Scoliosis is progressive, meaning it’s in its nature to worsen over time, especially if left untreated, or not treated proactively. While bracing has been used as scoliosis treatment for years, not all braces are created equal. Modern corrective braces reflect the culmination of what we have learned about bracing effectiveness, and the condition itself, over the years. Traditional braces focus on preventing progression, but they can also impact spinal health and function negatively.
The designs of different types of scoliosis braces are based on what they hope to accomplish and offer patients different potential results. Modern braces, like the ScoliBrace, have corrective potential, while traditional braces, like the Milwaukee, focus on preventing further progression.
Before we move on to explore the specifics of different types of scoliosis braces, what they can achieve, and how they work, let’s start by exploring the two main approaches to scoliosis treatment, as one relies mainly on modern scoliosis braces, while the other uses traditional bracing options.
Treatment Approaches for Scoliosis: Conservative vs. Traditional
When a patient receives a scoliosis diagnosis, they are facing an important decision: one with the potential to shape their experience of life with the condition.
There are two main scoliosis treatment approaches available, and as mentioned, each offers patients very different potential outcomes.
The conservative approach is what I offer patients here, at the Scoliosis Reduction Center®; it can also be referred to as a functional approach because it prioritizes the spine’s overall health and function.
Conservative Approach to Scoliosis Treatment
Here at the Center, I believe in being proactive and applying multiple scoliosis-specific treatment disciplines for an integrative and customized approach.
To me, being proactive means responding to the condition as close to the time of diagnosis as possible, with treatment that works towards corrective results; that means actually addressing the underlying structural nature of the scoliosis and achieving a curvature reduction.
Treatment will also involve increasing core strength so the muscles surrounding the spine can provide it with optimal support and stabilization.
I believe the multifactorial nature of idiopathic scoliosis (caused by multiple variables) necessitates a customized approach, so I combine multiple scoliosis-specific disciplines and apportion them accordingly based on how the patient, and their spine is responding to treatment: chiropractic care, in-office therapy, custom-prescribed home exercises, and ultra corrective bracing.
Once I have conducted a comprehensive physical exam and read a patient’s scoliosis X-ray, I have the information needed to craft an effective and customized treatment plan moving forward. A customized treatment plan will address the specifics of each patient, including age and overall health, plus important condition characteristics such as type (cause, if known), severity (mild, moderate, severe, or very severe), and curvature location.
While there are different types of the condition that can develop, affecting both adolescents and adults, the most prevalent form is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18: this is the form we’ll be focusing on throughout the article.
Adolescents are at risk for rapid-phase progression because growth is the condition’s number-one trigger for progression, and adolescents face the rapid and unpredictable growth spurts associated with puberty; being proactive is key to staying ahead of a condition’s progressive line and counteracting the abnormal spinal curvature’s tendency to increase in size.
Bracing has been recommended for adolescents with scoliosis for many years, but depending on the type of treatment approach and related brace, different approaches and braces achieve different things.
Here at the Center, as scoliosis is a structural condition, first and foremost, I want to impact it on a structural level, in the form of a curvature reduction. While I always work towards the goal of reducing a patient’s curvature and providing their spine with better support and stabilization, I don’t want any form of treatment to come at the cost of the spine’s overall health and function, and this is where the modern ScoliBrace comes in.
Before moving on to important characteristics of the corrective ScoliBrace, let’s talk about what the traditional approach to scoliosis treatment offers patients.
Traditional Approach to Scoliosis Treatment
The traditional approach to scoliosis treatment has been in place for hundreds of years, but that doesn’t mean there is no room for improvement.
Over the years, we have learned more about scoliosis, particularly in the arena of how it responds to different forms and combinations of treatment.
Along the traditional route of treatment, adolescents diagnosed with mild scoliosis are commonly told that watching and waiting for further progression is the best course of action.
During this time, they return for periodic physical exams and X-rays to see if/how much the condition has progressed over time. As mentioned, growth spurts are the condition’s number-one trigger for progression, and considering that these adolescents are in, or are entering into, the stage of puberty, what happens if in-between doctor’s visits, a patient has a huge growth spurt that causes their spinal curvature to increase in size?
Well, now, more work has to be done to work towards a reduction. It’s far simpler to treat an abnormal spinal curvature while it is still mild, is less rigid, and before the body has had time to adjust to its presence.
