Scoliosis Brace -Hard vs Soft

Scoliosis Brace – Static vs Dynamic

Not all scoliosis braces are created equally. Some scoliosis braces treat the body like it is a statue by statically holding it in place like a body cast. Other braces recognize that the human body is dynamic intended to move freely.

Although there are nearly a dozen different types of scoliosis braces on the market today, they basically fall into 2 categories:

Static and Dynamic

Static braces are designed to hold the body in place to stop a scoliosis from getting worse. It’s action is much like a body cast. A dynamic brace is designed to move with the body and strengthen specifically weakened muscles in the spine and can also reduce scoliosis curvatures.

Let’s examine the differences between these two types of scoliosis braces further.

Static Scoliosis Brace

A Static scoliosis brace (aka rigid or hard) is the current “standard of care” in conventional medicine in the US for scoliosis curvatures that have progressed to 25 degrees or more, despite the fact that there is a lot of controversy surround the effectiveness of such treatment. A rigid plastic brace molded from hard plastic is designed to act like a body cast to immobilize the spine in an attempt to keep the bones of the spine from deforming further in an attempt to stop the progression of the scoliosis.

While on the surface this may sound like a good idea, it ignores the fact that any time you immobilize a body part you get muscle atrophy. For instance, if you put a cast on a broken arm, you’ll notice the atrophy of the muscles when you remove the cast and that arm is smaller than the other.

That’s not the only problem with hard bracing. When you look deeper at what drives a scoliosis you soon realize that a static brace does not address many of the most important aspects of scoliosis, the muscular imbalances.

If you look at the back of a person with scoliosis the first thing you will notice is there is a muscular imbalance from side to side. On one side of the spine the muscles are bulged out and pushed back while the muscles on the other side are flattened. This is because the muscles on the inside of the scoliosis curve have shortened and weakened, causing stain to the muscles on the outside of the curve making them over develop in an attempt to try and hold the body up.

Interestingly, there are many studies of rigid bracing that show that it is not very effective for reducing scoliosis and only marginally effective in halting the progression of scoliosis, but only if as compliance in wearing the brace is kept up. Not any easy task with such an intrusive device. Most patients (teenage girls) find the brace not only physically limiting but also socially ostracizing at a time of their lives that all they want to do is fit in with their peers. Wearing a plastic “turtle shell” 20 hours a day makes that nearly impossible.

In fact, a study performed by the American Journal of Orthopedics, 60% of the patients surveyed felt that rigid bracing had handicapped their lives. Another 14% had actually felt that their experience with bracing had left them with psychological scars.

The long term outcomes associated with rigid bracing is even more frightening. While you may see an initial reduction in the curvature while “in” the brace, there is a good chance of a scoliosis progressing further once you remove the hard brace. That is because If you immobilize a muscular imbalance there is a significant risk of increasing it when you remove it because of the atrophy to the muscles caused by the immobilization of the muscles while wearing the static brace. Studies have confirmed that after skeletal growth has concluded and the brace is removed, the curvature is expected to return.

Although rigid brace technology and design has improved immensely over the past 30 years (The old style Milwaukee Scoliosis brace was extremely scary looking and greatly stigmatized the child because of it.) since the newer hard braces are still cumbersome and not easily concealed.

The appliance not only immobilizes the spine but also the entire torso. When a rigid brace is worn for an extended period of time it tends to cause atrophy of related muscles which can result in the following problems:

• Underdeveloped rib cage
• Pressure sores on the torso from the brace rubbing on the body
• Worsening of the scoliosis once the brace is removed caused by the muscle atrophy in the spine and rib cage

Because most patients find the long course of treatment too difficult to endure most orthopedists actually delayed bracing until the spine reaches the point that gravity will begin to start taking advantage of the curve and causing progression on it’s own (about 25 to 30 degrees), which means they miss the best window of opportunity of reducing the scoliosis when it is small and most correctable. Without proper intervention there is a significant chance of the abnormal curves worsening as gravity continues its pull on the imbalanced spine.

From a practical daily activity standpoint rigid bracing tends to cause the child to behave more like a statue than a fully functioning dynamic individual as the rigidity of the brace frequently interferes with or inhibits many of a child’s daily activities.

An article entitled Effectiveness of Bracing Male Patients with Ideopathic Scoliosis” in the Spine Journal, in September 2001 indicated that in many cases hard bracing actually worsened the curvatures following removal of the brace. The article stated: “Progression of 6 degrees occurred in 74% of boys and 46% reached surgical thresholds. Thus, it found that bracing of male patients with Idiopathic Scoliosis is ineffective.

The mechanism that causes this is likely the fact that the spine and rib cages were immobilized by the braces for prolonged periods of time causing the atrophy of related muscles of the spine and rib cage. Once released from the brace the muscles stayed weakened and caused further spiraling deterioration from a lack of muscular support.

Despite the poor track record static bracing remains the “standard of care” in the US, while in other countries its efficacy has come into serious question. For instance an article from the Children’s Research Center in Dublin, Ireland states: “Since 1991 (hard) bracing has not been recommended for children with AIS (Adolescent Idiopathic Scoliosis) at this center. It cannot be said to provide meaningful advantage to the patient or the community.”

Conclusion:

Although rigid bracing, if used as prescribed, can help temporarily halt the progression of the curvatures in idiopathic scoliosis, it does nothing to improve them. At best it can only stop the progression, at worse, it can further weaken imbalanced muscles in the spine resulting in a progression of the curve and a need for surgery after the brace is removed. Thus, it falls far short of being an effective solution. Also, the drawbacks to rigid bracing in terms of the mental health of your child clearly outweigh the limited benefits.

Dynamic Scoliosis Brace (Soft Brace)

The dynamic SpineCor scoliosis brace is an entirely different type of scoliosis brace that moves with the body to help it develop new movement patterns and can actually help reduce scoliosis curvatures, unlike hard braces. It is the first and only truly dynamic scoliosis brace that can be used for the treatment of scoliosis in both children and adults and has over 20 years of clinical research to back up it’s effectiveness.

Although SpineCor is called a scoliosis brace, it really is not because it does not restrict movement like a brace does, in fact it encourages movement in the corrective direction. The actual technical term for it is a “Tension Orthosis”, which means it uses elastic resistance to help strengthen specifically weakened muscles in the spine by encouraging specific corrective movements of the spine. Over time these corrective movements become habitual and predominant and can reduce the scoliosis curvatures.

SpineCor was developed by two Canadian orthopedic surgeons Dr. Charles Rivard and Dr. Christine Collard and their research team at St. Justine’s Hospital, who were given a $12 million dollar grant by the Canadian Government to how to better treat scoliosis. They discovered that static bracing actually weakened the bones and muscles of the spine by immobilizing them so they began to look for a way to provide mobility while still providing directed strengthening of the spinal muscles. The collective efforts of this research team came up three major advancements in the treatment of scoliosis, the most important being the SpineCor brace.