Tag: Scoliosis bracing

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

 

How To Stay Comfortable While Wearing A Scoliosis Brace

Posted on January 27, 2024 by - Blog

Scoliosis is a medical condition in which the spine curves abnormally to one side. Scoliosis braces are designed to help correct this curvature by applying pressure to the spine. However, wearing a scoliosis brace can feel uncomfortable, especially during the initial adjustment period. Much like wearing braces on your teeth, it takes a bit of getting used to. Once you’re through this part, however, you can make choices which make wearing a brace easy – or hard. Make your life easy by planning ahead! Let’s look at some of the easiest ways to make wearing a brace work for you.

 

Find the right fit

The first and most important step to ensure comfort when wearing a scoliosis brace is to find the right fit for the brace itself. A properly fitted brace should be snug but not too tight. If the brace is too tight, it can cause discomfort and even lead to skin irritation or sores. On the other hand, if the brace is too loose, it will not provide the necessary support and correction.

ScoliBrace, the system used at the UK Scoliosis Clinic is designed to fit the wearer like a glove – we measure and custom produce your brace to millimetre tolerances to ensure that it’s just right. Braces like the ScoliBrace also allow some degree of adjustment, so that we can get more life from the brace – it’s important to ensure that whenever your brace is adjusted you test it out for comfort and have it modified if anything is uncomfortable.

 

Wear a moisture-wicking undershirt

Scoliosis braces, like anything worn on the body, tend to retain heat – in the winter this can be helpful, but in summer it can cause sweating and discomfort, especially during very hot weather. Wearing a moisture-wicking undershirt can help keep the skin dry and prevent chafing or irritation. These undershirts are made of breathable fabric that wicks sweat away from the skin and keeps the body cool.

 

Use skin protectants

Wearing a scoliosis brace can cause friction and pressure on the skin, leading to skin irritation or sores. This isn’t usually an issue with a properly fitted brace during everyday wear, but if you’re using a lightweight brace like ScoliBrace and leave it on during exercise you might experience some discomfort. Using skin protectants, such as creams or ointments, can help prevent these problems. The protectant forms a barrier between the skin and the brace, reducing friction and pressure.

 

Practice good hygiene

Practising good hygiene can help prevent skin irritation and infection. It is essential to clean the skin under the brace daily using mild soap and water. Dry the skin thoroughly before putting on the brace since if you do sweat throughout the day the skin can become more prone to soreness.

 

Wear comfortable clothing

Wearing comfortable clothing can help reduce discomfort when wearing a scoliosis brace. Choose loose-fitting clothes that do not rub against the brace especially when relaxing at home. Avoid wearing tight clothing or clothing with thick seams, as they can cause pressure points and discomfort – this isn’t really to do with the brace – tight-fitting clothes can cause irritation for anyone – but when wearing a brace the effect is often more noticeable.

 

Stay active

Staying active can help improve comfort when wearing a scoliosis brace. Exercise helps improve muscle strength and flexibility, which can reduce discomfort and improve posture. Consult a healthcare provider before starting any exercise program, as some activities may be restricted when wearing a scoliosis brace.

 

Stay hydrated

Drinking plenty of water can help prevent dehydration and reduce discomfort when wearing a scoliosis brace. Dehydration can cause fatigue, headaches, and muscle cramps, making wearing the brace more uncomfortable. Aim to drink at least eight glasses of water per day.

 

 

How Long Does Scoliosis Bracing Take?

Posted on December 12, 2023 by - Blog

Scoliosis bracing is a highly effective, non-surgical treatment option for children and adolescents with moderate to severe scoliosis. Braces are custom-made to fit the patient’s body and apply pressure to the spine to encourage it to grow in a more normal alignment. The goal of scoliosis bracing is primarily to stop the progression of the curvature until the child’s spine has stopped growing, and, ideally to correct the existing curve to leave the patient with as straight a spine as possible.

