Tag: scolibrace

How Important Is Compliance For Scoliosis Bracing Success?

Posted on February 23, 2024 by - Blog

Scoliosis is a condition that affects the curvature of the spine. It can be caused by a variety of factors, including genetics, injury, or underlying medical conditions. Scoliosis can range from mild to severe, and treatment options depend on the severity of the curvature. One of the most common treatments for scoliosis is bracing. While bracing can be effective in preventing further curvature of the spine, compliance with the treatment plan is crucial for success.

 

What is scoliosis bracing?

Scoliosis bracing involves the use of a custom-fitted brace to prevent further curvature of the spine. The brace is typically worn for a set number of hours each day, depending on the severity of the condition. The goal of bracing is to prevent further curvature and ideally, to reduce the existing curve. Modern “over-corrective” braces, such as the SoliBrace make this possible, whereas with older braces stopping progression was the best possible outcome.

 

Why is compliance important for scoliosis bracing success?

Compliance is crucial for the success of scoliosis bracing. When a patient wears a brace as directed by a Scoliosis specialist, they are more likely to prevent further curvature of the spine and reduce an existing curve. Compliance also ensures that the brace is working properly and providing the necessary support to the spine. Ultimately, Scoliosis braces work by gently applying pressure to the spine in a direction which opposes the curvature – over time, the spine will tend to correct itself – but time is the keyword here. Unless the brace is on a patient’s body for enough time, it simply cannot do its job.

Non-compliance, or failure to follow the treatment plan, can lead to a number of issues. If the patient does not wear the brace as directed, the spine may continue to curve, which can lead to more severe scoliosis and potential surgery. Non-compliance can also cause discomfort and pain, as the brace may not fit properly or provide the necessary support if the curve worsens from its “starting” state.

Compliance is therefore critical to the success of bracing – and while many patients often perceive this as a negative (especially when adjusting to brace wearing) it’s important to realise that research suggests this relationship is proportional, so, consider the flip side – the longer you wear the brace, the faster your Scoliosis will improve![1]

 

How can patients increase compliance with scoliosis bracing?

There are several strategies that patients can use to increase compliance with scoliosis bracing. The first step is to understand the importance of compliance and the potential consequences of non-compliance. Patients should of course discuss any concerns or questions they have with their specialist to ensure that they fully understand the treatment plan and have made as many adjustments as possible to make it viable – this is all well and good for adults but for children, it can be more complicated.

Parents of children being treated with Scoliosis braces should do everything they can to explain the process to their children, but on a practical level, they can also work to make the brace more comfortable and convenient to wear. This may involve adjusting the fit of the brace or finding ways to wear it that are more comfortable. Braces such as ScoliBrace are highly customisable and provide a lot of flexibility in this regard. Some patients find that wearing the brace while sleeping or during sedentary activities is more comfortable than wearing it during more active times – again, braces such as ScoliBrace are easy to put on or take off yourself, which makes it much easier to be more flexible with the times of day that a brace if worn.

Support from family and friends can also be helpful in increasing compliance. Encouragement and reminders to wear the brace can help patients stay on track with their treatment plan.

 

Is compliance the most important factor?

Compliance is crucial for the success of scoliosis bracing. When a patient wears a brace as directed, they are more likely to prevent further curvature of the spine and potentially improve a curve or at least avoid surgery. Nonetheless, compliance with a program is only valuable if that program is optimised to achieve individual results for a given patient – and this is why the choice of brace, and clinic matters so much.

[1] ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

 

Bracing Scoliosis over 45 degrees

Posted on July 25, 2022 by - Blog

For many years it was considered to be the case that surgery was the only option for reversing Scoliosis – while Scoliosis braces did exist, their primary function was simply to stop Scoliosis from progressing. The best outcome available from bracing was therefore to slow Scoliosis down enough that a patient reached adulthood with a tolerable curve.

Today, modern Scoliosis braces have the ability not only to stop the progression of Scoliosis but also to reverse the condition. Such “over corrective” braces, such as the ScoliBrace we offer at the UK Scoliosis Clinic do this by applying gentle pressure to the scoliotic curve in the opposite direction to the curvature – over time, this can gradually help the spine to return to proper alignment. The success of bracing treatment depends on several factors – one of the most important being the flexibility in the spine, however, it’s possible for patients with Scoliosis up to around 60 degrees[1] to see excellent correction when they are young and flexible enough.

Nonetheless, the “wait and see” followed by surgery approach is still common today, which means Scoliosis patients should always do their research and explore their options before committing to a specific course of treatment.

 

When to brace

When to brace a Scoliosis curve is a tricky question, and one of the major benefits of seeing a Scoliosis specialist – very small curves may not need bracing, with an exercise methodology being enough to control the condition. Larger curves, but those under roughly 30 degrees could benefit from either bracing or exercise-based approaches, so the patient’s lifestyle factors and preferences start to play an important role in treatment selection. For curves over 30 degrees Cobb (Cobb angle being the way in which Scoliosis is measured), bracing is usually the best way forward – however many patients with curves over 45 degrees are often recommended a surgical approach, is this the only option?

 

Bracing curves over 45 degrees – study results

A 2011 study[2] looked specifically at treating Scoliosis patients who were recommended surgery but declined it. The purpose of the study was to verify if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment – in most cases, this means a combination of bracing and exercise. Specifically, the methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed.

Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°-58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment.

After the course of treatment, two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements were therefore found in 71% of patients, with only a single 5° Cobb progression observed in one patient. As such, the conclusion was that bracing can be successfully used in patients who do not want to undergo operations for Scoliosis, with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance.