If a patient’s scoliosis progresses from mild into the moderate severity level, the only form of treatment the traditional approach offers is traditional bracing, such as the Milwaukee brace, and this has its own shortfalls to consider.
If a condition progresses into the severe severity level and bracing has been ineffective at preventing further progression, spinal fusion is commonly recommended as the best course of action. In all surgical procedures, there are risks, complications, and potential side effects consider.
Scoliosis surgery is a lengthy and invasive procedure that involves fusing the most-tilted vertebrae (bones of the spine) of the curvature (at the apex) into one solid bone. While there are different types of spinal fusion, most involve using rods that are attached to the spine with screws to hold the spine in place.
An important thing to understand is that the end goal of spinal fusion is not to correct the abnormal spinal curvature on a structural level but to instead hold the spine, by artificial means, in a corrective position to prevent further progression.
Although no treatment results can ever be guaranteed, spinal fusion can be successful at straightening a scoliotic spine, but at what cost? Many patients who come to see me after having had spinal fusion are disappointed with the cosmetic results, their lack of spinal flexibility, and in some cases, increased pain levels post-surgery.
For those looking for a less-invasive, more natural approach to scoliosis treatment and have decided to forego a surgical recommendation, the results I have achieved here at the Center, without surgery, speak for themselves.
So now that we have talked about the two main scoliosis treatment approaches in general terms, let’s talk in a more general way, about the use of scoliosis bracing for treating scoliosis in adolescents.
Scoliosis Bracing and Adolescent Idiopathic Scoliosis
Adolescent idiopathic scoliosis affects millions of young people in the United States and throughout the world.
While each case is unique, many of these young people face huge lifestyle changes once they are diagnosed with the progressive spinal condition, including not being able to participate in the sports and activities they love.
In many cases, particularly for those following the traditional path of scoliosis treatment, treatment is passive and more reactive, than proactive. Doctors commonly take a wait-and-see approach, which means while a condition is mild, observing for further progression is the only response; to me, this is wasting valuable treatment time.
With the traditional approach to scoliosis treatment, these adolescents typically progress to a certain point, as no proactive efforts have been made to hold their scoliosis where it is, or to reduce it further, and then these young people are fitted with a traditional scoliosis brace, such as the Milwaukee.
Traditional braces, like the Milwaukee, have been used for decades to treat scoliosis in adolescents, but they are somewhat ineffective when it comes to actually reducing the spine’s abnormal curvature.
What traditional braces can offer, at best, is to prevent further progression, although results are never guaranteed. The unfortunate reality is that patients who are fitted with a traditional brace often end up progressing to a point where surgery is recommended, but had proactive treatment been applied earlier on, reaching that point might have been avoided.
Now, that is not to say there is no place for scoliosis braces in effective treatment. Here at the Center, I mainly rely on a very different type of brace, the modern ScoliBrace, which addresses the shortcomings of traditional bracing, and has the end goal of achieving corrective results.
When combined with other effective scoliosis-specific treatment disciplines, corrective bracing can help work towards a curvature reduction by addressing the true 3-dimensional nature of the condition.
Let’s now move on to the specifics of two very different types of scoliosis braces: the modern corrective ScoliBrace and the traditional Milwaukee brace.
Modern Corrective Scoliosis Brace: ScoliBrace
As mentioned, just as different treatment approaches offer different potential results, different types of braces, favored by each approach, are part of those results.
Just as the main goal of conservative scoliosis treatment is correction and spinal stabilization, the modern ScoliBrace that I favor here at the Center, when combined with other complementary treatment disciplines, can deliver corrective results.
A big difference in the effectiveness of traditional versus modern scoliosis braces is not just in terms of their end goals, which we’ve discussed, but how those end goals are achieved.
Here at the Center, we don’t simply observe how a patient’s progressive condition progresses because we know that, at some point, every case of scoliosis is virtually guaranteed to progress; we get to work on our patients by providing them with the tools and techniques needed to strengthen the spine, improve its function, and reduce its irregular curvature on a structural level.
By combining multiple treatment disciplines, my teen patients can experience relief, a more functional spine, and less activity restrictions; this is important. I feel it gives my young patients the best possible quality of life throughout treatment and beyond.
When necessary, I use scoliosis bracing techniques and devices, such as the ScoliBrace, because it involves pushing the spine in a corrective manner, versus squeezing the spine in a way that can weaken it and limit function.
