Common Mistakes When Managing Adolescent Scoliosis
We’ve been involved in the non-surgical treatment of scoliosis for well over two decades now, both personally and professionally. Over time, in our interactions with thousands of scoliosis families, rarely a week goes by that we do not hear of a scoliosis story gone awry. We’ve decided to share some of the common mistakes parents have come to regret when managing their child’s scoliosis (AIS) so you can hopefully avoid them with your child.
Every family/individual has to determine their own path. Hopefully sharing some of these insights will serve as guidance and help you determine the right path for your child’s scoliosis journey.
Mistake #1 – Not Paying Attention to Your Parental Instincts
We recently spoke to a mom whose premenarchal daughter had just been diagnosed with scoliosis at 13 years old. The mom was upset as she explained that on every annual visit to the pediatrician, she asked him to check for scoliosis. She did this because four years prior, she had noticed that her daughter’s hips were “off.” The doctor obliged for the first three years, but on the last visit, he informed the mom there was no need to check any longer. Fast forward to a couple of weeks ago: her daughter’s scoliosis was “suddenly discovered” at 41º. Mom had known for a long time that something wasn’t right. If you suspect a problem with your child’s posture and you aren’t taken seriously, consult another practitioner for a second opinion.
Mistake #2 – Watch & Wait
While scoliosis research states that not everyone’s scoliosis will get worse, there is probability inherent to that statement. In many instances, waiting to see what happens is not in your child’s best interest. Waiting to act until scoliosis progresses may mean that scoliosis progresses to the point where it is too late to avoid bracing, the recommendation for surgery, or both.
Watch and wait is particularly questionable advice, especially for growing kids who still have a substantial amount of growth potential. When a child is at high risk of progression, this is akin to playing the odds. Scoliosis usually progresses during a growth phase. For girls, who have scoliosis at a rate of about 8:1 to boys, this usually happens just before the start of menses. Read more about scoliosis progression.
The “do nothing” advice for managing adolescent scoliosis is not the best course of action. The basis for our statements is research. Martha C. Hawes, the author of Scoliosis and the Human Spine, reported that sometimes scoliosis begins as a functional curve. When a curve is functional, it may be reversible [1]. This means that early conservative treatment for scoliosis may have a positive influence on a functional curve. To us, there is no better argument for early intervention! When a curve persists it can become a structural spinal deformity. When this happens, the spine becomes decompensated and in this “unbalanced” state the spine is more likely to progress [2].
Another issue related to ‘watch and wait’ is not bracing in a timely manner. While this is situation-dependent, we have heard of many instances where the parents of growing patients, with 25º plus curves, were told to continue monitoring the curve(s). This creates the impression for the parents that bracing is not of immediate importance. Nothing could be further from the truth! Many parents we know have come to regret that advice only after they discover their child’s scoliosis has progressed. We’ve covered this topic in other posts. It is our philosopny to brace scoliosis as early in the process possible when the spine is decompensated and there is growth potential. We don’t recommend waiting around until 25º if you can help it.
Mistake #3 – Using the Wrong Scoliosis Brace
The Boston Brace, the Wilmington Brace, the Providence Brace, and the Charleston Brace (the latter two being nighttime braces) for years have been the go-to braces most doctors prescribe and are still prescribing. That time has passed. Not only that, rigid braces are a far better choice than the well-marketed soft, stretchy braces like SpineCor. What parents ultimately want when navigating scoliosis treatment is the best back brace possible for their child and their child’s circumstances.This may mean you will be doing some research to find the right scoliosis brace.
For more than ten years we’ve been advocates of Chêneau style braces. And, we still are BUT what parent don’t know is that there are so many variations of a Chêneau concept brace in existence today. This is because each brace is individually created for the patient. Who is designing your child’s brace? Have they thoroughly examined your child? Do they understand how best to design the brace for your child’s spine? Do they have a lot of experience with this type of brace. Chêneau braces have not been in the US for very long and there are still parts of the country that don’t even offer these as an option. It’s why we’ve had so many parents bring their kids to see us from all over the United States, and Canada! It is nearly impossible for parents to differentiate among these types of brace and to know if the brace their child receives will have the optimal effect on their child’s spine. We are confident that our Schroth method experience gives us a major advantage over others providing this type of brace. We are committed to a positive fitting process and are also very sensitive to the psychological impact of being braced. We get to know the patient and take as long as it takes to make them happy in the brace, fit wise. Fittings at our facility are over three days to ensure comfort and wearability but it also builds trust. Your child needs to “buy in” to the experience to be able to improve their chances of success.