 

Is bracing always the right choice for larger curves?

Weather bracing is the right choice for any given curve depends very much on the patient – as studies like this show it’s certainly possible to achieve great results without undergoing surgery – however, the spine needs to be sufficiently flexible and there needs to be time before skeletal maturity is reached still remaining so that treatment has time to work. A consultation with a Scoliosis specialist is always the best way forward when dealing with a suspected or confirmed Scoliosis case, but today it’s certainly true that there are far more tools we can use to prevent and treat Scoliosis than ever before.

 

 

 

[1] Maximum indicated cobb angle for ScoliBrace

[2] Stefano Negrini  1 , Francesco Negrini, Claudia Fusco, Fabio Zaina, Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements Spine J. 2011 May;11(5):369-80.doi: 10.1016/j.spinee.2010.12.001. Epub 2011 Feb 2.

Types of ScoliBrace

Posted on January 25, 2022 by - Blog

At the UK Scoliosis Clinic, our current “go-to” solution for Scoliosis treatment is the ScoliBrace. ScoliBrace is, in our opinion, currently the best scoliosis bracing solution available – we’re always open to adding alternative braces, but for the time being we feel that ScoliBrace is an excellent solution for nearly every case requiring bracing. We’re able to say this is because ScoliBrace design itself, is unique & flexible and is available in many different variants. This week, we’re taking a look at a few of the options.

 

Standard ScoliBrace

The “standard” model of ScoliBrace is optimised for treating “classic” adolescent scoliosis. Of course, each scoliosis case is totally unique – however, the standard ScoliBrace design covers the majority of those “typical” curve profiles.

This brace is ideal for Major thoracic curves, Thoraco-lumbar curves, and Lumbar curves – although it has the significant advantage of also being suitable for treating Double curvatures with a major thoracic and lumbar component, as well as complex triple curves with a high thoracic component (i.e. apex at T2-T6)

 

ScoliBrace comes in a wide variety of colours and is a low profile solution in all cases, making this brace an effective tool for treating most scoliosis cases.

 

High Thoracic ScoliBrace

The High Thoracic scolibrace is designed to target Thoracic curves for more rapid treatment. This version of the ScoliBrace uses a high thoracic closure, which helps maintain stability of the correction in larger degree curvatures and helps in the treatment of high thoracic curves. This kind of brace is unsurprisingly suitable for curves which are located in the thoracic spine.

 

 

 

 

Lumbar ScoliBrace

The Lumbar Scolibrace is focused on the correction of curves in the lower spine – this is often an area associated with degenerative Scoliosis, making this brace an excellent supportive option for those suffering with “de-novo” scoliosis. This brace specifically targets single lumbar or thoracolumbar curvatures, but without any thoracic compensation, making it unsuitable for patients with any thoracic curvature.

As an additional advantage, this brace is incredibly low profile, especially under clothing and  maintaining excellent in brace correction of lumbar and thoracolumbar curves.

 

 

 

ScoliNight

ScoliNight is a version of the ScoliBrce which is designed primarily for night time wear – this kind of brace is therefore best for those needing a smaller brace wear time, and therefore tends more towards the treatment of smaller curves. ScoliNight is considered an option for patients with smaller, less complex curves – such as single thoracic, lumbar or thoracolumbar curves less than 25 degrees.

On average a ScoliNight brace will only be worn for roughly 8 hours at night, which may be more convenient for some patients – however, it’s also possible that a scoliosis case which would be viable for a ScoliNight brace could be treated more quickly with a standard brace – an important point to consider.

 

 

 

KyphoBrace

The KyphoBrace is a sister product to the ScoliBrace, which, as you may imagine is designed primarily to treat Hyperkyphosis, rather than Scoliosis. Unlike Scoliosis, the majority of Kyphosis cases do not get significant enough to require treatment, hence the  KyphoBrace is recommended for curves from 50-80 degrees (Kyphosis)  and is suitable for thoracic and thoracolumbar hyper-kyphosis, as well as Scheuermann’s hyper-kyphosis.

KyphoBrace uses a pair of pivoting shoulder paddles to hyperextend the upper thoracic spine. This keeps the brace essentially invisible under clothing while still maintaining an excellent in brace correction of the kyphosis.

 

 

 

Hybrid Kypho-ScoliBrace

To address the needs of patients with mid scoliosis alongside Kyphosis, there is also a hybrid Kypho-Scolibrace, designed to counteract both conditions at once. This kind of brace is suitable only for milder instances of both conditions, however.

 

 

 

Want to know more?

Do you, or does someone you know suffer from Scoliosis – to find out if ScoiBrace could be a good option please just get in touch! We’re now offering a free X-ray review service for those who want to learn more about their options for treatment, so don’t wait  – contact us today!

Scolibrace Vs. Hospital brace – which is better?

Posted on January 25, 2021 by - Blog

At the UK Scoliosis clinic, our primary focus is to allow as many patients as possible to benefit from the chance to beat scoliosis through non-surgical methods as possible. Research as well as our own experience demonstrates that scoliosis bracing is the best way to achieve this – and for this reason were broadly supportive of any kind of scoliosis bracing technology available. This being said, we’ve said before that all braces are not created equal – some are just more effective than others.

 

Why ScoliBrace?

