Do back braces help scoliosis?

The topic of back bracing to help with scoliosis always ends up being a huge conversation when a new person with scoliosis comes into my Pilates studio for the first time. This is especially true if it is a child coming in with a parent. Each and every case of scoliosis is different, so I can’t provide a “blanket statement” when clients and their families ask for my thoughts on the topic. Instead of a one-size-fits-all answer, I have a very open and honest conversation where all sides of the issue are looked at.

Back bracing for scoliosis is a hot topic! You’ll find people with very strong opinions on all sides of the spectrum here. Much like conversations I have in my studio, I will point you to research findings and additional resources so you can explore the benefits and consequences of this treatment for yourself.

1. Are you and your child OK with the concept of wearing a back brace?

The effective back braces are made of hard plastic (the soft ones don’t work) and are pretty much a hard shell with some holes cut in them that encase the torso (1, 2). Most are prescribed to be worn about 18 hours a day. Research shows that the longer you wear a brace the more effective it is (3).

You’ll have to sleep in the brace, and it will not let you move around while you sleep. Are you OK with that? Is your child okay with that? If not, then the conversation ends here and another form of therapy for scoliosis needs to be looked at.

2. Not all back braces are created equally.

Most people have no idea that there are many different kinds of scoliosis back braces. When I ask parents what kind of brace their teen has or who made it, most are clueless. They just did what their orthopedist told them to do and didn’t know they had options.

In certain circumstances, research has shown that back bracing can be effective at reducing scoliosis curvatures (4). However, not all types of scoli back braces produce the same result (5). To complicate it further, not all brace makers create high quality back braces. The skill of the brace maker plays into the effectiveness of the brace at correcting scoliosis.

If you’re going to have a brace made, I’d recommend the Cheneau-Gensingen brace (here’s another good source on it). It’s an over-corrective brace that pushes the body to a neutral position. There are also holes cut out in it allowing the body to actively breathe and move out of the scoli curve.

Another type of hard brace is called a compression back brace. I’m not a fan of these because they pretty much squeeze you in an attempt to not let the scoli get worse. A long-term study was done showing people who wore them experiences significant, debilitating low back and neck pain years after the brace treatment ended (6).

If your child’s pediatrician or orthopedist suggests brace treatment for your child with scoliosis, chapter eight from the recent Schroth Therapy book, Brace Treatment, is a great read that includes research, years of experience and case studies, along with photos, from around the world.

To conclude, it’s vital that you do your research before choosing a brace and a brace maker.

3. What is the emotional state of the person wearing the back brace?

In an interview Robert Pashman, M.D., a scoliosis specialist and surgeon, is quoted as saying, “because having scoliosis gives a pretty big psychological hit, being braced takes more of a psychological hit. That’s why I’m not so hip on it (7).”

Adolescence is hard enough without adding a hard-plastic brace that makes many pre-teens and teens feel like an outsider. I don’t think any child would happily sign up for a back brace. Just because something may be able to help somebody physically doesn’t necessarily mean it’s the right option. Emotional stability plays a bigger role in bracing than one might think.

Should you pursue bracing, you’ve got to have a plan on how to stay in-tune with your emotional state or that of your child. To help teens work through the emotions that can accompany scoliosis, I’d recommend picking up My Scoli Journal to help document the journey.

4. How much does a scoliosis back brace cost?

Most good back braces are not covered by insurance and cost a few thousand dollars. Your child may need a few different back braces as they continue to grow, so the cost can easily triple or quintuple. You may have to travel to have a back brace made and fitted as most cities don’t have good braces or brace makers, so more money is required. You’ll need regular check-ups to make sure the brace is continuing to do its job, so again, more money will be required.

The monetary burden of getting a brace can be very heavy for some families. In The Beautiful Scoliotic Back, I recount a story about a young male client of mine whose family struggled to pay for a brace, which caused a great deal of emotional distress for the family—especially when the boy refused to wear it. I’m not saying a good back brace isn’t the right path to take, I just want you to know monetarily what is all involved. I’d also highly suggest you read my blog post titled Warning: Scoliosis is a Big Money Business about how some medical companies make a ton of money off those who have scoliosis.