 

Factors which impact bracing time

Scoliosis bracing works over time – the fundamental aspect of the treatment is the gradual application of corrective force over a period of months, and probably years. The exact length of time a person needs to wear a brace depends on several factors, including the severity of the curvature, the age of the child, and the rate of spinal growth. Children who are diagnosed with scoliosis at a younger age are more likely to need longer treatment times because their spines are still growing, and the curvature may progress more quickly. The severity of the curvature is also an important factor, as more severe curvature may require a more rigid brace or a combination of bracing and other treatments, such as surgery. At the same time, cases which are caught early in young children have some of the best chances of a complete correction – although these patients will generally need to continue with some form of Scoliosis prevention until they reach adulthood.  Cases which are treated for the first time in Adults (often a form of Scoliosis known as degenerative or “de-novo” Scoliosis) often improve with only part-time bracing[1].

The compliance of a patient with wearing the brace is also an essential factor. If a patient wears the brace as directed, they are more likely to see positive results and need to wear the brace intensively for a shorter period of time. Again once a curve has been corrected, some maintenance is required, but this can usually be part-time brace-wearing, often at night or in the evening.

The length of time a patient needs to wear a brace can therefore vary widely, but on average, children wear a brace for a considerable amount of time (often 20+ hours a day) for two to three years. After this part-time wear or a program of Scoliosis specific exercise is usually sufficient to prevent a reoccurrence.

 

Is wearing a Scoliosis brace hard?

The duration of scoliosis bracing is an important consideration for parents and children. It can be challenging for children to adjust to wearing a brace consistently for an extended period, but it is crucial for the success of the treatment. Parents can help their children by providing emotional support and encouragement and ensuring that the child wears the brace as directed – as a clinic, we do everything we can to make brace wearing as comfortable and manageable as possible!

It’s also important to monitor a patient’s progress regularly as part of treatment to ensure that the brace is working as intended. Based on this progress, wear time can be adjusted up or down based on goals as well as how well the brace is being tolerated. We usually recommend regular X-rays to check the progression of the curvature and adjust the treatment plan as necessary – this approach allows maximum flexibility in the trade-off between in-brace time and speed of treatment.

While scoliosis bracing can be challenging for children and adolescents, it can also be an opportunity for personal growth and resilience. Children who successfully complete scoliosis bracing often develop increased self-confidence and a sense of accomplishment.

[1] ‘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

 

The History Of Scoliosis Bracing

Posted on October 15, 2023 by - Blog

Today, bracing is rightly recognised as one of the most effective ways to treat Scoliosis without surgery. While bracing is not suitable in every case, research suggests that in the majority of patients bracing can at least halt the progression of a Scoliosis curve[1], and in many cases, a significant degree of correction to the curve is usually possible[2].

While bracing is only now starting to be viewed as a viable alternative to surgery (not least because the success rates for modern braces are not widely known) spinal bracing for Scoliosis is not a new idea – in fact, there have been Scoliosis braces for almost a long as there have been written records!

 

Early Bracing Techniques

Throughout history there is evidence of attempts to correct spinal conditions using bracing – for much of history, however, bracing techniques were crude and often uncomfortable. Hippocrates is thought to have been the first physician to describe the use of a wooden board to straighten a curved spine. However, this technique was not widely used until the 16th century, when Ambroise Paré, a French surgeon, developed a similar device. His device consisted of a wooden board that was wrapped around the patient’s torso and secured with leather straps. Paré believed that the device could straighten the spine by applying pressure to the curved area. Paré was clearly an intelligent man – not only was he the first to formally document the preponderance of Scoliosis in Females, his basic theory for the non-surgical treatment of the condition was essentially correct.

In the 17th century, a German physician named Lorenz Heister developed a metal brace that was designed to be worn around the torso. Heister also believed that the brace could help straighten the spine by applying constant pressure to the curved area. However, the brace was heavy, uncomfortable, and not very effective.

 

18th and 19th Century Bracing Techniques

In the 18th century, a French physician named Jean Baptiste Bouvier developed a new type of brace called the spinal brace. The spinal brace was made of metal and leather and was designed to fit snugly around the torso, providing support for the spine. Bouvier believed that scoliosis was caused by weak muscles and that the spinal brace could help strengthen these muscles and correct the curvature of the spine. However, the spinal brace was again, uncomfortable and not very effective.