Our preferred brace and the one we offer at the clinic is the ScoliBrace. ScoliBrace is a totally customised brace, designed to achieve maximum curve correction as quickly as possible – but as well as being a highly effective corrective device, ScoliBrace is (in our opinion) the most patient-friendly brace on the market. It’s a low profile brace, and is practically invisible under clothing – unlike traditional braces, ScoliBrace opens and closes at the front making it easy to wear and remove without assistance. ScoliBrace is even flexible enough to allow the wearer to participate in normal physical activity while wearing the brace. What’s more, you can customise your ScoliBrace! – There are a variety of colours and patterns available for patients to personalise the look of their brace – overall, we think these factors make it the best choice for patients today.

 

How effective is ScoliBrace?

ScoliBrace stacks up favourably vs. the traditional thoracolumbosacral orthosis (TLSO) braces available through hospitals and some other clinics – and one recent study shows just how great the difference can be. The recently published study from Dr Jeb McAviney of ScoliCare (Sydney, Australia) concerned a male patient who was referred to the ScoliCare clinic at the age of seven with a previous diagnosis of juvenile idiopathic scoliosis. The patient had previously been fitted with a traditional 3-point pressure thoraco-lumbo-sacral orthosis (TLSO) that had been designed by a hospital orthotist[1].

The patient reported that he regularly participated in rugby, soccer and swimming. Aside from the spinal deformity, the patient was otherwise healthy. On examination a right thoracic curve and a left lumbar curve were noted.

The patient provided x-rays that had been taken at the time of the initial diagnosis as well as x-rays taken soon after the brace fitting (Figure 1). The initial pre-brace x-rays revealed that the patient’s primary thoracic curve was 32° Cobb and the secondary lumbar curve was 27° Cobb.

An examination of the in-brace x-rays for the hospital made TLSO demonstrated that an adequate in-brace correction had not been achieved with only an 11° reduction in the thoracic curve and no measurable change in the magnitude of the lumbar curve (Figure 1).

Dr McAviney proceeded to design and fit a customised ScoliBrace for the patient – In-brace x-rays taken soon after the fitting of the new ScoliBrace demonstrated a significantly better in-brace correction compared to the previous brace.

The patient’s primary thoracic curve had been reduced to down to 13° Cobb, which represented a 59% correction of the initial curve and a 25% improvement on the correction obtained with the hospital-made TLSO.

The lumbar scoliosis was almost completely reduced (3° Cobb) in the new orthosis. The hospital-made TLSO had not achieved any correction in this region of the spine (Figure 2).

 

This is just one case which demonstrates that all braces are not equal – the right brace at the right time is needed for real improvement.

Is ScoliBrace right for me?

If you’ve been diagnosed with scoliosis you will have numerous treatment options – bracing is one of these, while exercise-based therapy is the other major one. For very small curves exercise-based approaches may be preferable, but in most cases, we recommend you consider bracing.

Since Scoliosis presents in a unique way in every patient, ScoliBraces are custom designed to fit your exact needs – Fundamentally, Scoliosis is a 3 Dimensional condition, so we believe effective treatments need to be 3 dimensional too. Your brace will be designed using 3D full-body laser scanning technology, x-rays and posture photographs.

Each brace is then produced for the individual with Computer Aided design (CAD) and then created with Computer Aided Manufacture (CAM).

ScoliBrace is typically recommended for the treatment of Cobb angles from 25-50 degrees. It is suitable for wearers of all ages and comes custom-designed for your specific requirements. For curves less than 25 degrees, bracing may still be the preferred choice, as it’s a faster treatment than exercise – it’s also much easier for smaller children to manage (just put the brace on, rather than performing complex exercises). For curves greater than 50 degrees, bracing may still be possible – book an appointment with a scoliosis professional today!

Don’t forget that the UK Scoliosis clinic now offers online consultations too – so if you have questions, book an appointment today!

 

Images in this article are courtesy and copyright ScoliCare Australia.

 

 

[1] Dr Jeb McAviney, Superior In-brace Correction Achieved with a ScoliBrace Compared with a Standard TLSO in a Juvenile Scoliosis Patient (ScoliCare, 2020)

 

 

How to choose a scoliosis brace – questions to ask your practitioner

Posted on February 4, 2020 by - Blog

Regular readers of this blog will know that at the UK Scoliosis clinic, we believe that scoliosis bracing is the best approach to reducing cobb angle in the majority of scoliosis cases, and indeed, it is becoming clear from larger-scale studies that this is the case. [1]

It’s certainly true that some smaller degree curves can be effectively treated with exercise approaches alone, however even these cases treatment with a brace will often be faster, and much easier in terms of effectiveness and compliance with younger patients.

In many instances then, parents of patients or patients may find themselves interested in the idea of bracing, but unsure about which type of brace will be the most appropriate. This week, let’s look at the factors you may want to consider when choosing a brace, and questions you may want to ask your scoliosis bracing practitioner.

 

 

1 – Active, or passive?

Once upon a time, the only kinds of scoliosis brace available were what are now known as “passive” braces – these include models such as the “Boston brace”. Passive braces are not really intended as a treatment for scoliosis, instead as a method to slow its progression. Passive braces work by holding the spine in its current, scoliotic position – this can slow and perhaps stop the progression of the condition but will do nothing to reverse it, and therefore nothing to alleviate the symptoms.

Passive braces are still offered by some clinics and are sometimes provided via the NHS – we would strongly recommend that you avoid passive braces since in the long run they will not improve the condition.

The below image shows a adolescent with idiopathic scoliosis, with a right thoracic curve measuring 49.50 degrees out of brace, and in the second X-ray (with a passive brace on)  shows the curve as almost the same, as the goal of a passive brace is too just hold the current spinal position not straighten the spine.

Active braces, such as our recommended model, the ScoliBrace, are the opposite – over time they are designed to gently guide the spine back into the correct position so that the longer the user wears the brace the greater their spine correction will be.

