One of the oldest, most tried-and-tested methods of scoliosis treatment is bracing. This is where the scoliosis patient wears a brace around their torso to prevent the curve in their spine from getting worse as they grow.
There have been huge leaps forward in both the design and functionality of scoliosis braces since this approach was first tried, and modern scoliosis patients may wear all sorts of different braces depending on the nature of their condition.
The main difference between different types of scoliosis brace lies in the level of pressure that is applied to the wearer's spine and ribs. Some braces must be worn on a full-time basis, whereas others need only be worn while sleeping.
Let's take a closer look at the various scoliosis braces currently in use.
The most commonly-prescribed brace for scoliosis patients today is the Boston brace. This model was first developed in the early 1970s by Dr John Hall and Mr William Miller of The Boston Children's Hospital (hence the name). It is a type of thoracolumbosacral orthosis (TLSO), commonly referred to as 'low-profile' or 'underarm' braces.
Other models of the Boston brace exist, such as a CTLSO, which is a TLSO with a neck extension. These are used for high-degree curves located on the thoracic spine, but are generally used far less often.
The Boston brace is small in size, with plastic components that are custom-made to fit the wearer's body exactly. At the front, the Boston brace starts just below the breast and extends all the way to the beginning of the pelvic area. At the back, it begins below the shoulder blades and continues all the way down to the tail bone of the spine - covering most of the torso.
The Boston brace works by applying pressure to the spine's curve pattern in order to prevent further curvature. This forces the lumbar areas to 'flex', pushing in the abdomen and flattening the posterior lumbar curve.
The Wilmington brace is another common TLSO. However, unlike the Boston brace, the Wilmington brace is entirely custom-made for each wearer, based on a cast taken while they patient is lying down and facing upwards. Once the cast is produced, corrective forces specific to the wearer's spinal curve are added to complete the brace.
The Wilmington brace is applied to the body in a similar fashion to a tight jacket and is known as a full-contact TLSO as a result of its lack of open spots and gaps.
The Milwaukee brace is the original cervico-thoracic-lumbar-sacral orthosis (CTLSO), prescribed to individuals who have been diagnosed with a high thoracic curve. This type of scoliosis brace has a distinctive design that is designed to manipulate the wearer's full upper body. The Milwaukee brace extends from the pelvis all the way up to the neck and is made with a contoured plastic pelvic girdle and neck ring. These are connected with a metal bar in both the front and back of the brace.
These metal bars play a vital role in scoliosis correction, as they help the torso to extend while the neck ring keeps the wearer's head in a central position over their pelvis. Pressure pads are strategically placed to the metal bars with straps, aligning to the shape of the wearer's spinal curve.
First developed in 1945 by Dr Albert Schmidt and Dr Walter Blount of the Medical College of Wisconsin and Milwaukee Children's Hospital, the Milwaukee brace is seen by many as the first modern scoliosis brace. Since its introduction, it has undergone a number of tweaks and improvements; however, the current design has been in use since 1975.
Charleston Bending Brace
The Charleston bending brace is the most commonly-prescribed night-time scoliosis brace. Just like the Wilmington brace, it is custom-fitted based on a cast taken of the patient's torso. Once the case has set, corrective forces are added to the brace based on X-rays of the patient's spine.
This Charleston bending brace is designed to be worn laying down, not while up and moving around. This allows the brace to apply greater forces and isn't restricted by considerations for the head to remain balanced over the pelvis.
As well as applying lateral forces to push the spinal curve closer to the back's midline, the Charleston bending brace also applies pressure to bend and hold the spine in an overcorrected position. This extreme position can be held much more easily at night, while laying down and sleeping, than during the day when the wearer is going about their daily activities.
The Providence brace applies the same hypercorrective force on the spine as the Charleston bending brace, which is only possible whilst laying down and sleeping at night. However, the main difference with this type of scoliosis brace is that, instead of the spine's curve bending in the opposite direction, one shoulder is slightly elevated to apply lateral and rotational forces on the curve.
The Providence brace aims to push the curve toward the midline or even beyond in some cases.
The Gensingen brace was designed with a view to encouraging corrective movement instead of restricting movement like the braces we've already seen. It positions the wearer's back in the opposite position to their spinal curve.
Read our blog about the Gensingen brace to learn more about this option.
Bracing tends to deliver better outcomes for scoliosis patients when combined with a specialised physiotherapy course. To find out more, read 'Why Is It Important to Do Specialised Physiotherapy Alongside Wearing a Back Brace for Scoliosis?'
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