The ScoliBrace is corrective and patient-friendly. Its over-corrective design works by guiding the body and spine into better body-positioning that’s in opposition to the shape of a patient’s scoliotic curve, thus counteracting it.
By doing so, the brace can help address the asymmetries that scoliosis is known to cause throughout the body, and curvature reduction can be achieved. While every case is different and no treatment results can ever be guaranteed, postural deviation such as the presence of a rib arch, uneven shoulders, and an uneven waistline can be improved upon through the use of a ScoliBrace.
In addition, the ScoliBrace opens and closes at the front for easy wearing and removing. There is also a wide variety of colors and patterns available so patients can customize the brace’s appearance.
I mentioned earlier that scoliosis isn’t just an abnormal sideways curvature of the spine because it also involves rotation; this makes it a 3-dimensional condition, yet not all treatment approaches and braces address it as such.
Any effective form of treatment, bracing or otherwise, has to address the condition’s true 3-dimensional nature. In order to do this, the ScoliBrace uses BraceScan, which combines 3D full-body laser-scanning technology, X-ray images, and postural photos for a truly customized fit.
Every brace is custom-designed to address the specifics of each patient and their condition using Computer-Aided Design (CAD) and made with Computer-Aided Manufacture (CAM).
As the modern ScoliBrace is as bespoke to each individual as possible, it’s more effective, comfortable to wear, and places less mobility restrictions on patients, and this addresses one of the biggest challenges associated with bracing in the treatment of AIS: compliance.
So now that we understand how the modern ScoliBrace functions based on design and application, let’s move on by comparing it to a common traditional brace used: the Milwaukee brace.
Traditional Scoliosis Brace: Milwaukee
Also known as a CTLSO (Cervico-Thoraco-Lumbo-Sacral Orthosis), the Milwaukee is a traditional scoliosis brace used to treat abnormal spinal curvatures of the high thoracic (middle/upper back) curves.
Once again, the design of traditional scoliosis braces used in the treatment are based more on stopping progression, than achieving corrective results on a structural level.
The Milwaukee brace extends from the neck down to the pelvic area; a neck ring and pelvic girdle are connected via metal bars at the torso’s length and keep the head centered over the pelvis.
While measurements are taken to ensure the best possible fit, traditional braces are mass-produced and not fully customized as comprehensively as the modern ScoliBrace; this can make them bulkier, less comfortable to wear, and only best-suited to certain body types, which also doesn’t help the issue of patient compliance.
They are designed to be worn full time, which can mean having to wear them for 18 to 23 hours a day for up to five years, although each patient is different with their own unique bracing and treatment needs.
The Milwaukee’s end goal of stopping progression involves applying pressure, using strategically-placed pads, to certain points of the curvature, and squeezing/compressing the spine so it’s held in position. At the same time, a relief area of the brace is placed opposite the pad.
Essentially, the pad uses a three-point pressure system to squeeze the spine so that it is held in position and can no longer increase in size, but when the spine is compressed that intensely for long periods of time, it can actually weaken the spine.
In addition, traditional braces like the Milwaukee are not addressing the condition’s 3-dimensional nature, and are instead treating it as a 2-dimensional abnormality; in order for scoliosis to be treated effectively, treatment has to target all areas of the spine affected, including the rotational component (twisting), rather than just the spine’s side-to-side bend.
So what are the downfalls of traditional scoliosis braces compared with modern scoliosis braces?
The Milwaukee vs. the ScoliBrace
Here at the Scoliosis Reduction Center®, when appropriate, I prescribe the use of the ScoliBrace for many adolescent idiopathic scoliosis patients. The ScoliBrace is modern and innovative, representing a new era of scoliosis bracing.
As the Milwaukee, and other traditional braces like it, have squeezing designs that can actually restrict and weaken the spine and abdomen, in some cases, this can lead to an opposite outcome to what was intended.
The ScoliBrace doesn’t squeeze the spine, but rather pushes it, on all 3 dimensions, resulting in a structural change to the curvature itself. When combined with other proactive and effective scoliosis-specific treatment disciplines, it has the potential to achieve correction.
Part of the issue with traditional braces is, as explained, they are most commonly prescribed as part of a traditional scoliosis treatment approach, and this approach does not believe in combining multiple forms of treatment for an integrative and fully customized approach; instead, the Milwaukee will be commonly prescribed once a condition has progressed from mild to moderate, and if the brace on its own does not stop progression and a condition progresses further into the severe or very-severe classification, patients can be funneled towards spinal-fusion surgery.