5. Regardless of if you choose back bracing for scoliosis or not, you must keep your body strong and mobile.

When a body is in a brace for most of the day, for a few years, you can expect a fair amount of muscle atrophy to take place in the torso. The torso is not allowed to move, so the brace takes place of muscle engagement because the hard plastic is holding up the body in place of muscles. You must, it’s non-negotiable, you must be doing wise strengthening exercises for the few hours a day that the brace is taken off so the torso muscles are allowed to work and stay strong.

When doctors deem that the back brace is no longer needed, you must already have the very strong torso muscles so they can continue to hold it up in the correct place. All too often I’ve seen scoliosis progress drastically when a back brace is no longer being worn because the body doesn’t have the torso strength to hold itself up.

Lastly, I want to mention a client of mine who has a 75-degree scoliotic curve. Even though she is in her 20s and past puberty, she wears a Cheneau-Gensingen brace at night to sleep, which she loves. It gives her extra support for her very scoliotic spine. Since her diagnosis as a teenager, her parents spent approximately $50,000 on different types of braces and therapies for her scoliosis. Some of the back braces and therapies were helpful, some did nothing for her, while some actually made her curves worse.

She started regularly working with me years ago and we began seeing a real change in her back. Her scoliometer readings were showing a 10-degree rotational change (at minimum) in just a one-hour session. She recently came to the conclusion that committing to doing this type of exercise was the absolute best thing she could do for her scoliosis, so she decided to become an instructor. She starts in a few months, and I can only fathom what kind of transformations her back will go through during the rigorous training.

Some teens hate their brace and hate their parents for making them wear it. Some back braces are ill-fitting and physically hurt the person wearing it. Some people find comfort from it and receive much benefit. Some back braces stabilize the scoli curves, some make the scoli curves progress.

Every scoliosis case is different. Every teenager is different. Every brace maker is different. I’ve shown you all the sides to the conversation and you can make an informed decision on your own.

Whether or not you choose to brace, I encourage you to attend my Scoliosis Intensive workshop. This two-day intensive will help you learn to live with your scoliosis, create a strong body, manage the emotional side and find a local practitioner for regular check-ins.

*Much of this update is taken from chapter 16, Back Bracing, of my book Analyzing Scoliosis; the Pilates Instructor’s Guide to Scoliosis.

 

This post was originally published in  November ’15 but has been updated for accuracy and comprehensiveness.

 

Sources

1. Wong, M.S., Cheng, J.C., Lam, T.P., et al. “The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with adolescent idiopathic scoliosis.” Spine, vol. 33, no. 12, 2008, pp. 1350-5. PubMed, doi: 10.1097/BRS.0b013e31817329d9.
2. Guo, J., Lam, T.P., Wong, M.S. et al. “A prospective randomized controlled study on the treatment outcome of SpineCor brace versus rigid brace for adolescent idiopathic scoliosis with follow-up according to the SRS standardized criteria.” European Spine Journal, vol. 23, 2014, pp. 2650-7. PubMed, doi: 10.1007/s00586-013-3146-1.
3. Weinstein, Stuart L., Dolan, Lori A., Wright, James G., and Dobbs, Matthew B. “Effects of Bracing in Adolescents with Idiopathic Scoliosis.” New England Journal of Medicine, vol. 369, no.16, 2013, pp. 1512-21. doi: 10.1056/NEJMoa1307337.
4. Karavidas, Nikos. “Bracing In The Treatment Of Adolescent Idiopathic Scoliosis: Evidence To Date“. Adolescent Health, Medicine And Therapeutics, vol. 10, 2019, pp. 153-172. Informa UK Limited, doi:10.2147/ahmt.s190565.
5. Gutman, Gabriel et al. “The Effectiveness Of The Spinecor Brace For The Conservative Treatment Of Adolescent Idiopathic Scoliosis. Comparison With The Boston Brace“. The Spine Journal, vol 16, no. 5, 2016, pp. 626-631. Elsevier BV, doi:10.1016/j.spinee.2016.01.020.
6. Misterska, Ewa et al. “Back And Neck Pain And Function In Females With Adolescent Idiopathic Scoliosis: A Follow-Up At Least 23 Years After Conservative Treatment With A Milwaukee Brace“. PLOS ONE, vol 12, no. 12, 2017, p. e0189358. Public Library Of Science (Plos), doi:10.1371/journal.pone.0189358.
7. Thek Lineback, Karena. Scolio-Pilates: Exercise For Scoliosis, The Step-By-Step Exercise Guide For Professional And Their Clients. 1st ed., Pilates Teck Publications, 2011.