Bracing for Scoliosis 101
So your kid was just recently diagnosed with scoliosis. Where do you go from here? Are they eligible for a brace? Will it be a nighttime-only brace or a full-time (21 hours/day) brace? Will it prevent them from having to have surgery? Navigating the world of scoliosis bracing can be daunting. Consider this your instruction manual.
When is it appropriate to brace?
Scoliosis bracing is recommended only for patients who have growth remaining; we call this being “skeletally immature.” Most girls are done growing by the ages of 14-16, while most boys are done growing by 16-18 years of age. In order for bracing to be effective, it must be initiated before a patient is done growing, or before they are “skeletally mature.” The earlier a scoliosis is braced, the better the outcome. I repeat: THE EARLIER A SCOLIOSIS IS BRACED, THE BETTER THE OUTCOME.
Ok, so does every case of scoliosis need to be braced? No. It depends on the amount of curvature.
Let’s talk severity of scoliosis………
Mild Scoliosis: 10°- 29°
Moderate Scoliosis: 30°- 49°
Major Scoliosis: greater than 50°
Full-time bracing, which is considered 18-21 hours per day, is recommended for curves that reach 25° and above. Most scoliosis physicians have adopted a “wait-and-see” philosophy for curves less than 20°, meaning they will not recommend a brace, and will instead monitor the curve via x-ray every 6 months.
For curves clocking in between 20-25°, a prudent scoliosis doc will recommend nighttime bracing (8-10 hours per night). We as Schroth Physical Therapists are very agreeable to this. Along with the orthotists who make the braces, we believe in early intervention. Some orthotists will even encourage kids with 15° curves to begin nighttime bracing! It’s all about prevention.
How do we predict progression of scoliosis?
It’s sooooooooooo difficult with curves less than 20°: they are unpredictable; some will progress and others will not. Our best hypothesis of progression comes down to the 3 G’s: GROWTH. GRAVITY. GENETICS
This means that the more growth a child has left, the higher the risk of progression. This also means that if there is a family history of scoliosis (mom, dad, sister, aunt, grandma) there is a higher chance of progression. Lastly, good ol’ gravity. The force of gravity alone, “pushing down” on our heads and spines contributes to the lateral curvature and rotation that accompanies scoliosis.
If a scoliosis is going to progress, it will do so rapidly during puberty, especially during large growth spurts. Therefore, we want to brace kids before these big growth spurts happen. Bracing is always the most effective in skeletally immature patients, as it will prevent the scoliosis from progressing during growth.
Take this example: an 11 year old female’s x-ray shows 22° of curvature. She hasn’t been through her big puberty growth spurt yet. She has a family history of scoliosis. She hasn’t yet hit that threshold of 25° of curvature requiring a full-time brace, but does the “wait-and-see” approach make sense for this patient?
That’s going to be a resounding NO.
Somebody get this girl a bracing consult! As you can see, we have to assess on a case-by-case basis in order to make the best bracing decision for the patient.
Ah, bracing consults. Where should you go? To the place your doctor recommends? To the place that takes your health insurance? What brace is best – the Boston brace? The Rigo-Cheneau brace?
Here’s what you need to know. There are generalists and specialists in the world. We see this in our physicians: the general practitioner, or primary care physician, is a jack-of-all-trades doctor. They are covering many, many bases, consulting on cases of abdominal pain, headaches, stubbed toes, and on and on. They will refer out to a specialist when needed, a physician who is specifically trained for that specialty (i.e. gastroenterologist, neurologist, podiatrist, etc.)
Similar to medicine, orthotists/prosthetists, the professionals making scoliosis braces, can also be generalists or specialists. Rather than fretting about the “style” of scoliosis brace, invest your time in checking out who is making your child’s scoliosis brace. Has this individual spent their career making prosthetic limbs for amputees? That’s wonderful, but they probably aren’t well versed in scoliosis-bracing. The spine, and therefore scoliosis, is complex, intricate, and three-dimensional: a scoliosis brace should therefore be all of those things. Orthotists who decide to specialize in scoliosis bracing are who you are looking for.
As a scoliosis therapist, I’ve seen some bad braces in my time. From braces that aren’t providing any curve correction, to braces that are actually pushing in the direction of the scoliosis and making it worse. It happens often enough for me to write this blog post to encourage all parents to find a specialist. It is worth your time and your money to invest in a customized, 3-dimensional brace for your child, made by a specialist.
Will bracing keep my kid out of surgery?
When done in a timely manner, and when done well, YES! Early intervention is key, when the spine is still flexible and “mold-able”. There are many instances of bracing actually reversing scoliosis in juveniles - Read about Ellie’s journey here. In our adolescent population, bracing often prevents further progression of scoliosis. Imagine bracing a progressive 25° scoliosis that if left untreated would have progressed to 55° during the pubertal growth spurt – you just kept your child from having an hours-long spinal fusion surgery that will impact their spinal mobility for life. That is a giant win.
In summary, when you have a kiddo with scoliosis:
1. Consider their degree of curvature
2. Assess their skeletal maturity status
3. Note if there is a family history of scoliosis
4. If your child is a candidate for bracing based on the above findings, Find a specialist to make a customized, 3-dimensional brace