities. The individual brace design takes into consideration the patient’s scoliosis curve type, ensuring a personalized fit for the patient’s specific needs.

On the other hand, the Rigo-Cheneau brace is a custom-made, 3D-corrective brace that has gained recognition for its effectiveness in scoliosis treatment. This brace design accounts for the patient’s curve type, taking into consideration the unique characteristics of the scoliosis curve. The Rigo-Cheneau brace addresses the individual patient’s needs and aims to provide the most effective treatment outcome.

The orthotist’s skills play a crucial role in the design and fit of both the WCR and Rigo-Cheneau braces. These professionals use their expertise to create individual brace designs that maximize the brace’s effectiveness. Their skills ensure that the brace provides the necessary support, promotes spinal alignment, and minimizes the risk of brace-related complications. Through close collaboration with the care team, the orthotist ensures that the brace is well-fitted, comfortable, and tailored to the patient’s unique scoliosis curve. The brace is only as good as it is fit properly!

Choosing the most appropriate brace, whether it is the WCR brace or the Rigo-Cheneau brace, requires a thorough assessment of the patient’s scoliosis curve type, their treatment goals, and the stage of treatment. The care team, including orthotists, physical therapists, and physicians, will work together to determine the best brace option for each individual patient.

the different types of braces

Scoliosis bracing constricts breathing and may increase the rib hump!

Braces like the most common thoracolumbar-sacral-orthosis (TLSO) brace squeeze and mold to the chest wall and abdomen. A Norwegian study of the TLSO found it decreases breathing capacity. Breathing impacts thoracic, muscle and fat composition, and cognitive performance. One study showed that children who wore a hard brace had a 30% decrease in vital capacity (VC). Also, a 45% decrease in expiratory reserve volume (the air you can push out after a normal exhale). These decreases in pulmonary function are identical to those 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 which can lead to spinal deformities. More modern options for conservative treatment for your child’s scoliosis condition are available. Scoliosis-specific nutrient therapies, combined with scoliosis-specific core strengthening exercises and the use of therapy, can halt curve progression and reduce spine curves.

The Impact of Scoliosis Bracing on Daily Life

Living with scoliosis and wearing a brace can impact a patient’s daily life in various ways. It is important for patients to understand the effects of scoliosis bracing and how to navigate their daily routines while wearing a brace. Whether it is engaging in physical activities, such as sports, or finding ways to dress comfortably with a brace, there are strategies and support available to help patients adapt to their new normal. Let’s explore the impact of scoliosis bracing on physical activities and dressing, and how patients can navigate these aspects of their daily life.

Physical Activities and Scoliosis Brace Treatment

Engaging in physical activities while wearing a scoliosis brace can be a concern for many patients. It is important to note that moderate scoliosis patients can participate in physical activities with the brace, as long as they follow the guidelines provided by their care team. A physical therapist specializing in scoliosis therapy can be a resource for patients looking to maintain an active lifestyle while wearing a brace if this route is the one chosen.

Conservative Treatment and bracing

Non invasive treatment like ScoliSMART can complement the effects of bracing by focusing on exercises and stretches that promote spinal alignment and improve core strength. The doctor can create a personalized exercise plan tailored to the patient’s specific scoliosis curve type, ensuring that the brace and therapy work in harmony to address the patient’s individual needs.

During periods of rapid growth, it is recommended for patients to wear the brace for the recommended number of hours each day. This stage of growth plays a significant role in managing scoliosis curves, and adherence to several hours a day during remaining growth to wear a brace can directly impact its effectiveness.

In addition to Therapy, the orthotist’s skills play a crucial role in the design and fit of the brace. An individual brace design that considers the patient’s scoliosis curve type is essential for optimal treatment outcomes. The care team, including the scolismart doctor, orthotist, and the patient, should work together until skeletal maturity to ensure that the the treatment provides the necessary support for the patient’s physical activities while addressing the unique aspects of their scoliosis curve pattern.