In the 19th century, several other types of braces were developed to treat scoliosis. One of the most popular was the Taylor brace, which was developed by Dr Robert Taylor in 1864. The Taylor brace was made of metal and leather and was designed to fit snugly around the torso. Critically, the brace was adjustable, allowing the physician to apply pressure to specific areas of the spine. The Taylor brace was the first brace to be widely used in the United States and, in its adjustable nature was a key step towards the technology we have today.

Another brace that was developed in the 19th century was the Risser cast. The Risser cast was made of plaster and was designed to be worn around the torso. The cast was used to immobilize the spine and prevent further curvature. While the Risser cast was effective in preventing further curvature, it was uncomfortable and limited the patient’s mobility.

 

20th-Century Bracing Techniques

By the 20th century, various types of braces had already been developed – they all focused on the key goal we still have today – gently guiding the spine back into the correct alignment. What early braces lacked, however, was a material which provided enough flexibility in design to be truly effective.

One of the most significant developments of the 20th century was therefore the use of plastics in brace construction. Plastics allowed for the creation of lightweight and more comfortable braces which could be much better formed to the torso of the patient. One of the most popular of these new braces was the Boston brace, which was developed by Dr John Hall in 1972. The Boston brace was made of plastic and was designed to fit snugly around the torso, with a series of pads and straps that could be adjusted to apply pressure to specific areas of the spine. The Boston brace was more comfortable than previous braces and was effective in treating scoliosis in many patients – while the Boston brace was not often effective in reducing Scoliosis, it was the first to have a high success rate in preventing the worsening of the condition.

 

Bracing post-2000

Another significant development in scoliosis bracing – and one which brings us up to date – is the use of computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies. These technologies allowed for the creation of custom-made braces that are specifically designed for each individual patient. This allowed for a more precise fit and better results. Modern plastics also allow braces to be more flexible and easy to wear than ever before.

Perhaps the most important development facilitated by CAD, however, was the introduction of “active” or “over corrective” braces – such as the ScoliBrace that we offer here at the clinic. The precision offered by computer-aided design and manufacture makes it possible to produce a brace which actually opposes scoliosis – therefore actually correcting the curve over time rather than just trying to stop its progression.

 

Learn more about Bracing

As you can see, modern braces such as the ScoliBrace are a refinement of literally hundreds of years of thought on Scoliosis – inventors and doctors have been aware of the way to treat Scoliosis without surgery for hundreds of years, but it’s only now that we finally have the technology to make this a reality. If you’d like to learn more about scoliosis and Scoliosis bracing, why not sign up for our free information series here.

 

 

[1] ‘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

‘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.

 

[2] ‘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

 

The advantages of Scoliosis Bracing

Posted on April 27, 2023 by - Blog

Scoliosis is a condition characterised by an abnormal curvature of the spine, which can cause pain, discomfort, and even breathing difficulties. Scoliosis bracing is a non-surgical treatment option that involves wearing a brace to stabilise and/or correct the curvature of the spine. While bracing may not be a cure for scoliosis, it has many advantages that make it an effective treatment option. Research shows that the use of modern, custom designed Scoliosis braces can prevent the need for surgery in most cases[1].

While Scoliosis bracing is a fantastic approach to treatment, it does come with some downsides – bracing takes time and commitment, and can be an adjustment especially for a young person. Similarly, while bracing is a cost-effective treatment over a period of time, Scoliosis braces can be expensive and represent a significant up-front cost for some families. The disadvantages however usually outweighed by the benefits!

 

Bracing Slows the Progression of Scoliosis

The primary advantage of scoliosis bracing is that it can slow down the progression of scoliosis in most instances.[2] When used correctly (and when a modern brace is used) it’s often possible to not only stop the progress of Scoliosis but also to reverse the condition – often by a considerable amount.[3]

Bracing is also more effective than alternative non-surgical approaches, such as exercise based therapy.[4] In children and adolescents with moderate to severe curves, bracing can reduce the likelihood of the curve getting worse and the need for surgery. The brace helps to apply pressure on the spine, which helps to straighten the curvature and prevent it from progressing further.

