When your child is diagnosed with scoliosis, a sense of confusion may set in as you start to research scoliosis treatment alternatives. How should you proceed? Who should you listen to? If the diagnosis is mild, is doing nothing the best strategy? Is a scoliosis brace necessary, and if so, when? Which scoliosis specialist should we see? Or, Which scoliosis brace is best? What if surgery is recommended and you flat out don’t want that for your child? 

Many adult patients also experience similar frustrations and seek out scoliosis treatment alternatives when conventional medical doctors offer only a few options, some of which are not congruent with your way of thinking. When the patient is a growing child or adolescent, there is greater urgency due to the limited window of opportunity to take steps to positively impact scoliosis or at least prevent progression. Doing nothing rarely resolves or improves scoliosis. However, taking the right conservative steps can improve life with scoliosis.

As parents of children with scoliosis who started by following the traditional medical path but learned the hard way that not taking the right steps from the beginning can be costly (in terms of lost time and progression), we finally discovered what we now consider the best way to take some control over scoliosis. Since then, we’ve spent more than two decades educating others about viable scoliosis treatment alternatives. Our purpose is and always has been to provide others with the insights we’ve gained both personally and professionally. To that end, we’ve created a list of questions/considerations to help you formulate the best plan for you, and your family. We have a lot to say on this topic, so you may want to skip the next few paragraphs and scroll down to Scoliosis treatment alternatives – what to consider. Or continue reading and we promise to get to the meat of the topic.

When undertaken promptly, the right non-surgical approach can be very effective for adolescent idiopathic scoliosis (AIS). Treatment goals are, at minimum, curve stabilization with the potential for some degree of scoliosis correction and postural improvement. When scoliosis turns out to be of some other origin – for example, a Chiari malformation, tethered spinal cord, or connective tissue disorder – then reducing scoliosis is unlikely and the goal is stabilization.

We’ve found curve-pattern scoliosis exercise rehabilitation to be the best approach– above all other methods. Schroth Therapy has the longest history among non-surgical scoliosis exercise methods and the Schroth method and variants have a growing body of evidence in support of its protocols. We introduced our program for patients back in 2007 and awareness of Schroth has spread rapidly in the US. However, feedback from patients we’ve seen has made it clear that it’s becoming tricky for patients to discern who they should trust for treatment. 

With that said, other types of practitioners also claim to offer help for scoliosis. Many orthopedic surgeons send to patients for physical therapy, not understanding the importance of curve-pattern specific exercises for scoliosis. We commend these therapists for their efforts to try and help patients however, most patients we see report that general physical therapy for their scoliosis didn’t really help.

There are also a variety of other modalities and practitioners claiming to offer help for patients with scoliosis. However, most of these treatment alternatives lack long-term evidence. Clinically, we’ve seen patients who have tried other methods and unfortunately experienced progression. Despite that, many of those patients have gone on to achieve some degree of improvement using our protocols. (The likelihood of success (in terms of improving scoliosis) diminishes as skeletal maturity approaches. It’s why our mantra is Scoliosis 3DC®: Not wait and see!). For adolescents especially, making the wrong treatment choice may result in lost time or potential progression.

Some practitioners recommend ONLY spinal manipulation as a scoliosis treatment alternative. Unfortunately, to date, there is no evidence available in support of manual therapy alone for AIS. That said, we are advocates of spinal mobilization as a worthwhile adjunct to an evidence-based exercise rehabilitation program for scoliosis. 

The Clear method – a passive therapy practice administered via mechanical traction in conjunction with other practices administered by a growing segment of chiropractors – is also not recommended.

Other practitioners of varying types (bodywork, exercise-based and some yoga instructors) also claim to provide benefits for patients with scoliosis. Certain bodywork methods are acceptable adjuncts to Schroth treatment and, like manipulation, can help with mobility and pain. If you decide to go this route, look for evidence and a sufficient practitioner track record of success. Yoga geared toward patients with scoliosis is not the best choice due to the unusual configuration of each scoliotic body. It’s an unpopular stance to take on our part and a complicated topic, but to help you understand why this is our position read our posts entitled, Yoga and Scoliosis and Yoga for Scoliosis.

When choosing scoliosis treatment alternatives, use caution and skepticism. Following the wrong advice or choosing a practitioner/program based on promises or proximity may be a costly error (in terms of time lost). Our list of considerations for scoliosis treatment alternatives is based on our clinical experiences and the vast experiences of families that we’ve guided and instructed. Many of those families had pursued some or all of the scoliosis treatment alternatives mentioned above but were compelled to continue seeking help.

Scoliosis treatment alternatives – what to consider:

Results: Before/after pictures and x-rays tell the story best! Photos/x-rays should be over the long-term to indicate if results are lasting. The results should be from the same practitioner you are considering entrusting.

X-ray Protocols: Are x-rays taken on-site or independently? How often is x-ray recommended? Are x-rays taken 24 hours or more out of brace? For an accurate assessment of Cobb angle X-rays should never be taken immediately after scoliosis exercise (common practice at Clear facilities) This will not provide a true representation of the spine.

