23 Apr 2022   |   By :

Bracing for Scoliosis

Bracing for Scoliosis


Posture is an important part of our movements and body functions. Every movements such as sitting, standing, walking, climbing up and down stairs, squatting, jumping, running, lifting, and so on would be better if we can perform them with optimal posture. To have a good posture, we would need to have a straight spine (when we view from the front or back), we also need to have an upright spine (when we view our posture from the side). To have a straight spine, we need to have balance and coordination in our deep involuntary muscles. Our deep involuntary muscles are consisting of multifidus muscles which are connected between one spinal bone with one below and above them. diaphragm, pelvic floor, and transversus abdominis muscles. These deep involuntary muscles helps keeping our spine upright, furthermore our posture and movement would be protected by our bigger muscles such as hamstrings, quadriceps, gluteus muscles, latissimus dorsi, trapezius muscles and many more. Combination of all these muscle groups will protect our posture from collapsing and creating chronic injury over time. To protect our posture we require to reduce the amount of time staying stationary on a desk, applying stretching movement to keep our joints and musculature fluid no matter what our age are, regular strengthening exercises, getting plenty of sleeps, and proper food intake would support our healthy physical being.

Scoliosis posture

How can we determine that someone has scoliosis? In general we would assess posture to determine if a person has posture problem. The assessment consisting of balance posture off the shoulders, ears, hips, knees, and feet between left and right of the body if we are assessing from the front or the back. When we assessing from the side, we would determine if there is forward head posture that causing this person to hunch and over arching their lower back; and if we take a vertical line from the ear, then this vertical line should pass the midline of the shoulder, midline of the hip, midline of the knee and the ankle. When we are doing posture assessment for scoliosis condition, we would look at shoulder imbalance, if there is head tilt and head rotation, hip tilt and rotation, furthermore, we would also assessing forward bending to see if shoulder blade is protruding on one side (Adams’ forward bending test) from different directions and also assessing head positioning from the top in comparison to the shoulders. In addition to the above posture assessments, we would also measure patients back for rotation using a scoliometer in a bending down position and prone position. There are also additional examination for further scoliosis assessments such as balance, eye coordinations, lung capacity, ranges of motions of the neck and lower back, scoliometer measurements for torso rotation of the middle-back, lower back, and upper back; orthopaedic examinations and muscle tests for balance. All these examinations and posture assessment would not be completed if there is no 3 dimensional X-rays to support these findings.

The X-rays

X-rays should be done in anterior posterior position full spine from head to hip and also lateral full spine from head to hip. The purpose of X-rays are to confirm the degree of the scoliosis, the severity of the rotation of the spine, to find out if there are underlying condition in the bones that may cause scoliosis and also if there is a need of further imaging such as MRI to rule out pathology. Scoliosis develops through many factors. Factors such as genetics and epigenetic that leads to imbalance growth. Subsequently, hormonal alteration that can cause neuro-motor development and eventually asymmetry growth that causing deformity of the spine. Deformity of the spine would lead to adaptation in movements such as sitting, standing, walking, running, lifting, climbing, and so on. Over period of months to years, these movements would lead to increase of severity of the lateral bending and rotation of the spine especially during growth spurt. Lateral bending and rotation of the spine would cause balance and coordination problems during each individual movement of the body, in other words, patients that have scoliosis unable to find their centre of gravity, one side of their body musculature are stiffed while the other side unable to balance out.

What are we going to do when you or your child has been diagnosed with Scoliosis?

