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What is Scoliosis and When Is Bracing Needed?
Interviewer: Hearing that your child may need to wear a brace for treating scoliosis can be kind of scary. It might bring a lot of emotions and questions like: What does this mean for my child's daily life? Will it be painful? Will it work?
Today, we're talking with Dr. Joshua Speirs, a pediatric orthopedic spine specialist at 91麻豆天美直播. Now, Dr. Speirs, let's begin with just the basics. What is scoliosis, and when may a brace be suggested as treatment?
Dr. Speirs: Yes. Scoliosis is an abnormal curvature of the spine that, for the most part, develops in adolescence during our adolescent growth spurt. The concept behind a brace is similar to that of braces on your teeth, where you're wearing a brace in order to help the spine grow straight or encourage the spine to straighten out and avoid it from getting worse.
Interviewer: So when is a type of scoliosis something that, say you just watch, and when do you kind of determine, "Hey, we need to get this braced to make sure that it doesn't get any worse"?
Dr. Speirs: That comes down to the size of the curve and how much growth the patient has left. And you kind of match those two. If you are done growing, a brace is probably not going to be helpful. If you have a very small curve, a brace may not be indicated. So we kind of look at how much growth you have remaining and how big your curve is.
How Effective Is Bracing for Scoliosis?
Interviewer: And when it comes to bracing, how effective of a treatment is it? I mean, you just likened it to, say, you know, braces on teeth, which we see all the time, how, you know, the results turn out. How effective is it for, say, the spine?
Dr. Speirs: So, the initial study that really got the whole brace movement going was initially published in the "New England Journal of Medicine," which is one of the top medical journals in the world. And the study looked at they gave a bunch of braces to some kids and no braces to other kids. They looked at the outcomes, and they stopped the study early because the bracing was so effective at preventing curve progression that they felt it was unethical to continue not including kids in the group that didn't get a brace.
Interviewer: Oh, wow.
Dr. Speirs: So that initial study showed about 75% effectiveness of preventing curve progression with brace wear, whereas the non-braced group was in the 40s.
Interviewer: Wow, that's impressive. And what are some of the things that could be prevented from, say, you talked about maybe the curvature getting worse over time? What are some of the things that could be prevented by wearing a brace?
Dr. Speirs: Yeah, other than just having a bigger curve in your back, which, depending on the size of the curve, can cause pain or some cosmetic changes, rotation of your chest, really big curves end up needing surgery often. And so, our main goal is to avoid spinal surgery on curves that get bigger.
What Does a Scoliosis Brace Look Like?
Types of Scoliosis Braces
Interviewer: For someone who maybe has not experienced this themselves, what is a scoliosis brace? What does it look like? How is it fitted? How do we wear it?
Dr. Speirs: There are a lot of different types of braces out there, and unfortunately, there's a lot of misinformation or just incomplete information that's easily accessible. The most commonly used brace today, the brace with the best outcome, is a custom-fit or custom-molded brace. Each brace is made to fit the patient, and the brace is designed to create a three-dimensional correction of their spinal curvature. So you can't take a brace off one kid and give it to the other. Each brace is made and fitted to the individual patient. And the braces are designed to essentially straighten out the spine to make it as straight as possible.
Materials and Construction
Interviewer: And what is this brace made out of? Is it heavy? Is there a lot of moving pieces or parts? Or is it just . . . What are we looking at?
Dr. Speirs: The most common one, like the ones we normally order, they're made out of a plastic shell, with a lot of padding to make it as comfortable as possible, and then some padding to also put pressure in the correct areas in order to straighten the spine. There are other types of braces, soft braces, things that allow for a little more motion than the typical kind of plastic shell brace. Unfortunately, all those have been shown to be less effective. So it's not normally the one we recommend.
Wearing a Brace: Over or Under Clothing?
Interviewer: The most popular type of brace you were just talking about, can you wear these underneath clothing? Or is this something that has to be on the outside?
Dr. Speirs: They're almost always worn under clothing. Normally, it's something you wear, like a thin tank top or a T-shirt, and so it's not directly on the skin, but then you put the brace on, and then any other clothing can go on top of it.
Helping Your Child Adjust to the Brace
Interviewer: So, I guess, as maybe a parent who's listening, like how can parents maybe help their child adjust to wearing the brace? Because I assume that this is not the most comfortable thing to be putting on at the start. And is this something that they have to be in for the rest of their lives? What are some ways that the parents can kind of help their kid to adjust to wearing it?
Dr. Speirs: It is not a lifetime thing. We use the brace while you are growing in order to encourage symmetric growth of the spine. So when you're done growing, we stop using the brace. So how long you are in the brace kind of depends on how much more growth you have. And then it's not something that you're going to put on and wear for the 16 to 18 hours a day that often we recommend on day one. There's usually a break-in period, like you mentioned. Initially, it is a little more sore to wear, and that's because the spine's a little stiff. The brace is stretching, just like anything that makes you stretch there's some. Like a new set of hiking boots, it takes a while to break in, and the same thing happens with the brace. But as you increase the time in the brace, your body kind of adapts to the brace, and it becomes much more tolerable.
