Scoliosis Bracing Plan

Why we brace

Idiopathic scoliosis gets worse mainly while a child is growing. A rigid brace holds the spine straighter during that time, and that changes how the bones grow. The best study ever done on bracing, which followed hundreds of children, showed that a brace worn as prescribed stopped three out of four moderate curves from reaching the surgical range, compared with about half of curves that were only watched. The more hours worn, the better the result. Bracing does not usually make a curve smaller, and it does not work once growth is finished. Its job is to get your child to the end of growth with a curve that never needs surgery.

Who braces

• A curve of about 25 to 40 degrees in a child who still has significant growth left: before the growth spurt is finished, as judged by the hand X-ray, the pelvis X-ray, and, in girls, time since the first period.
• A curve of 20 to 25 degrees that has grown 5 degrees or more between visits in a young child.
• Smaller curves are watched. Curves above about 45 to 50 degrees are past what a brace can hold, and we talk about surgery.
• In younger children, under about 10, a brace, sometimes worn part-time, can occasionally improve a small curve, not just hold it.

The brace

I prescribe a rigid underarm brace, molded to your child from a scan or a cast, made by an orthotist who does this every day. The common types, Boston, Rigo-Cheneau, Providence, and Wilmington, work in similar ways; the fit and the hours matter more than the brand. Soft or elastic braces do not work and I do not use them.

• Wear time: 18 hours a day is the goal, and at least 13. That usually means to school, after school, and all night, with time out for sports, showering, and a few hours of freedom. A nighttime-only brace is an option for some smaller curves with a single bend.
• A thin, seamless shirt goes under the brace. Expect pressure marks that fade within an hour of removal. Red marks that do not fade, blisters, or sores mean the brace needs adjusting; call the orthotist.
• The brace is checked by the orthotist every few months and remade as your child grows, usually once or twice during treatment.
• Breaking in: the first week, build up by two to three hours a day until full time. Most children are comfortable in it within two weeks.

How we know it is working

• An X-ray in the brace about four to six weeks after fitting shows how well it is holding the curve. A good brace corrects the curve by at least a third or more while on.
• Then an X-ray out of the brace every four to six months. The curve staying within about 5 degrees of where it started is a success.
• Many braces have a small temperature sensor inside that records wear hours. I use it as a coach, not a judge. It lets us talk honestly about what is realistic and fix the problems that keep the brace off, like heat, school, or sports.

Exercise, school, and sports

• Scoliosis-specific physical therapy (such as the Schroth method) teaches your child to correct their own posture and strengthens the trunk. Added to bracing, it improves muscle endurance, body image, and quality of life, and may add to the brace's effect. It is not a substitute for bracing in a growing child with a moderate curve. A program of three to four months with a trained therapist, then a home routine, is a good investment.
• Normal activity is encouraged. Walking, swimming, gymnastics, dance, team sports, all of it. Sports are done out of the brace, and those hours count as the time off.
• School: a note for a second set of books, a locker on the main floor, and permission to adjust the brace privately. Most schools are used to braces.
• Sleep: the night hours are the most valuable, since they are easy to count on. Most children sleep well in the brace within a couple of weeks.

Talking about it

Many preteens and teens hate the idea of a brace, and some grieve it. That is normal and worth saying out loud. What helps: letting your child choose the pattern and the under-shirts, connecting with another teen who wore one, naming the end date ("until the end of growth"), and separating the brace from their identity. I am glad to speak with your child alone at a visit if that helps.

How it ends

Bracing stops when growth is essentially finished: the hand X-ray shows the growth plates closing, height has not changed for several months, and in girls it is about two years after the first period. We wean the brace over about six months rather than stopping at once, and then take one more X-ray after a season out of it. If the curve is under about 40 degrees at the end, it is very unlikely to need surgery in adulthood.

If the brace is not enough

Some curves keep growing despite a well-worn brace. That is not a failure by your child. If a curve passes about 45 to 50 degrees while growth remains, we talk about surgery: vertebral body tethering for a flexible curve in a child with growth left, or fusion. Both are described in my guides.

Learn more

Scoliosis Research Society, Bracing: srs.org (opens in a new tab)

Pediatric Orthopaedic Society of North America, Scoliosis: orthokids.org (opens in a new tab)

My guides to adolescent idiopathic scoliosis and vertebral body tethering.

More for families

OrthoKids · POSNA

POSNA's OrthoKids: illustrated, family-friendly information on this condition.

Open on OrthoKids (opens in a new tab)

Scan for the OrthoKids page

This plan is general guidance for Dr. Wey's patients and their families and does not replace the advice we discuss in clinic about your child's specific curve.