The below image shows a right thoracic curve similar to that of the first patient – The curve measured 41 degrees – however, this time when the In-brace x-ray was taken,  the curve reduced to 13 degrees.

 

2- Flexibility

Most modern scoliosis braces are designed using a CAD/CAM process and are therefore perfectly fitted for their users – this makes the majority of models low profile, but low profile braces are not necessarily also flexible braces. Braces such as Scolibrace are designed to be minimally restrictive when being worn and even allow the user to participate in sporting activities while wearing the brace. This may be more or less of a factor depending upon your lifestyle, but it worth keeping in mind.

 

3 – Adjustability

A big factor differentiating the cost of modern braces is their durability for use over the course of scoliosis treatment. Some cheaper scoliosis braces are manufactured to fit your body at a specific time and for a specific degree of correction only. Once you have either outgrown the brace, or you have reached the maximum degree of correction which the brace can provide, a new brace will need to be fitted. If your case is not a severe one, a single brace may be enough to correct your scoliosis – but many patients will end up paying for multiple braces, thus driving up longer-term costs when non-adjustable braces are used.

An alternative (albeit an alternative which will be slightly more expensive upfront) is an adjustable brace. Scolibrace falls into this category and allows for periodic adjustment and augmentation of the brace to allow it to follow along with your scoliosis correction. Patients with significant curves may still need more than one scolibrace, but by contrast, 3 or even 4 fixed shape braces would certainly cost more in its place.

In the picture below you can see the effect of a corrective brace pad reducing the curve from 13 degrees down to just 7.5.

 

4 – User-friendliness

An often-overlooked factor for scoliosis braces is the ease with which they can be put on, or taken off. Depending on your treatment protocol you may only need to wear your brace for a certain part of the day, only at night or may be able to take the brace off for physical activity. This is, of course, only possible if the brace is easy for the user to take it off, or put it back on!

Pay special attention to this factor if you live alone, or have children who require a brace, since a brace which is not correctly fitted will not do its job!

 

5- Style

While style probably isn’t the best criteria to judge the success of a brace by, compliance  – that is to say how often patients actually wear the brace – is certainly a major factor. Braces such as Scolibrace are available in a range of colours and patterns so that they can either be produced in a style which matches your own preference, or in colour designed to blend in under clothing, especially school uniform.

 

[1] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the

patients with adolescentidiopathic scoliosis in Mainland China? –A randomized controlled trial study

SPINE: An International Journal for the study of the spine [Publish Ahead of Print]

Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace

Posted on November 29, 2019 by - Blog

New research just published by our partner ScoliCare has once again gone to show that the ScoliBrace, coupled with an appropriate exercise regime can be effective not only in reducing scoliosis, but also in treating Scheuermann’s Kyphosis.

Regular readers of the blog will know that a treatable case of Scoliosis is considered to exist when the cobb angle (the bend in the spine) exceeds 10 degrees. Scoliosis causes the spine to bend “from side to side”.  In Scheuermann’s Kyphosis there is a malformation of the spinal vertebrae – specifically, they are slightly shorter in height at the front than at the back, leaving them slightly wedge-shaped – This leads to a “forward hunching” curve in the spine. While both conditions can and do frequently present independently, it is entirely possible for both to be present.

With respect to treatment for Scheuermann’s kyphosis and scoliosis, a course of conservative (that is to say, non-surgical) therapy is recommended wherever possible, with surgical intervention reserved for those patients with severe pain and/or disability at the time of the initial consultation or for individuals who have not responded to conservative management attempts.  The research from 2019 provided a case study of a patient in which both conditions were present, and were managed successfully with ScoliBrace, and appropriate exercise.

Let’s take a look at the recent case study[1] – both because we can learn something about the way that ScoliBrace can be used to treat these cases, but also because many readers may recognise something of their own experience!

 

Scoliosis and Scheuermann’s, a case study

Initial X-ray, taken at the start of treatment

On the 22nd of February 2016, a 26-year-old Caucasian male presented to a chiropractic clinic suffering with from lower back pain and poor posture. He also had a previous diagnosis of Scheuermann’s kyphosis and adolescent idiopathic scoliosis. The patient reported difficulty with prolonged standing and sitting, dissatisfaction with his cosmetic appearance, and difficulty with leisure activities – all of which are common issues for sufferers of both conditions.

Interestingly, the patient in question had not left his spinal conditions untreated – on the contrary, at the age of 15, the patient was referred to the local Children’s Hospital and was prescribed a hospital made thoraco-lumbo-sacral orthosis (TLSO) (a brace) which he wore full-time (23 hours per day) between the ages of 15–17 years.  Unfortunately, the brace provided was not like ScoliBrace, in that it’s action was preventative, rather than corrective – meaning that its objective was simply to hold his curves in place to avoid progression of the scoliosis, rather than to reduce it. The brace also had no effect on the Kyphosis.

At the point of initial examination, the patient reported that he was significantly unhappy with his physical appearance and rated his back pain as 4/10 on average and 7/10 at worst.

Full spine radiographic assessment was performed which revealed a thoracic hyper-kyphosis measuring 79° Cobb (Fig. 1), and a 30° Cobb lumbar scoliosis and sacral obliquity (Fig. 2). A loss of disc height, vertebral wedging and endplate irregularities were noted at several levels in the mid-thoracic spine. A true leg-length discrepancy (short left leg relative to the right) of 6 mm was also noted during the radiographic examination.