For those following a conservative approach, there are multiple forms of treatment that are integrated in the crafting of comprehensive and customized treatment plans, and those different forms of treatment are apportioned accordingly, based on how the spine is responding to treatment.
As the ScoliBrace is commonly prescribed by those following a conservative approach, while the brace is being worn, other crucial work towards strengthening and stabilizing the spine is done to protect, and improve upon, the spine’s overall health and function.
It’s also thought that as the 3-point pressure system used by the Milwaukee, and other traditional braces, applies pressure from the sides, and scoliosis is an abnormal sideways curvature of the spine, that can actually increase postural deviation associated with the condition, such as the presence of a rib arch.
In addition, as the Milwaukee is not 100-percent custom-fitted for each patient, its fit can cause side effects; if a brace is too tight, it can lead to difficulty breathing, and when a brace applies too much pressure to the ribs, it can also lead to bowel obstructions and digestive issues.
As touched on earlier, compliance is a challenge when it comes to prescribing a scoliosis brace to a teen. Adolescents tend to want to fit in with their peers, and many are embarrassed by the brace, not wearing it full-time as is necessary for it to have any chance of stopping progression.
While there have been changes to the design of the Milwaukee since its development in the 1940s, it has remained virtually unchanged since 1975, whereas the modern ScoliBrace responded to the issues associated with scoliosis bracing by making the brace more customized, comfortable to wear, and by pushing, instead of squeezing the spine.
In addition to pain and discomfort, some patients who have used traditional scoliosis braces cite the following issues:
- Restricted breathing
- Sore and/or tight hip muscles
- Being uncomfortably hot
- Restricted mobility, meaning activity restrictions
- Inability to bend the torso
- Increasing spinal rigidity
The bottom line is that different treatment approaches offer different potential outcomes, and the type of brace used can be an important part of delivering those results.
Here at the Center, I rely on the ScoliBrace as much as possible to meet my patients’ bracing needs as I feel it addresses the condition’s 3-dimensional nature, has corrective potential, and isn’t known to weaken the spine as much as the Milwaukee. In addition, in the conservative approach, other forms of treatment are being simultaneously applied to protect the spine’s health and function, and the ScoliBrace, as it is custom-fitted, is more likely to be worn as prescribed.
Conclusion
So when it comes to addressing whether a traditional Milwaukee brace, or the modern ScoliBrace is best, that answer will depend on the type of results that are desired. For patients of the Scoliosis Reduction Center®, correction and spinal stabilization are valued as I believe these things preserve the spine’s function and overall health.
I also think that the way the ScoliBrace can help achieve these things, by addressing the condition’s 3-dimensional nature and pushing the spine, instead of squeezing it, gives patients the best possible quality of life throughout treatment and beyond.
The bottom line is that different treatment approaches offer different potential outcomes. The two main scoliosis treatment approaches (conservative and traditional) favor a certain type of brace aligned with their treatment goals.
For those following a conservative approach, the modern ScoliBrace is what I prefer to prescribe, when appropriate.
In the traditional approach, traditional braces like the Milwaukee are prescribed. Still, this approach is more reactive, than proactive. While the design of the Milwaukee has changed since its development, it hasn’t consistently evolved alongside our understanding of the condition, particularly its 3-dimensional nature.
As the Milwaukee squeezes the spine from the sides, it’s only addressing the condition on 2 dimensions, but the rotational element that characterizes the condition involves a 3rd dimension that needs to be included in treatment.
The manner in which traditional scoliosis braces squeeze and compress the spine to prevent further progression can also come at the cost of the spine’s strength, function, and can increase related postural deviation.
In addition, compliance is a significant challenge when it comes to treating the condition’s most prevalent form: adolescent idiopathic scoliosis. Over the years of treating the condition with traditional braces, we saw that no matter what potential a scoliosis brace has of improving a condition, if patients don’t wear them full time as prescribed, they will be ineffective; the ScoliBrace has responded to this challenge by ensuring every brace is 100-percent customized to suit the patient’s body type and condition.
While both types of braces hold a place in scoliosis treatment, they offer very different results and impact the spine in different ways.
Here at the Scoliosis Reduction Center®, as I, first and foremost, want to address the condition’s underlying structural nature, the modern ScoliBrace, when combined with other effective treatment disciplines, offers the most potential for helping to reach those corrective goals.