Dressing with a Scoliosis Brace

Dressing comfortably with loose fitting clothes with a scoliosis brace is a common concern for patients, especially when transitioning to a new brace. While a scoliosis brace may have a significant impact on clothing choices, it should not prevent the patient from wearing normal clothing or expressing their personal style.

The outer edge of the scoliosis curve determines the side of the body and hips that the brace will cover. This consideration is important when selecting clothing, as it helps ensure that the brace remains concealed and does not cause any discomfort. Patients may need to adapt their clothing choices to accommodate wearing the brace, opting for looser or stretcher clothing options.

It is important for patients to remember that each stage of bracing is a crucial. The care team, consisting of treating team of orthotists and other scoliosis professionals, will guide the patient through the process of adapting to the new brace and provide solutions for any challenges that may arise.

In some cases, scoliosis brace side effects, such as skin irritation, spinal deformities may occur. It is important for patients to maintain good skin hygiene, regularly inspect the skin for any redness or irritation, and promptly report any concerns to their care team. The orthotist can provide recommendations for skin care and address any issues related to the brace, ensuring the patient’s comfort and well-being.

Why is a Scoliosis Brace Recommended? 

Bracing is recommended for children in early-stage growth with a scoliotic curve between 25 and 40 degrees. The “hope” is that bracing, such as hard plastic braces, metal braces, and even softer dynamic braces, will delay or halt curve and scoliosis progression, since the condition is progressive. One major problem with most braces is they cause muscles to weaken, leading to discomfort and possible curve worsening. When you wear a brace you don’t use your muscles, they atrophy. For example, when your wear a brace for your arm, the muscles inside the brace/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 worsens once the brace treatment is taken off. Using brace treatment, your child’s spine becomes stiff. Joints that don’t get necessary movement often develop more degenerative issues and spinal deformities. Bracing also puts stress on the ribs and causes a rib hump. Doctors almost always recommend removing the brace when they see this negative change using 3D x-rays, yet the damage may have already occurred.

The Process of Getting Fitted for a Scoliosis Brace

Getting fitted for a scoliosis brace is a crucial step in the treatment process, ensuring that the brace fits comfortably and provides optimal support. This process involves a collaborative effort between the patient, the care team, and the orthotist. In the following sections, we will explore what to expect during the fitting session, the importance of regular brace adjustments, and how these factors contribute to the overall effectiveness of scoliosis bracing.

What to Expect During the Fitting Session?

During the fitting session, the care team will verify the patient’s scoliosis curve type and assess the degree of the curve. This information is vital for the design of the brace, as it ensures the most appropriate treatment for the individual patient. The orthotist will take detailed measurements of the patient, which are essential for creating a personalized brace.

Once the measurements are obtained, the orthotist will use brace based materials to create the custom brace. This process involves heating the thermoplastic brace construction material and molding it to the patient’s body. The orthotist will ensure that the custom made brace fits comfortably and provides the necessary support for the patient’s scoliosis curve.

In addition to the physical aspects of the fitting session, the care team will provide comprehensive education on how to wear, remove, and care for the brace. This includes instructions on the recommended to wear the brace, wear hours, skin care tips, and general do’s and don’ts. Clear communication between the patient, the care team, and the orthotist is crucial during this stage, as it sets the foundation for successful brace treatment.

The Importance of Regular Brace Adjustments and scoliosis bracing guidelines

Regular brace adjustments play a critical role in the effectiveness of scoliosis bracing. As the patient’s body changes and grows, the brace needs to be modified to ensure an optimal fit. To achieve positive outcomes, regular evaluation of the brace’s fit and necessary adjustments are essential. The orthotist, working in collaboration with the patient and the care team to treat scoliosis well, ensures that the brace continues to fit properly and provides the necessary support for the patient’s scoliosis curve throughout the treatment journey.

The stages of treatment, including the initial stage, consist of sequential hours that gradually increase over time. Adhering to the recommended brace wear hours is vital for the brace to exert the necessary corrective forces on the spine. The care team, including the orthotist, physical therapist, and physician, will monitor the patient’s progress and make adjustments accordingly.