Subsequently, he was prescribed a ScoliBrace custom spinal orthosis, a rehabilitation program and a 6 mm heel lift. The ScoliBrace, unlike the Boston brace the patient was previously provide with, is an over-corrective brace, which takes and active approach to correction – this means that rather than simply trying to stop scoliosis progressing, it actually works to reduce the curve. The patients home exercises were simple for him to perform and included a mixture of stretching and strengthening exercises designed to oppose both undesirable curvatures.

 

12 months with ScoliBrace, results!

Follow up X-ray

Since the entire ScoliBrace process is designed to be flexible, reactive and adaptable, patients are typically seen every 6 months or so to assess progress and make any necessary treatment changes. Our patients first follow-up assessment was performed 4.5-months after the initial assessment. After just 18 weeks, the patient reported that, on average, he had been pain-free, with his worst occasional pain being rated as 2/10 pain on occasion.  In terms of the spinal deformity, the hyper-kyphosis had reduced by 16°, from 79° down to 63°, and the lumbar scoliosis curve was reduced by 5°, from 30° down to 25°.

At a further follow-up, 12 and a half months after the initial consultation, another series of x-rays showed that the postural improvements had all been maintained. An analysis of follow-up radiographic images (Fig. 6) showed a maintenance of the original postural improvements. [2]

 

 

Treating Scoliosis and Scheuermann’s at the UK Scoliosis clinic

The above case study results are interesting, because fairly few studies have addressed the use of active correction braces in adults, and there is also very little research on the correction of both conditions simultaneously. This case study certainly suggests that ScoliBrace, coupled with targeted home exercise can indeed have a positive impact on these conditions.

Of note is also the fact that this is yet another study to indicate a link between scoliosis and pain. At the UK Scoliosis clinic, we have long observed that pain and discomfort are often associated with these conditions, even if research has yet to confirm this association in an absolute sense. It would be fair to mention on this point that much of the research that would go to establish the validity of bracing as an approach to pain reduction have been affected by low adherence of study participants to their prescriptions – which is a common issue for many studies in bracing.[3]

At the UK Scoliosis clinic, we also offer the Kyphobrace system (from the same developers as scolibrace) which is ideal for treating Kyphosis cases which occur without scoliosis. To learn more, click here.

 

 

[1] Christopher M. Gubbels, DC, Paul A. Oakely, DC, MSc, Jeb McAviney, MChiro, MPainMed, Deed E. Harrison, DC, Benjamin T. Brown, PhD,  Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report, J. Phys. Ther. Sci. 31: 159–165, 2019

 

[2] Christopher M. Gubbels, DC, Paul A. Oakely, DC, MSc, Jeb McAviney, MChiro, MPainMed, Deed E. Harrison, DC, Benjamin T. Brown, PhD,

Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report, J. Phys. Ther. Sci. 31: 159–165, 2019

 

[3] See for example Weiss HR, Moramarco K, Moramarco M: Scoliosis bracing and exercise for pain management in adults—a case report. J Phys Ther Sci, 2016, 28: 2404–2407.

Palazzo C, Montigny JP, Barbot F, et al.: Effects of bracing in adult with scoliosis: a retrospective study. Arch Phys Med Rehabil, 2017, 98: 187–190.

A scoliosis Journey – Week 3

Posted on July 8, 2019 by - Blog

This week, we round out our journey with Patient X – having correctly diagnosed scoliosis and chosen an appropriate treatment methodology, it’s now time to explore her progress and eventual results using the Scolibrace system.

 

5. Treating scoliosis with scolibrace – the results

As you will remember from previous instalments of this series, there are two main categories of scoliosis brace – active correction and “passive” braces. Active correction braces are the type now used by most scoliosis specialist clinics, and have been shown to be highly effective in treating scoliosis.[1] While scolibrace is certainly not the only active correction brace on the market, we firmly believe it is the best available today.

There are two main reasons we believe this – firstly, scolibrace is highly user-friendly. Unlike some braces, scolibrace can be put on and taken off by the wearer without any assistance, it’s also easy to secure, requiring just a couple of Velcro straps to hold it in place. Scolibrace also has a low form factor, meaning it can be worn under clothes without being visible in most cases – and a wide variety of colour choices goes to make this even easier. Being made from the latest materials, and fabricated using CAD/CAM technology scolibrace is also lightweight and so easy to move in that many wearers even leave their brace on to participate in sports activities. Taken as a whole this makes life during bracing very much more comfortable (and far preferable to surgery!).

Perhaps more important in the long term, however, are scolibrace’s results. In the case of patient X (who began treatment with a 33-degree Cobb angle), a one-month in-brace x-ray showed that the curve had reduced to 13 degrees. At the 3 month out of brace x-ray, the curve had reduced to 26 degrees. In just three months the out of brace curve had reduced by 7 degrees.

At this point, the flexibility of the scolibrace design was once again important since, where other systems may require a whole new brace, scolibrace allows extra corrective padding to easily be added to the brace to increase the 3-dimensional corrective action and keep up the progress. At the 12-month mark, an out-of-brace x-ray was taken – The results of which showed that the spine was down to just 11 degrees without using the brace – a reduction of 22 degrees which brought patient X within one degree of “normal” measurement.

The final x-ray for patient X was taken 22 months after the start of treatment after a period of weaning off the brace. This x-ray was an out-of-brace x-ray where the patient was required to be out of the brace for at least 6 hours. The results of the final X-ray showed her spine to have a 6-degree curvature, which according to definition (greater then 10 degrees cobb) cannot be classified as a scoliosis.