 

Bracing is a Non-Invasive Treatment

Another advantage of scoliosis bracing is that it is a non-invasive treatment option. Unlike surgery, which involves cutting into the body and a long recovery time, bracing involves wearing a brace for a set period. The brace is designed to be worn under clothing and is not visible, so it does not need to impact daily life to a considerable extent. This makes bracing an excellent option for those who want to avoid surgery or cannot undergo surgery due to medical reasons.

 

Bracing Helps Improve Body Image

Scoliosis can cause a visible deformity in the spine, which can impact self-esteem and body image. Bracing can help improve body image by correcting the curvature of the spine, which can make the deformity less noticeable. For children and adolescents who may be self-conscious about their appearance, bracing can help boost confidence and self-esteem in the long term. Similarly, bracing in Adults who suffer pain or postural issues due to Scoliosis can improve movement and therefore independence and confidence.

 

It Provides Pain Relief

Scoliosis can cause back pain and discomfort, which can impact daily activities. Bracing can help to relieve pain and discomfort by applying pressure on the spine, which can reduce the strain on the back muscles. Bracing is often best combined with a Scoliosis specific exercise plan for this purpose – in combination, the two can lead to improved mobility and a better quality of life.

 

It’s a Customisable Treatment

Each scoliosis case is unique, and as such, each brace must be tailored to the individual. Early braces lacked the ability to be highly customised, but thanks to modern CAD/CAM techniques, current braces like Scolibrace can be fully customised to fit the unique curvature of the spine, ensuring that the brace is effective in treating scoliosis. This customisable treatment approach means that bracing can be an effective treatment option for a wide range of scoliosis cases.

 

Is Scoliosis bracing right for me?

Scoliosis bracing is a flexible and dynamic approach to treating scoliosis which is appropriate in many cases – both older and younger people can and do utilise Scoliosis braces to treat Scoliosis and its effects. Similarly, a range of Scoliosis types can be supported with modern braces making it an excellent option for a huge variety of people.

If you would like to learn more about Scoliosis and Scoliosis bracing, why not sign up for our free information series here.

 

 

 

[1] ‘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’   [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

 

[3] 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

[4] 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 [Publish Ahead of Print]

 

How to choose clothes with your Scoliosis Brace

Posted on April 20, 2023 by - Blog

Scoliosis is a condition that affects the spine, causing it to twist and curve sideways. It is often treated with a brace, which is worn around the torso to support the spine and prevent the curvature from worsening.

 

Scoliosis Braces

Modern Scoliosis Braces, such as the ScoliBrace which we offer at the UK Scoliosis Clinic are nothing like braces from the past – they are lightweight, low profile and even come in a wide variety of colours. Many people actually choose to wear their scoliosis brace as a sort of accessory – and with so many design patterns available, why not! Many people, however do prefer to keep their brace covered for all sorts of reasons. Moving about in a Scoliosis brace isn’t a huge issue, but choosing the right clothes can help with making the process as comfortable as possible – with a few tips and tricks, it is possible to find clothes that are both stylish and practical for all sorts of situations.

 

Tips and tricks!

Without further ado, here are the tips and tricks you need!

Look for clothes with stretchy or adjustable waistbands.

One of the most important things to consider when choosing clothes with a scoliosis brace is the waistband. The brace will add bulk to your midsection – and although it’s a small amount if you want to be able to wear clothes both with the brace on and off it is essential to choose clothes with waistbands that are stretchy or adjustable. Trousers with elastic waistbands or drawstring waists are obviously comfortable, but slightly stretchy options, like leggings, also work fine.

 

Avoid clothes with tight-fitting or restrictive waistbands.

On the flip side, it is best to avoid clothes with tight-fitting or restrictive waistbands, as they can be uncomfortable and even painful when worn with a scoliosis brace. This includes high-waisted pants, tight skirts, and tight-fitting shorts. Instead, opt for looser-fitting clothes that will allow for some movement and flexibility.

 

Choose clothes that are easy to put on and take off.

Putting on and taking off clothes can be a challenge when you are wearing a scoliosis brace – putting the brace on is easy (if you’re using a ScoliBrace!) but once you have the brace on it’s not possible to move the spine a great deal. Therefore, it’s best to choose clothes that are easy to put on and take off. This includes clothes with wide necklines, open fronts, and loose-fitting sleeves. Avoid clothes with tight or restrictive necklines, as these can be difficult to get over your head.