Treatment Premise: Are the treatment techniques specific to an individual’s spinal configuration? Is the methodology active or passive? Is the treatment premise logical? Will the patient acquire skills to manage their scoliosis independently or will they need to rely on the therapist or specific equipment?

Treatment Goals and Objectives: Goals of treatment may differ for adolescents and adults. In terms of Cobb angle, both should strive for stabilization. We aim to reduce rotation and improve posture for all patients. For adolescents, we aim to reduce Cobb angle, when possible.

Evidence & Longevity: Is there a track record and/or a growing body of evidence to support the concepts and techniques taught? Many scoliosis treatment alternatives for scoliosis are in their infancy and research is relatively scant for many techniques. This is where the clinical experiences of the individual practitioner are extremely important as well as patient results.

Practitioner/Practice: Consider a practitioner’s experience, knowledge of scoliosis, results, reputation, reviews, attitudes, and passion for the process. Is the practitioner genuine and competent? Do they use scare tactics? Does the practice treat scoliosis full-time or only occasionally? There is variation among practitioners of the same technique.

Education/Understanding? Will the patient learn about their curve and scoliosis in general? Will they come to understand WHY they are doing what they are doing? Are you provided with detailed, individually created instructions and/or video? Follow-through? Ultimately, will the patient understand how to prevent their scoliosis from worsening? 

Sagittal/Transverse Plane – Does the therapy address the sagittal plane? Rotation? Scoliosis is a three-dimensional condition. All three planes must be addressed to improve posture. See “A Cause of Scoliosis–the Sagittal Plane.”

Customer Service (pre AND post-treatment): Is the office staff pleasant, approachable, thorough, responsive? Will they guide your child through skeletal maturity? And beyond? Is your child comfortable with the clinician? If they want, are the parents/family educated about scoliosis too? Can you take photos, take video for your own reference?

Individual vs group instruction? There are pros and cons to each type of instruction. Scoliosis is a highly nuanced condition. No two spines/patients are alike. We prefer individual instruction to streamline the process and for time efficiency. Individual attention ensures the patient has a thorough understanding of the process. 

Ease of Use: Is the process feasible? Can it be integrated easily into daily life? How much time is required for daily practice? Is the commitment excessive (that’s not realistic), or require too many props to facilitate practice (not always available)?

Expensive/cumbersome equipment: The requirement of added equipment can add significantly to costs and space requirements. If cumbersome special equipment is required then the concepts don’t incorporate easily into everyday life. When a methodology can’t be integrated/practiced easily it won’t be something that can be used when traveling or away from home.

ADLs for Scoliosis: Will you learn how to carry a bag or backpack, pull a suitcase, raise your hand in school, reach for items in a cabinet, and learn the best way to sit, stand, or rest to avoid progression? These are essential components of reducing asymmetrical loading and progression. Not everyone is trained in or understands the biomechanics of scoliosis, or takes the time to address scoliosis in this way during instructional sessions.

Does the technique have any side effects?:  We’ve had patients tell us they experienced dizziness, pain during treatment, etc. with other scoliosis treatment alternatives. Aside from the sensation of using muscles that haven’t been used often that shouldn’t happen! If you experience symptoms or side effects that don’t seem right, use caution and alert your practitioner.

Program Structure and Follow-through: How long is the program? If it’s Schroth, is it an immersion program? Schroth was designed to be learned and practiced in a short span of time. It’s how it’s been done in Germany for decades. Few Schroth practitioners in the USA use immersion, but we are of the opinion that it’s important. This is especially true for growing adolescents. The Schroth Method is best learned via immersion because the patient can grasp the concepts and apply them faster. Growing adolescents need the skills to combat scoliosis in the present – not over sixteen or twenty weeks when they are in the midst of a growth spurt. Are repeat visits recommended? What type/length of follow-up is needed? 

Unreasonable promises – As with anything else, when it comes to scoliosis treatment alternatives, if it sounds too good to be true, it usually is. You should have hope, but also reasonable expectations. Beware of practitioners who make guarantees. With scoliosis, there are NO guarantees as outcomes be it scoliosis exercise, bracing, or surgery. 

Does the technique empower or burden the patient? What do your instincts tell you?

Does the practitioner seem like a bully or pressure you into a commitment you are unsure of? You may not have complete confidence as you venture down this unknown path but when something seems questionable, trust your instincts.

Naturally, every practitioner/program is different. Practitioner/patient rapport is essential when it comes to scoliosis treatment. When you are confident you/your child are in the best hands and learning everything possible to help then that is great! Alternatively, if you suspect there may be a better experience to be had, keep looking–just don’t wait to long with there is growth ahead. Results are always individual. Several factors should be considered but curve severity at the start of treatment and compliance are two of the big ones. Successful outcomes require work!