The combination with scoliosis specific exercise assisted in speeding the correction of the Cobb angle[2], but also made a substantial contribution to the overall postural correction which scoliosis treatment also provides. Postural assessments showed continuous improvement of her posture with her body showing good balance after 4 months of treatment, with improvements continuing so that she was visually symmetrical by the 12-month mark. The postural improvements were then maintained throughout the treatment period.

One potential risk of scoliosis bracing which has been highlighted is the potential for loss of mobility or deterioration of fitness, however the incorporation of exercises in the program also assisted in this regard[3], such that a functional assessment of fatigue ability and strength of her core muscles, together with the flexibility of her spine showed no deterioration of strength, endurance or flexibility at the end of treatment.

 

6. After scoliosis

After just 22 months of treatment, patient X no longer suffered from scoliosis – an unmitigated success for scolibrace, but what about in the future, could scoliosis reoccur?

While a patient is continuing to grow, there is always the chance that scoliosis could begin to develop again – scoliosis patients should, therefore, be monitored until they have reached adulthood and their skeleton has finished growth. Having said this, recent research has indicated that continuing with some targeted scoliosis specific exercises after bracing can be effective in preventing any loss of correction[4].

So what now for patient X? Having completed her treatment and with a handful of ongoing exercise to keep her on track she’s free to get on with the rest of her life, scoliosis free!

 

scoliosis braces

Scoliosis braces have come a long way!

Could ScoliBrace be right for you?

We hope that this series of articles has been informative and has given you an outline as to the path that a typical non-surgical scoliosis treatment can take. If you have concerns about scoliosis, or would like to find out if ScoliBrace might be right for you, why not get in touch today, and arrange a one to one consultation with our specialists.

 

 

 

 

 

 

[1] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘
Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

 

[2] Negrini S, Negrini A, Romano M, Verzini N, Parzini S: A controlled prospective study on the efficacy of SEAS.02 exercises in preparation to bracing for idiopathic scoliosis. Stud Health Technol Inform 2006, 123:519-522.

 

[3] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A: Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys 2005, 41(2):183-201

[4] Fabio Zaina et al. Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT’s 2008 Award for Best Clinical Paper,  Scoliosis 2009, 4:8

 

A Scoliosis Journey: Week 2

Posted on June 22, 2019 by - Blog

Last week we began to explore the case of Patient X – a scoliosis patient who, after successful treatment with a ScoliBrace, avoided the need for corrective surgery and now lives scoliosis free.  This week, we learn about her treatment prescription. If you missed week one, we suggest reading it here first.

 

3. The best treatment?

Having confirmed a scoliosis case and with that case being below the surgical threshold, it was possible to move forward with a non-surgical approach for patient x – but which is the best treatment methodology on offer?

In dealing with any scoliosis case, there are at least three elements to treatment which need to be considered – firstly, the Cobb angle (that is to say, the angle of the scoliotic curvature) needs to be reduced. Secondly the angle of trunk rotation (rib hump) and thirdly, muscular imbalances which have developed alongside the scoliosis, need to be addressed and balanced.

In terms of Cobb angle reduction, Scoliosis braces are the most effective non-surgical approach.[1] There are many different kinds of scoliosis brace and many work slightly differently. Broadly speaking braces can be classified as either active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position). Passive braces which are typically provided by hospitals, once the only option available, obviously do nothing to reduce cobb angle – so bracing with an active correction brace is the recommended approach.

The angle of trunk rotation or the “rib hump” is best addressed by a active scoliosis brace such as Scolibrace which addresses the scoliosis in a 3-dimensional manner, helping to de-rotate the spine to reduce rib hump progression, whilst preserving the spines natural curves in the low and mid-back.

The best approach to correcting the muscular and postural imbalances associated with scoliosis are specialised exercise methodologies which have been designed for scoliosis treatment. There are two main approaches to consider. The first is SEAS or the “Scientific Exercise Approach to Scoliosis”. SEAS consists of an individualised exercise program adapted for the purpose of treating an individual’s scoliosis. Different exercises are used to correct different types and elements of scoliosis, so by combining them in the correct way, an ideal exercise plan can be produced.

SEAS treatment is often used as a stand-alone approach when treating smaller curves and as a compliment to bracing with large curves and where there is a significant risk of progression.

The other main exercised based method, Schroth therapy, is a well-established and easy to use treatment methodology which some experts consider to be the best exercise-based approach for treating Idiopathic Scoliosis.[2]  As an independent treatment, some studies have shown a reduction of Cobb angle of 10-15 degrees over the course of a year[3] – however, Schroth therapy combines particularly well with bracing. When Schroth is combined with bracing superior results can often be achieved more quickly than either approach alone.[4]

Patient x’s scoliosis, being 33 degrees cobb, was already beyond the point where exercise alone would have been an ideal treatment. As the patient was still growing and the curve was already greater than 30 degrees, she was also considered a high risk for her scoliosis to worsen. While this specific combination of factors meant that hers was a high-risk case overall, she was an ideal candidate for correction with a highly advanced scoliosis brace – the ScoliBrace. (This is the brace we offer at the UK Scoliosis Clinic)

In this case, scoliosis specific rehabilitation exercises and use of a scoliosis orthotic device, a Scolibrace, were therefore recommended.

 

4. Treatment with ScoliBrace

ScoliBrace, unlike many braces, is a totally customised, 3D designed, rigid active correction brace. ScoliBrace isn’t just customised for your scoliosis case, you can also choose a colour or pattern which suits your style – or opt for something which matches your skin tone to blend in well.