 

Look for clothes with extra room in the back.

Since the scoliosis brace will add bulk to your back, it is essential to look for clothes with extra room in the back. This includes jackets, blouses, and dresses with a loose or flowing back. Avoid clothes with tight or fitted backs, as they can be uncomfortable and restrict movement. With oversized clothing being in fashion, oversized fleeces, sweatshirts or hoodies worn with baggy joggers or leggings will keep adolescent girls feeling comfortable and looking on trend.

 

Choose clothes made from soft and breathable fabrics.

When choosing clothes to wear with a scoliosis brace, it is important to choose clothes made from soft and breathable fabrics. This includes cotton, linen, and bamboo fabrics, which are gentle on the skin and allow for air circulation. Avoid clothes made from synthetic fabrics, as they can be uncomfortable and trap sweat.

 

Consider layering your clothes.

Layering your clothes can be a great way to add warmth and style while wearing a scoliosis brace. Start with a soft, breathable base layer, such as a cotton tank top or t-shirt. Then, add a loose-fitting blouse or sweater on top. This will allow you to adjust your layers depending on the temperature and will provide some coverage for your brace.

 

Try on clothes with your brace.

Before buying any clothes, it is essential to try them on with your scoliosis brace. This will allow you to see how the clothes fit and feel with the brace, and you can make any necessary adjustments. If possible, try on clothes in a dressing room that has a full-length mirror, so you can see how the clothes look from all angles.

 

 

Should I remove my brace before a progress X-ray?

Posted on February 17, 2023 by - Blog

X-rays are the gold standard when it comes to diagnosing scoliosis and tracking the progress of treatment for the condition. Scoliosis is notoriously difficult to gauge from a visual inspection alone, meaning that regular X-rays are critical to ensuring that treatment is progressing as expected and that any adjustments to a patient’s brace are made at the correct time. In the usual course of treatment, Scoliosis professionals take X-rays every 6-12 months with these goals in mind – which often leaves patients asking, should I take my brace off before the X-ray?

 

In-brace vs out of Brace correction

What’s important to understand is that a Scoliosis Brace provides better correction while being worn than not being worn – that might sound obvious but it’s important to remember that the role of the brace is to correct, or often, over correct Scoliosis, in order that over time the spine is corrected when the brace is removed.

When you put a Scoliosis brace on, research suggests that it takes around 2 hours[1] to reach the maximum correction that can be obtained by using a brace. After removing, the correction obtained is gradually lost over around 2 hours, after which the curve/spine stabilizes[2]  Over time, the goal of Scoliosis treatment is to reduce the amount that correction is lost when the brace is removed – over corrective braces, such as ScoliBrace achieve this by adding corrective force to he spine to help to move it towards its proper position.

 

Braces and X-rays

So, should you remove your brace before a progress X-ray?  Taking the brace off, perhaps even days before the X-ray gives a truer picture of what’s “really” happening with the spine – but tells us little about how much correction the brace itself is providing. By contrast, leaving the brace on during the X-ray, or removing it right before gives us an excellent idea of how well the brace is working (and whether it’s time to adjust it), but isn’t as good at showing us how the spine might look after hours, or days of no wear. A good compromise is often an in-brace X-ray, followed by an out-of-brace X-ray after a short break which can give an idea of in-brace correction, and allow us to approximate an out-of-brace figure.

Nonetheless, it’s a complex issue, and for these reasons, at present, there’s no defined standard for the best way to carry out progress X-rays – generally speaking, it’s up to the Scoliosis practitioner to decide how to perform X-rays, based on the specific needs of the patient.

But let’s not forget the most important fact about Scoliosis bracing – it’s a treatment method which works over time – for this reason, we’re often less concerned with the exact method used to take progress X-rays, and more with the fact that the x-rays are performed in a consistent way. That is to say, during treatment, we care less about the exact degree of correction and more about the direction of travel.

 

Should I remove my brace before a progress X-ray?