Chêneau braces are created via CAD/CAM technology. It’s a dynamic area that is constantly evolving. Interview your brace provider to get answers to your questions about the brace creation process and the fitting process. The brace they create and fit your child in matters because it’s hard to gain back the opportunity for improvement once scoliosis progresses.
A completely new concept in bracing– The Whisper Brace® is new to the market! We are very excited to become the Boston area scoliosis clinic to be launching The Whisper Brace® for Massachusetts families and those from all over New England! This brace is a completely different concept in bracing. It offers increased mobility for kids who just can’t tolerate a rigid brace due to skin irritations or sensory issues. It’s also a pressurized brace but because it’s adjustable, a patient can go longer without having their brace replaced. It’s also Bluetooth-capable. As practitioners, we are excited that we will be able to gain feedback on our patients brace wearing habits and the amount of pressure being exerted on the spine! Another bonus is that fitting time is very short. It’s pretty cool!
Either type of brace can be used as a full-time brace or a nighttime brace for scoliosis. This will depend on the circumstances of your child’s scoliosis. Each type of brace will be custom-created for your child (adults can wear them too!) and fit according to an individual’s unique body. If you aren’t sure which brace might be best for your child, Dr. Marc and his team can guide you through the decision-making process of choosing the best scoliosis brace for your child.
Mistake #4 – Rushing to Scoliosis Surgery or Having Surgery
Often, parents are told their child with scoliosis should have surgery at Cobb angles around 45º – 50º. We’ve heard some recommendations for surgery at 35º – 40º for growing kids–which we consider to be quite aggressive! While the decision to have surgery is personal and dependent on several factors, in many cases, surgery can be avoided with bracing and an educational program that teaches the patient with scoliosis how to avoid progression for their unique spine.
Contrary to what many people are led to believe, some families/kids choose to forego surgery and take proactive steps. Before considering surgery, we recommend you read, Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study, by Weinstein et al. [3]. Our research page has a link to that article and additional links for your reading pleasure. Consider a telling comment from the not too distant past by orthopedic surgeon, Dr. Timothy Ward:
“My patients without surgery are doing every bit as well as my patients with surgery. Plus, they haven’t been subjected to these surgical risks…. and some of the complications are large.”
Mistake #5 – Not Considering Scoliosis Rehabilitation
Schroth exercise in its original form first began in Germany in 1921. When taught correctly, it’s a highly nuanced program of scoliosis exercises that are taught according to an individual’s specific scoliosis curve pattern. Dr. Moramarco was first exposed to the Schroth concepts in Germany back in 2002 when he visited the clinic to try to help his own daughter. He returned several times and went on to gain his Schroth Certification there in 2007–the first American to do so! He and his team, Amy Heller and Kim Kruzel, both occupational therapists, will guide you through the scoliosis maze and show you that there is almost always hope and treatment options that do not involve surgery. Their dedication to patients is unmatched. Our team educates patients–and their families–about their unique scoliosis and instructs in our comprehensive multi-faceted program using the best strategies for scoliosis management. Our sole focus is to educate, engage, and empower our patients.
At Scoliosis 3DC®, we aim to open your eyes to scoliosis treatment in new ways. Our goal is to help you avoid a misstep when it comes to managing your or your child’s scoliosis. We’re committed to helping others learn what we have learned about managing scoliosis for children, and also helping adults, who can be a forgotten segment of the scoliosis population! To learn more, check out some of our Schroth method results or check out our Facebook Page.
Mistake #6 – Expecting or Looking for Guarantees
Our advice is to avoid any practitioner/practice who makes guarantees about results/outcomes. In truth, there are NO GUARANTEES when it comes to scoliosis treatment. This applies to scoliosis exercise, scoliosis bracing – of any type, and especially in regard to surgery. That said, we’ve witnessed that there is much hope for patients who take an active role in managing their scoliosis conservatively (curve reduction in kids, improved posture, reduced pain, etc. are not out of the realm of possibility). However, we never make, or imply, a guarantee. Each patient is unique. Compliance, flexibility, and other factors play a role in outcomes. Have realistic expectations. If your child has a curve that a spinal surgeon recommends for surgery, your child is not likely to end with a 20º or 25º curvature after conservative treatment of any type.
