Scoliosis: Bracing

Scoliosis makes a person's spine curve from side to side. Curves can get worse as kids grow and may cause health problems. Health care providers sometimes suggest kids 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 parents and their kids to choose the right one. The right brace is the one that works best for the kind of curve a child has. It's also the one a child is most likely to wear.

Why Is Bracing Done?

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

How Does Bracing Work?

For bracing to work, a child must still be growing. Before prescribing a brace, orthopedists will check to be sure that a child isn't too far along in growth and development. To do this, they may measure a child's height; ask questions about a girl's periods; 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 the child and recommend a brace based on the type of scoliosis, how severe it is, and where it is on the spine.

Each child's body and curve is unique, so a brace must be specially made. Your provider will send your child 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 kids 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 fit under clothing. They cover the torso from hips to armpits and are made of lightweight rigid plastic. They're made to fit a child's 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 fit each child. An orthotist makes a plaster mold of the child's 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 kids need to wear a brace can vary, but usually is 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, kids wear a Milwaukee brace 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 child's 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 Kids Wear a Brace?

Bracing works best when a child is growing and before the curve is too big. Bracing ends after a child stops growing. That can take a couple of years. How long kids wear scoliosis braces depends on their curve and when they'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 your child always wears 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.
  • Your child develops blisters or sores.
  • Your child develops a rash under the brace.

A couple of other temporary issues can happen with braces. For example, some kids may not be able to breathe as deeply with the brace on. Or, the brace may feel too tight right after eating. But the biggest problem with scoliosis braces is that some kids don't want to wear them.

What If My Child Won't Wear It?

Most kids do well with wearing their brace. But when kids struggle, an understanding parent can make a big difference.

You can make the day-to-day reality of wearing a brace easier just by being there for your child as a supporter and cheerleader.

Encourage your child to come to you when things get tough — and promise you'll just listen. Don't jump in with solutions unless you're asked for your help. Then, work together to come up with solutions and incentives to get your child to wear the brace. And agree on the occasional "night off" for important events, like a dance or beach day.

Your care team is a resource — for you and your child. They know that some kids struggle with wearing a brace at times and can give you tips and ideas on how to handle the challenge.

Looking Ahead

What can you expect when your child is finished with bracing treatment? Most kids easily transition to their brace-free life. Sometimes, if they have back pain they might need physical therapy to build up muscle strength. Other than that, kids can return to all their normal activities.