Scoliosis: Bracing

Scoliosis makes a person's spine curve from side to side. Curves can get worse as you grow, and may cause health problems. So health care providers sometimes suggest teens wear a brace while they're growing.

What Is a Scoliosis Brace?

A scoliosis brace is a stiff plastic jacket that fits around the torso, from underneath the arms down to the hips. It has straps to keep it in place and straighten the spine.

A brace is also called an orthotic or orthosis. There are different types. An orthopedist works with you to choose the right one. The right brace is the one that works best for the kind of curve you have, but it's also the one you're most likely to wear.

Why Is Bracing Done?

Wearing a brace is often the first step if you need treatment for idiopathic scoliosis. Doctors prescribe the brace hoping it will stop your curve from getting worse and help you avoid spinal fusion surgery.

How Does Bracing Work?

For bracing to work, you must still be growing. Before prescribing a brace, the orthopedic team will check to be sure that you aren't too far along in your growth and development. To do this, they may measure your height; ask questions about periods if you're a girl; or take X-rays of hip, hand, and wrist bones.

Braces don't work on every curve. Bracing won't help if a curve is too big (usually more than 40 degrees). And a brace may not be needed if a curve is too small (less than 20 degrees).

The orthopedic specialist will examine you and recommend a brace based on what type of scoliosis you have, how severe it is, and where it is on the spine.

Every scoliosis patient's body and curve is unique, so a brace must be specially made. Your care team will send you to an orthotist to be fitted. Some hospitals have in-house orthotics experts who can make braces in a day. In other cases, it may take a few weeks to make a brace.

As you grow, orthotists may need to adjust or even replace the brace.

Wilmington Brace and Boston Brace

These jacket-style braces treat moderate curves in the ribcage and lower spine. Both have excellent track records for success and research to back them up.

These braces are worn under clothing. They cover the torso from hips to armpits and are made of lightweight rigid plastic. They fit the body and use special shaping and padding to adjust the spine's alignment in the brace.

• The Wilmington brace closes in the front and is custom molded to each person's body. An orthotist makes a plaster mold of the torso, then uses it to create a brace.
• The Boston brace closes in the back. It's available in many sizes that are customized with pads and cut-outs.

The number of hours per day that people need to wear a brace can vary, but it's usually between 12 and 20 hours.

Rigo-Cheneau Brace

This is a custom plastic brace that is sometimes used with the Schroth method of physical therapy.

Charleston Bending Brace

This brace is worn only at night. Like daytime jacket-style braces, it's a solid piece of plastic that holds the back in position. Instead of keeping the person upright, it's shaped to "overcorrect" the curve by keeping the spine bent to one side. Charleston braces usually only help with C-shaped curves in the lower back.

Milwaukee Brace

This is the first type of brace invented to treat scoliosis. Like jacket-style braces, people wear it 12–20 hours a day. It's a solid piece of plastic that fits around the hips and waist with vertical bars in the front and back that attach to a ring around the neck. Because it's harder to wear, this brace is rarely used anymore.

SpineCor

This is a more flexible bracing method that uses bands and a cotton vest. So far it doesn't seem to be as effective as hard braces.

How Long Do People Wear Braces?

Bracing works best when the patient is still growing and before the curve is too big. Bracing ends after the person stops growing. That can take a couple of years. How long you wear a scoliosis brace depends on your curve and when you're done growing.

Sometimes doctors can tell that a brace isn't helping, so they stop early. When a brace doesn't work, the next step is often surgery.

What Problems Can Happen?

Braces are designed to fit tightly against the body, and that can lead to skin irritation from heat or rubbing. Protecting the skin is important:

• Follow the instructions for cleaning and caring for the brace.
• Be sure you always wear a thin, tight-fitting, sweat-wicking shirt under the brace.
• Some redness is normal when wearing a brace, but call your doctor's office if:
  • Redness doesn't go away within 30 minutes after taking off the brace.
  • You get blisters or sores.
  • You get a rash under the brace.

A couple of other temporary issues can happen with braces. For example, some people may not be able to breathe as deeply with the brace on. Or, the brace may feel too tight right after eating.

What If I Have Questions?

Most people do well with wearing their brace. But it's natural to have questions when it comes to wearing a brace on a daily basis. Your care team is a resource — for you and your parents. They help many teens who wear braces and have tips and ideas on how to handle any challenges.

Having understanding family members helps too. It's always best to talk to parents or other adults if there's anything that you struggle with.

Looking Ahead

What can you expect when you are finished with bracing treatment? Most people easily transition to their brace-free life. Some need physical therapy to build up their muscle strength. Other than that, you can return to all your normal activities.

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