The answer to the question is simply… do as your practitioner suggests! When to remove, or not remove the brace isn’t an issue that you as a patient need to worry about – but you should make sure that you comply with the instructions you’re given, and that you do so each time you visit for a progress X-ray. Rember, it’s consistency which matters!

 

 

 

[1] Katarzyna Zaborowska-Sapeta et al. The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis Acta Orthopaedica et Traumatologica Turcica 53 (2019)

[2] Meng Li  1 , M S Wong, Keith D K Luk, Kenneth W H Wong, Kenneth M C Cheung, Time-dependent response of scoliotic curvature to orthotic intervention: when should a radiograph be obtained after putting on or taking off a spinal orthosis?  Spine (Phila Pa 1976). 2014 Aug 1;39(17):1408-16.

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.

Do curves continue to grow after bracing?

Posted on July 15, 2022 by - Blog

Scoliosis Bracing is one of the most effective ways to treat Scoliosis – today it’s the preferred method used by Scoliosis specialists, and increasingly it’s seen as a worthwhile methodology even by some spinal surgeons. Bracing works by gently applying pressure to the spine while the brace is being worn – this slowly guides the spine back into the correct position, correcting Scoliosis over time. A natural question which often comes up is, therefore, what happens after bracing? Will the curve return?

 

Scoliosis progression

Scoliosis itself is a progressive condition – this means it tends to get worse over time. In children and young adults it worsens very quickly, especially around growth spurts. Once the body reaches Skeletal maturity (which is usually a bit later than the point at which someone is legally considered an adult) the progression of Scoliosis tends to stop, or at least slow. Research suggests that the size of  a Scoliotic curve a person carries into adulthood is a major factor in determining wheather their cure continues to grow. Larger curves (approximately 30 degrees or more) which are carried into adulthood tend to progress throughout life – about 1 degree per year is a commonly cited figure[1] – conversely, curves which are less than 30 degrees often don’t progress.

Scoliosis also commonly impacts older individuals – the prevalence of scoliosis increases with age, so that roughly 30% of the population over 60 have adult scoliosis, although in older people the cause is slightly different – most cases are age-related due to wear and tear on the spine, although having Scoliosis already can make this kind progress more quickly.

What we can take away from this is that the core objective of Scoliosis bracing should be to get people to skeletal maturity with a curve as small as possible, and below 30 degrees wherever viable. This gives a person the best chance of living the rest of their life with minimal or no impact from Scoliosis.

 

Curves after bracing

While most of the research being carried out in the Scoliosis field relates to treating curves in the first place, some studies have looked at the issue of loss of correction. One recent study aimed to evaluate the

loss of the scoliotic curve correction in patients treated with bracing during adolescence and to compare patient outcomes of under and over 30 Cobb degrees, 10 years after brace removal.

As part of the study, researchers reviewed 93 (87 female) of 200 and nine patients with adolescent idiopathic scoliosis (AIS) who were treated with the Lyon or PASB brace at a mean of 15 years (range 10–35). All patients answered a simple questionnaire (including work status, pregnancy, and pain) and underwent clinical and radiological examination.

The patients underwent a long-term follow-up at a mean age of 184.1 months (roughly 15 years) after brace removal. The pre-brace scoliotic mean curve was 32.28° (± 9.4°); after treatment, the mean was 19.35° and increased to a minimum of 22.12° in the 10 years following brace removal. However, there was no significant difference in the mean Cobb angle between the end of weaning and long-term follow-up period. The curve angle of patients who were treated with a brace from the beginning was reduced by 13° during the treatment, but the curve size lost 3° at the follow-up period.

The groups over 30° showed a pre-brace scoliotic mean curve of 41.15°; at the end of weaning, the mean curve angle was 25.85° and increased to a mean of 29.73° at follow-up; instead, the groups measuring ≤ 30° showed a pre-brace scoliotic mean curve of 25.58°; at the end of weaning, it was reduced to a mean of 14.24° and it increased to 16.38° at follow-up.

The basic conclusion was therefore that Scoliotic curves did not deteriorate beyond their original curve size after bracing in both groups at the 15-year follow-ups.  Interestingly, there was also no significant difference in the mean progression of curve magnitude between the ≤ 30° and > 30° groups at the long-term follow-up, which tends not to support the traditional thinking that larger curves progress more through adulthood.