Medical model of scoliosis treatment relying on the size of the scoliosis curve without considering the posture, biomechanics, movements, musculature imbalance that scoliosis patients have. Scoliosis measuring up to 20 degrees usually observation until if the curve is worsening with curve measuring from 20 up to 40 degrees treatment is wearing a hard brace such as Boston brace with a purpose to stop worsening of the scoliosis curve. If curve goes beyond 45 degrees then surgical procedure would be implemented to the patients. Severe scoliosis always start with mild scoliosis curve, scoliosis would get worse because the body continues to adapt and compensate each movements such as standing, sitting, walking, running, climbing, jumping, lifting, and so on. As the core unable to hold the posture upright during these movements, then patients with scoliosis would continue to rotate their spine and utilise muscles that are stiffed to continue doing movements. Gradually these would cause posture to collapse and increase severity of the scoliosis curve. We wouldn’t know if we have scoliosis unless someone would notice our posture to be slanted on one side and/or when we are bending down one side of our shoulder blade would protrude posteriorly. A complete posture analysis would be helpful to understand the conditions of the scoliosis, severity of the scoliosis, biomechanics of the individual with scoliosis, and what need to be done to improve his/her conditions.

Non-invasive Scoliosis Treatment

There are many scoliosis treatment that are very effective to give improvement for scoliosis patients. Treatment such as CLEAR Institute scoliosis treatment protocol, Schroth method of scoliosis treatment, SEAS scoliosis treatment and many others. These treatment protocols have been researched and proven to give improvement and reduction of the scoliosis curvature. CLEAR Institute scoliosis treatment is consisting of different tools and specific equipments with purpose to help increase spine, muscles, and nerve (musculoskeletal) flexibility and mobility. These equipments including Scoliosis traction chair, Vertebral traction, flexion distraction table, Sensory Motor re-integration or posture balancing. Schroth Method is a conservative evidence based physiotherapy method of scoliosis treatment to improve curvature rather than merely stopping progression during pubertal growth spurt. SEAS or Scientific Exercises Approach to Scoliosis is another conservative scoliosis treatment program that is develop in Italy. It is an evidence based treatment with goals to build improvement for scoliosis patients from different ages. There are many other scoliosis treatments that are being done, however, these three treatments are being used the most by many scoliosis specialists out there to help improve patients condition without going through surgical procedures.

Scoliosis Bracing

Bracing is one type of treatment that being prescribed by many orthopaedic doctors, chiropractors, physiotherapists. It is a common aspect of scoliosis treatment in children and adolescents. This is because bracing works when a spine still in growth spurts. Standard guideline for bracing is for any curve above 20 to 40 degrees. The purpose of bracing is to reduce the likelihood of the scoliosis worsening and avoid the need for spinal surgery. A typical bracing concept is to stop scoliosis curve from progressing by putting pressure to the area of the spine with curvature. In other words, a typical bracing is to hold the spine with a hope that the spine curvature would not get worse. A crooked spine when it is being held in position with a typical brace can lead to reduction of overall strength and flexibility to the spine and musculature surrounding it. When a spine already rotated and lack of balance and coordination, adding improper bracing would cause long term deformity. Traditional bracing such as Boston brace, Charleston brace, Milwaukee brace design concept started in 1970s and the design have not changed ever since. The concept is to treat crooked spine in a 2 dimensional and try to hold it in a straighter position by creating a push to the curvature part of the spine. Many of these traditional bracing system usually have shortcoming and some brace design may cause worsening of the spine due to pushing method especially around the rib cage area. These typical bracing usually not perfectly fit and causing physical and emotional challenges to the person that wears it. All Well Scoliosis Centre adopting the ScoliBrace™ asymmetric bracing system as part of our scoliosis treatment program. Scolibrace is a 3-dimensional brace that is custom design for every individual with scoliosis condition. Scoliosis condition is not just bending on the lower back, middle back, and neck, however it started with rotation of the spine. As the spinal rotation worsen, then the spine will continue to bend and create a compensated posture that eventually becomes a full blown scoliosis curve. Treating scoliosis with a 3-dimensional bracing is addressing the rotational component of the spine and Scolibrace design as an over corrective brace. It is not a surprise that when a scoliosis patient wearing a customised and properly designed and custom fit bracing such as ScoliBrace™, there is a significant improvement to the spine. With combination of specific spinal strengthening exercises such as CLEAR scoliosis Institute, Schroth Method, and SEAS, the progress would be substantial and long term improvement can be seen after a few years of proper scoliosis treatment.