Interviewer: And going back there, how long are you expected to wear it per day?
Dr. Speirs: It does depend on the type of brace. There are some scoliosis curves that are amenable to only a nighttime brace. Basically, you sleep in it only. Not all curves are amenable to that. If it is a curve that we need to wear what we'd call like a full-time brace, then usually you're somewhere around that 16 to 18 hours per day.
Interviewer: So you take it off when you're going to sleep or sometimes in . . .
Dr. Speirs: We always want kids to wear it when they sleep because those are easy hours. And that's actually been studied. It takes a couple of weeks to get used to sleeping in it. But most kids can adapt to sleeping in a brace, and it doesn't really affect their sleep quality. So that's an easy eight hours a day. And then everyone kind of has to adapt when they take it off and when not. My athletes take it off for their sports and activities and wear it the rest of the time. Some kids really do not want to wear it at school and then don't wear it at school, but then have to wear it the rest of the time in order to get in those hours. So we can kind of adapt the hours in order to fit your life and what extracurricular activities are. But, it has been shown that more hours in the brace is more effective. So there is something to the more you wear it, the more effective they are.
Addressing Common Concerns About Bracing
Comfort-Level
Interviewer: All right. Those are some of the basics of using a brace. But I'm sure parents still have questions or concerns. I actually did a little bit of research and found a couple of these top concerns. These were on Reddit forums and on some of these different blogs that I was able to find, so I'm hoping to maybe answer a couple of these questions. First, will wearing a brace be painful or uncomfortable for my child?
Dr. Speirs: Initially, there is a period where you have to adapt to a brace. Some kids describe that as uncomfortable or a little painful. That is just like when they put your braces on and they tighten the braces; everyone feels their teeth are sore. But that's not permanent. As you wear the brace, you become much more accustomed to it, and your spine becomes more flexible and adapts to it.
Duration
Interviewer: And how long is that time period for most kids?
Dr. Speirs: It's probably different for every kid. It's probably a little different depending on the size of your curve. It's usually less than a month.
Sports and Physical Activities
Interviewer: One of the next concerns is, will my child be able to play sports or participate in physical activities? I know there are a lot of parents who really want their kids to be active. The kids love going out and playing. How is this brace going to impact those kids?
Dr. Speirs: All my patients take their brace off for sports activities and for working out. We all know that if you wear a brace all the time or any cast or anything like that, there can be some muscle atrophy. We want to avoid that. I do want you to take the brace off daily and do some physical activity. Now, whether that's dance or ballet or gymnastics or tackle football, all of it's allowed, but it's totally appropriate to take it off and exercise.
Impact on Social Life and Self-Confidence
Interviewer: All right. And the third most common one that I came across is, will wearing a brace affect my child's social life or self-confidence, especially during these kind of formative years?
Dr. Speirs: That is a very real concern and a very real question because most kids are wearing these in middle school or early years in high school. Everyone adapts to wearing a brace a little differently. And so I don't think it's a one-size-fits-all model, but it's definitely something that we make as discreetly as possible. Again, we tend to try to find the hours during the day that work out best for that individual adolescent. If wearing it at school is just not going to work, then we find other hours in the day to wear it and still get the time in so it has the least impact on their personal life, social life as possible.
How to Know If the Brace Is Working
Interviewer: Another question I was thinking is what signs should parents be on the lookout for to make sure that the brace is working for their child?
Dr. Speirs: When we order a brace, an orthotist makes the custom brace, and then we request that when you get the brace delivered and fitted, we take an X-ray of your spine in the brace. So we prove that the brace is actually doing what we want it to, essentially making your scoliosis curve smaller. And then, from there on, we know it's doing what it's supposed to. Usually, you monitor how well it's going based on how it feels. After you go through that break-in period, if you notice it's starting to get more snug or more uncomfortable, that usually means you're outgrowing the brace, and it either needs to get adjusted, or we need to get you a new brace. And so, usually it's based on feel after you've kind of adjusted to it.
Supporting Your Child Through Scoliosis Treatment
Interviewer: Now, just to kind of wrap up, I know we provided as much information as we possibly could. But what would you say to a parent that is maybe still maybe feeling a little overwhelmed by this type of diagnosis?
Dr. Speirs: I would say you are not alone. Those are very real concerns. As a parent myself, I have felt those concerns for my own kids' medical issues, and to just share those concerns when you meet with the scoliosis provider you're meeting with. I think it's very real to have concerns, and it's better when you come to the appointment to discuss the X-ray, to discuss what the treatment options are, to voice those concerns because, often, we as providers are able to adjust the treatment plan or find a way that will help accommodate those concerns as much as we can possibly. But if we don't know about the concerns, we don't know how to address them. And so I would just say write those concerns down, come into the appointment, go through all the options, and then express your concerns, and let's see what we can do to still provide the appropriate care, still treat the scoliosis, but also make this whole process, this whole journey that you have to go through scoliosis as comfortable and easy as possible.