A ScoliBrace is not like most braces which use 3 point pressure. It uses a 3D inverse correction of the spine ie it shifts the spine into the opposite direction by moving the spine towards the correct position

For Patient X, the scoliosis brace was initially to be worn full-time. This is 23 hours per day with up to a maximum of 4 hours out of the brace if the patient was actively participating in sports during those out of brace hours. Brace wear was started at 2 hours on the first day, followed by adding another 2 hours every subsequent day until the required full-time hours were attained. Time in brace is often adjusted throughout scoliosis treatment period -but is generally high at the start in order to arrest the curve development and begin to reduce it as soon as possible.

Patient X was also given a program of scoliosis specific exercises, which were initially taught in the clinic as twice a week for 3 weeks, followed by once per month. The patient was required to complete the exercises each day out of the brace, but this was easy to do at home and it was included as brace time wear.  A  ScoliRoll (scoliosis orthotic device) was also used daily for 20 minutes to stretch the spine into the opposite direction of the curve, to help improve the spines mobility back to a normal position.

Next week, we’ll focus on Patient X’s progress with ScoliBrace!

 

 

[1] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine (2018) [Publish Ahead of Print]

[2] Steffan K, Physical therapy for idiopathic scoliosis,  Der Orthopäde, 44: 852-858; (2015)

[3] Kuru T, et al. The efficacy of three-dimensional Schroth  exercises  in   adolescent idiopathic scoliosis: A randomised controlled clinical trial, Clinical  Rehabilitation,  30(108); (2015)

[4] Marinela, Rață;Bogdan, Antohe, Efficiency  of the Schroth and Vojta Therapies in Adolescents with Idiopathic Scoliosis. Gymnasium, Scientific Journal of Education, Sports, and Health Vol. XVIII, Issue 1/2017

Why choose ScoliBrace?

Posted on August 11, 2018 by - Blog

When thinking about the right scoliosis treatment there are many options to consider. This is what you would expect since scoliosis itself is a complex and often highly variable condition which requires a treatment plan specifically designed for each patient.

The two main approaches used in non-surgical scoliosis treatment are scoliosis specific exercise methodologies and bracing. Of the two, bracing is probably the more effective, although a scoliosis specific exercise program can sometimes be sufficient. In some instances, patients might prefer bracing over exercise due to the improved results which can be obtained without conscious efforts.

At the UK Scoliosis clinic, we often use both approaches to achieve the best possible outcome for patients – but today let’s consider bracing.

 

Why is bracing so popular?

Today, scoliosis patients can benefit from the latest and most technologically advanced braces available through our clinic. Unlike some older brace designs, modern braces present a high likelihood of a successful non-surgical outcome.

To take just a few points, recent research has shown that…

  1. Specialised scoliosis bracing when prescribed for high-risk patients, can prevent the need for surgery in most cases[1]
  2. Patients who wear scoliosis braces get better results the longer they wear the brace each day[2]
  3. Part-time bracing in adults significantly reduces progression of curvatures and improves quality of life[3]
  4. Conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, with most patients reaching a complete curve correction[4]
  5. Bracing is an effective treatment method for AIS cases, characterized by positive long-term outcomes[5]

Today, research is therefore clear – scoliosis bracing is an effective, affordable and safe alternative to surgery. But which brace should you choose? With the growth in interest in non-surgical scoliosis treatment, various brace designs have become popular – while each have their own benefits, here at the UK Scoliosis Clinic, we offer the ScoliBrace active correction brace – which we believe to be the most modern an effective brace on the market. Let’s see why:

 

Why choose ScoliBrace?

Scolibrace

ScoliBrace is comfortable, low profile and easy to use!

When choosing a new treatment option for our clinic, our scoliosis specialists scrutinise each aspect of a candidate product, both from a clinical and patient comfort perspective. To date, ScoliBrace is (in our opinion) the best scoliosis braces we have seen, that’s why it’s our go-to treatment in many cases. Originally developed in Australia we are one of only a handful of internationally approved ScoliBrace providers.

ScoliBrace improves upon many previous braces, and avoids some of the most common pitfalls – it is:

 

Highly effective

A ScoliBrace is an over-corrective brace – unlike braces which simply try to halt the progression of scoliosis, ScoliBrace works by guiding the body and spine into a posture that is the opposite of how the scoliosis is shaped. This means that all the time you are wearing a ScoliBrace, you are treating your scoliosis – not just slowing it down. A ScoliBrace can also help to improve the overall appearance of the body.

 

Comfortable

Most Scoliosis braces are quite tricky to get into and can sometimes have a less than optimal construction for your body shape. ScoliBrace opens and closes at the front making it easy to wear and remove without assistance. Thanks to our advanced manufacturing process, your brace will be custom made to fit you like a glove.

 

Stylish

Unlike most braces which are only available in white, ScoliBrace is available in a variety of colours and patterns which allow you to personalise the look of your brace. We can offer exciting patterns for younger children (featuring everything from dinosaurs to football, and butterflies to love hearts) as well as stylised looks from a Demin pattern to Zebra print!  ScoliBrace is also available in a wide variety of natural skin tones, to match your own completion if you prefer.

 

Adjustable

Many scoliosis braces are manufactured to a single size and shape, meaning that over the course of treatment some patients may require three or even four individual braces. ScoliBrace has a wide range of adjustment, meaning that in most cases patients require no more than two braces during treatment – which can save a great deal of money in the long term.

 

Low profile

ScoliBrace has been designed with everyday people living everyday lives in mind – this means the brace is as unobtrusive as possible and can even be worn during sports and other physical activities. ScoliBrace is intentionally low profile, so that it can be worn almost invisibly under even light clothing.