Properly fitted braces help prevent skin irritation, a potential side effect of brace wear. The care team will closely monitor the patient’s skin and address any concerns promptly. Maintaining good skin hygiene and following skin care recommendations provided by the care team are important for minimizing the risk of skin problems.

Dealing with Emotional Challenges of Wearing a Brace

Wearing a bracing can have emotional challenges for a child, including self-consciousness, body image concerns, and occasional discomfort. As a parent, understanding and validating your child’s emotions is crucial. Here are some strategies for supporting your child through the emotional challenges of wearing a brace:

  • Acknowledge your child’s emotions and provide a supportive environment for expression. Let your child know that it is normal to feel a range of emotions about wearing the brace and that their feelings are valid.

  • Discuss the brace’s role in treatment and the effects it may have on your child’s health. Help your child understand that the brace is designed to help manage scoliosis and promote spinal alignment. Emphasize the long-term benefits of brace wear in preventing curve progression.

  • Encourage your child to connect with others going through similar experiences. Support groups, online communities, or local events can provide opportunities for your child to interact with peers facing similar challenges. Sharing experiences and tips can help reduce feelings of isolation.

  • Validate your child’s feelings and offer encouragement during moments of doubt. Let your child know that you are there to support them unconditionally, and remind them of their own strengths and resilience. Encourage them to focus on the progress they have made and the positive impact bracing will have on their spinal health.

  • Create a safe space for your child to process and express their emotions. Encourage open communication, allowing your child to share their concerns, fears, and frustrations. By providing a safe, non-judgmental environment, you can help your child navigate the emotional challenges of wearing a brace with confidence and resilience.

  • By offering emotional support, understanding, and open communication, parents can play a vital role in helping their child navigate the emotional challenges of wearing a scoliosis brace.

Alternatives to scoliosis bracing (for kids and adults!) conservative treatment

At ScoliSMART Clinics, we teach your child conservative treatment options that creates new muscle memory to hold the spine straighter that don’t require them to wear the brace. Our Early Stage Intervention and Scoliosis Boot Camp a innovative scoliosis treatment program that halts curve progression, reduces curvature, provides pain relief, and improves your child’s breathing. We also decrease each child’s curve rigidity to help reduce spinal curvatures even more! 

The ScoliSMART activity suit and exercises work with the natural torque pattern of the body to create new posture memory and core muscle strength. The new posture memory helps the spine unwind, stabilizes asymmetrical muscles, and reduces curvature without pressure or pain. The ScoliSMART Activity Suit in combination with the Scoliosis “Boot Camp” program works well for patients under the age of 18. It can even be used for kids with mild curves and allows them to resume their normal activities, without limiting physical activity. It is also available to adult patients (even post fusion) looking for back support to help relieve back pain. The ScoliSMART activity suit and exercises are also effective alternative for patients who require a cervical-thoracic-lumbar-sacral orthosis (CTLSO) for treatment.

Now it’s even easier to connect with ScoliSMART. Schedule your free virtual consultation online with a ScoliSMART office. 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 ScoliSMART officeSchedule your consultation right here!

Proactive Treatment for Scoliosis

Children with mild or moderate spine curves benefit most from ScoliSMART exercises. This is because their bones are not yet deformed by months or years of compensating for abnormal twisting and bending of the spine. We use proactive treatment solutions such as genetic testing, nutrient therapies, and the ScoliSMART Activity Suit. Remember, all kids who have large spinal curves started out with small curves first! If a brace was suggested for your child, you deserve a second opinion. Our programs can replace full time bracing and surgery, or be combined with standard night-time bracing treatment — and allow your kid to still be a kid. Additionally, these proactive treatments can improve mobility and quality of life for children with scoliosis, leading to curve reduction.

Don’t know where to start?  Take our FREE “ScoliQuiz.”  (No x-ray required)

ScoliSMART Clinics are 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.

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