 

Preventing loss of correction

From the above, we can conclude that a small amount of curve increase is likely when discontinuing bracing treatment – however, It’s important to keep in mind that rather than simply weaning off of a brace, it’s possible to be more proactive about the end phases of treatment. One option, for example, is to continue with a Scoliosis specific exercise regimen – research demonstrates that doing so can help to prevent loss of correction after treatment.[2]

While we are not aware of any specific studies which have looked at this issue, one other factor to consider is a possible weakening of muscles which can take place during bracing. A brace takes much of the load off of the musculature which surrounds the spine, so that after a period of years wearing a brace a person may be less able to support themselves and maintain good posture. Studies have shown, however, that Scoliosis specific exercise can be effective in reducing muscle stiffness and loss of strength during bracing[3] suggesting again that a “proactive” end to bracing may help to reduce the risk of loss of correction even further.

 

 

 

 

[1] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

 

[2] 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

 

[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

 

Scoliosis Bracing in Older Adults, New Research

Posted on June 24, 2022 by - Blog

If you’ve been following the blog this Scoliosis Awareness month, you’ll know that Adult Scoliosis is generally defined as any scoliosis case that exists either in those over 18, or those having reached skeletal maturity – either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life.

The second type is Degenerative De-Novo Scoliosis– this is the development of a new scoliosis case, usually as a result of spinal degeneration.

Much recent (and not so recent) research into scoliosis treatment, especially bracing, has focused on younger patients – this is primarily because this group stands to gain the most from bracing – proper treatment of, say a 15 year old with mild to moderate scoliosis stands a good chance of allowing him or her to live the rest of their life free of the condition. Those who have reached adulthood with a scoliotic curve, or develop one through ageing have less of a chance for improvement in the cobb angle (degree of scoliosis) but equally, lower rates of progression in the curve itself. Bracing, however, has been shown to have positive effects for older individuals, primarily around daily function and pain reduction. A recent literature review of relevant studies has confirmed this view.

 

What causes Scoliosis in Adults?

Since there are two kinds of scoliosis in adults, we should take a moment to understand why and how they are different.

ASA is scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life.

Degenerative scoliosis, by contrast, does occur in adult life and is attributable to wear and tear on the spine, but is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age. For many patients, drawing a distinction between the two types may be academic at any rate, since in patients with no known history of scoliosis it may well be impossible to say whether a newly discovered case is a Do-Novo one, or ASA. It is thought that as many as 30% of over 60’s suffer from De-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

Recent study

The newest study[2] taking a broad view of the literature on scoliosis bracing for older adults was a review of relevant papers published between 1967 and 2018 – the study investigators used standardised criteria to select relevant papers for inclusion in their work.

In total, ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Right away, this shows one of the biggest issues with Scoliosis research, especially in older adults – there is a clear gender bias (probably due to the higher incidence of adolescents in females, about 75% of cases) and overall a lack of research, only 8 studies considering rigid bracing of the kind now most frequently employed isn’t a huge number!

In the studies, brace wear prescriptions ranged from 2 to 23 hours per day, and there was mixed brace wear compliance reported, both are consistent with our actual experience of bracing in older adults. Most of the included studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing.

 

Study conclusions

After their review, the study authors reported some key conclusions which are well worth noting. Firstly, they showed that there is evidence to suggest that spinal brace/orthosis treatment may have a positive short – medium-term influence on pain and function in adults with either de novo degenerative scoliosis or progressive idiopathic scoliosis. This finding essentially supports the use of bracing in older adults and tallies with our own experience in helping older patients to reduce and manage pain as well as improve function through bracing.

Secondly, and importantly, it was noted that a particular focus on female patients with thoracolumbar and lumbar curves made it difficult to make firm conclusions on the efficacy of bracing for males, and other curve types. It would therefore be highly desirable for further research in this area to focus on a wider variety of case types, in order for us to better understand treatment pathways for older individuals.

 

[1] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

[2] Jeb McAviney et al. A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data BMC Musculoskeletal Disorders volume 21, Article number: 87 (2020)