 

Totally customised

Many scoliosis braces today claim to be a custom design – but ScoliBrace braces take this principle a step further. ScoliBrace braces are planned out using brace Scan technology, which combines 3D full-body laser scanning, x-rays and posture photographs.  Each brace is then custom designed for the individual with Computer Aided design (CAD) and then created with Computer Aided Manufacture (CAM) to create a brace which is perfect both in terms of fit and correction. Thanks to this process our measuring and manufacturing tolerances are as low as 0.5mm.

 

scolibrace

Modern scoliosis braces like ScoliBrace are highly effective

 

 

 

[1]   ‘Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements’
Negrini S, Negrini F, and Zaina F, 2011, Spine J. 2011 May;11(5):369-80. doi: 10.1016/j.spinee.2010.12.001. Epub 2011 Feb 2.

‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’   [Results of the BrAIST Clinical Trial]
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

[2] ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

[3] ‘Effects of Bracing in Adult With Scoliosis: A Retrospective Study‘
Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C, Arch Phys Med Rehabil. 2016 Jun 22. pii: S0003-9993(16)30256-8. doi: 10.1016/j.apmr.2016.05.019

[4] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘
Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

[5] Curve progression after long-term brace treatment in adolescent idiopathic scoliosis: comparative results between over and under 30 Cobb degrees
Aulisa et al,  Scoliosis and Spinal Disorders 2017 12:36 https://doi.org/10.1186/s13013-017-0142-y

Catch scoliosis early, and don’t “wait and see”!

Posted on July 23, 2018 by - Blog

Catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the cobb angle is the key to a successful outcome. Our message today, to parents in particular, is to have your children screened regularly and act on any concerns you may have. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.

 

Scoliosis school screening is vital

children

3 – 4 % of children will develop Scoliosis

Since Scoliosis usually develops in children and should be treated as soon as possible to maximise the chances of a successful outcome, school scoliosis screening has been a topic of much debate and is something that we strongly advocate here at the clinic.

Studies have shown that school screening can effectively reduce the risk of requiring invasive spinal

fusion surgery[1]. Although there has been debate about the effectiveness of school screening in the past, it is now clear that screening does improve outcomes for children affected by scoliosis. The clinical effectiveness of scoliosis screening has been assessed in numerous studies of different designs, which have been synthesized in a systematic review with clear results.  The review covered 28 studies

published between 1977 and 2004 and concluded that there was sufficient evidence to suggest that school scoliosis screening is safe, may detect cases of Adolescent idiopathic Scoliosis (AIS) at early stages, and may reduce the risk of surgery[2].

Despite this, school screening is still not commonplace in the UK, although this is not the case everywhere. In Hong Kong, for example, scoliosis screening has been conducted as a routine health service since 1995, thereby making it one of the regions with the longest history of routine scoliosis screening in the world. Hong Kong’s screening protocol was demonstrated to be clinically effective for children who studied in the fifth grade during the first two academic years after the program was started; however, no longer term evaluation was attempted[3][4]. In response to this, a longer term study has now been undertaken, in which a total of 306,144 students participated in scoliosis screening. Clearly, screening is considered valuable around the world!

 

Why does early detection matter?

Early detection Is especially important in scoliosis cases since research has shown a direct link between the age of detection and the outcomes achievable. Today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[5]

The 2015 study included patients aged between 4 to 10 years at the beginning of treatment and with a curve magnitude of 20°-40° Cobb. Curves between 20° and 25° Cobb degrees were included only in the presence of documented curve progression. Patients were prescribed an appropriate scoliosis brace and wear time, based on their individual cases.

The results from the study showed that curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Critically however, the study also demonstrated that treatment appears to be more effective with curves under 30° (incidence of surgery: 1.6%) than curves over 30° (incidence of surgery: 5.5%) – which strongly suggests the need to catch curves early. [6]

 

Juvenile scoliosis almost never resolves without treatment

Scolibrace

Scolibrace is a comfortable and effective advanced brace

Unfortunately, “wait and see” is still a common approach here in the UK – unfortunately this approach is outdated and fails to recognise the outcome of research which has clearly shown that juvenile scoliosis tends to worsen, sometimes aggressively and almost never resolves.

Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability[7].

A 2006 study followed (but did not treat) 205 patients of which 99 (48.3%) were operated on. Of 109 curves less than or equal to 20 degrees at onset of puberty, 15.6% progressed to greater than 45 degrees and were fused. Of 56 curves of 21 degrees to 30 degrees, the surgical rate increased to 75.0%. It was 100% for curves greater than 30 degrees[8].

This research is particularly troubling, in light of the above study, which showed a very high likelihood of total curve correction up to and including 30-degree angles, had these cases been screened, caught early and treated with a corrective brace.

 

How we can help

At the UK Scoliosis clinic, we offer free screening to anyone concerned about Scoliosis. If you have already had a diagnosis and have been advised to wait and see, we especially urge you to book an appointment to see our specialists in order to avoid compromising your chances at a highly effective treatment plan.

 

[1] Richards BS, Vitale MG. Screening for idiopathic scoliosis in adolescents. An information statement. J Bone Joint Surg Am 2008;90: 195–8.

[2] Sabirin J, Bakri R, Buang SN, Abdullah AT, Shapie A. School scoliosis screening programme—a systematic review. Med J Malaysia

2010;65:261–7.

[3] Luk KD, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, et al. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine

2010;35:1607–14.

[4] Yawn BP, Yawn RA, Hodge D, Kurland M, Shaughnessy WJ, Ilstrup D, et al. A population-based study of school scoliosis screening.

JAMA 1999;282:1427–32.

[5]  ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘

Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

[6] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘

Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

[7] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[8] Ibid.