Mistake #7 – Believing Everything You Read on the Internet
If we’ve learned anything in the last 24 years, it’s that each case of scoliosis is different. While the internet is a powerful source of information, be wary. Techniques for managing adolescent scoliosis are evolving all the time. With the increased popularity and availability of newer treatment methods, please be cognizant of where you are getting your information from. Consider who a forum moderator is, what is their motivation for taking on such a task, and understand that forum moderators can block/exclude comments from contributors whose opinions and philosophies differ from their goals. Advice on the internet, just like ours, comes from people of varying philosophies and experiences. Look to other parents you know who have navigated the curves of scoliosis successfully with their child.
Mistake #8 – Taking the Wrong Course of Action
Since time is of the essence when it comes to managing adolescent scoliosis, taking the wrong course of action may be costly. In many instances, we’ve initially spoken to patients or parents of children on the phone months before they end up coming to see us. Sometimes it’s because they decided to attend another program, see another practitioner based on proximity, or because there is a financial or time factor that prevents people from coming. We get it, we’re in Boston, there’s a lot to consider and not everyone can make the trip.
Keep in mind though that when you drag a kid with scoliosis from place to place for treatment and results aren’t encouraging it can result in discouragement, burnout, confusion, and doubt. Making the right decision from the get-go will prevent lost time, make the process less stressful, and hopefully will result in the best possible outcome for your child– without having them look back with bitterness, regret, or worse yet, imprinting an indelible scar on their psyche for the rest of their lives. Don’t underestimate the psychological component of having scoliosis. A caring, compassionate approach is central to an outcome that everyone can live with.
Mistake #9 – Not Taking the Right Steps Simply to Avoid X-ray Exposure
Unfortunately, X-rays are necessary for managing adolescent scoliosis. Naturally, parents want to take steps to reduce a child’s X-ray exposure. Start by making sure shields are used to protect sensitive areas. Sadly, we’ve received x-ray files from parents coming from other doctors with ten images or more when a child’s curves are severe. This is often because doctors planning surgery tend to order an extensive number of X-ray views for planning purposes. If your child’s curve is in the range where the doctor mentions surgery, be aware of the number of views being ordered and their purpose unless you’ve consented to go forward with the surgery. They may not be necessary if you are opting out of surgery!
Initially, when scoliosis is diagnosed getting two full spine views is the norm: the PA view and the Lateral (or sagittal plane) view. After this initial series, a PA view is usually sufficient for monitoring. For kyphosis, both views are needed to monitor the spinal curves.
In our office, when we brace or see a patient for Schroth instruction, we use one PA x-ray view taken just before the visit to allow us to identify Schroth curve classifications and be able to teach your child with the true picture of their spine to refer to. We also need an in-brace X-ray to confirm the correction effect of the brace on the spine and to allow us to check pressure point pad placement for an optimal in-brace correction.
In the past few years, EOS X-ray has expanded to most major cities. EOS has significantly reduced radiation compared to standard X-rays and this is great news for kids who need to be monitored in six-month intervals. Ask us about where to find EOS in Boston, Connecticut, NYC, and other major metropolitan areas. We can direct you! Two Boston area hospitals now offer EOS for adults as well!
Mistake #10 – Not Keeping a Health Record
Each time a child has an X-ray, get a copy of the disc with the X-ray images on it to have as your own. If scoliosis is suspected and the Scoliometer™ reading is 5º or more with noticeable spinal asymmetries it’s not a bad idea to have a baseline X-ray. This allows you to see exactly what your child’s spine looks like so you can keep close track of any progression (deterioration) of scoliosis to react fast. You may get some pushback when you ask for an x-ray when your child’s Scoliometer™ reading is 5º but we recommend you should insist especially IF there is a family history OR if you have any intention of introducing proactive management techniques. If you live in the Boston area, we will be happy to see your child to make recommendations or monitor him/her when scoliosis is very mild.
Get a copy or note on health records including Cobb angle measurements and Scoliometer™ readings and any other assessments as they pertain to the scoliosis. For girls, monitoring and noting the date when menses begin, its regularity, and any changes in height can also be helpful. Family history often plays a role, so ask about any family relation with scoliosis or kyphosis to report to your medical practitioner.
1] Hawes MC, O’Brien JP. The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment. Scoliosis. 2006;1:3.
2] Stokes IAF. Hueter-Volkmann effect. In: Burwell RG, Dangerfield PH, Lowe TG, Margulies JY, editor. Etiology of Adolescent Idiopathic Scoliosis. Vol. 14. State of the Art Reviews: Spine; 2000. pp. 349–357. Philadelphia, Hanley & Belfus Inc.
3] Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and Function of Patients With Untreated Idiopathic Scoliosis: A 50-Year Natural History Study. JAMA. 2003;289(5):559-567.
Updated: February 12, 2025