Schroth Method Practitioners

The Schroth method is perhaps the most well-known of scoliosis treatment alternatives. Schroth method practitioners have varied training, experiences, and protocols. Sadly, Schroth is fractured, or often watered down in the US. Among the advantages of the Scoliosis 3DC® Program is that it is less confusing to learn, focuses on improved muscle engagement via upright scoliosis exercises, and includes techniques/concepts for spinal correction that make it easier to incorporate into the course of the day. For patients with very severe curves, the original Schroth exercises are retained. Barcelona Scoliosis Physical Therapy School (BSPTS) differs in that it does not include some of the updates and modifications we incorporate. Patients who’ve done both have shared that our protocols are simpler and more easily retained. Teaching is also typically delivered differently–we find concentrating the program of days, or weeks (for our Boston area patients) works well.

Philosophies, teaching styles, and support services after Schroth method training vary from practitioner to practitioner. Ask who/where a practitioner learned from, the extent of their scoliosis treatment experience etc. Schroth is quite nuanced (full-time or part-time scoliosis practice) and also about support services and follow-up. Knowing all of this upfront will provide the best idea of what you can expect. Hopefully, we’ve provided a lot of food for thought to help you distinguish the protocols/program that will best suit you/your child’s needs.

Scoliosis Bracing

There are practitioners of all types who we’ve mentioned that may or may not recommend scoliosis bracing – either alone or in conjunction with scoliosis rehabilitation or therapy. Some practitioners offering scoliosis treatment alternatives claim that bracing is not necessary. For kids with curves of 20-25º or more with a fair amount of remaining skeletal growth, we are of the opinion that this is the equivalent of playing Russian Roulette with scoliosis. Bracing is, and has been, the primary non-surgical treatment for scoliosis for many years, for a reason! As a treatment approach for scoliosis, bracing was documented as valid in 2013 by a study known as BrAIST (Bracing Adolescent Idiopathic Scoliosis Trial). However, what parents should know is that not all braces perform the same way or strive for the same result. Some aim to halt progression while others strive to improve posture, Cobb angle, and spinal balance. 

Deciphering which philosophy/practitioner to place your trust in for bracing may mean the difference between progression, creating spinal stabilization, or ideally giving your child the potential for curve reduction. Fortunately, bracing has evolved and improved in recent years as has the software braces are interpreted on. Chêneau – derivate braces aim to improve the spine in all three planes. Most Chêneau braces are technologically advanced and when custom-created for the individual patient may help improve posture and Cobb angle, when attainable. After being informed by some physicians that it’s virtually impossible to reduce Cobb angle, some of our hardworking patients have disproven those establishment claims. See Scoliosis 3DC® patient results here.

Let’s face it, it’s far easier for everyone involved (child and parents) to forego bracing. However, after progression happens, there may be no turning back as your child gets nearer and nearer to skeletal maturity. Obtain the facts, guidance, and the best information and tools to help your child. Deciding NOT to brace a growing child with moderate scoliosis or greater, in the best brace possible, may end up being a risky decision.

The importance of the right brace in terms of fit, correction effect, and wearability can help ease the burden. We like to think that the right team of practitioners with a friendly patient-centric approach will facilitate acceptance and adjustment to a new normal. 

We’ve found that Cheneau-style braces designed and manufactured according to Augmented Lehnert-Schroth classifications, constructed of lightweight malleable material, fit to exacting standards for comfort allow for improved compliance and most of the time, a very good result.

What are the goals of the brace?

Does the brace strive to improve the curve or only stop the curve(s)? Does the brace offer an in-brace correction effect? Is it compatible with other steps you are taking to improve scoliosis?  Look for 30% to 50% in-brace improvement on x-ray as evidence of correction effect.

Does the brace have the ability to overcorrect the spine?

This is most achievable for flexible curves braced early in the growth phase (usually most attainable for the patient with a Cobb angle in the mild to mid-moderate ranges with flexibility in their spine).

Does the brace aim to improve posture, make a 3D correction?

Braces that address the three – dimensions of scoliosis are best when it comes to trying to positively influence posture. (Some braces claim to be 3D, but don’t demonstrate that effect upon x-ray analysis). Buyer beware.

Is the brace heavy and stiff?

Many are. What material is the brace made of? With the right design, a very hard-density material isn’t necessary needed (except perhaps for extremely severe, rigid curves of 60º – 70º plus). Plastics used for brace-making today come in various densities and different practitioners use different materials. Nearly all braces we fit use lightweight, moldable polyethylene in comparison to the material used for other scoliosis braces. Patients who have switched from other braces tell us they prefer the material we use since it makes a difference in terms of comfort but they still get excellent in-brace corrections.

How easy is it to wear/conceal the scoliosis brace?

The less material a brace is made from, the more lightweight it will be. This is contingent on the brace design. Can the patient sit comfortably? When the material is lighter and more moldable the likelihood that it can be fitted for relative comfort increases. (It’s still a brace!). Does the brace go down to the thighs, and interfere with the chest area – a well-designed brace doesn’t need to – and shouldn’t!

Is the brace custom-designed for the patient’s curve pattern? Is the brace Schroth method compatible?

Augmented Lehnert-Schroth classifications determine Schroth curve patterns and compatibility. Some practitioners use other types of curve classifications.

What is the brace fitting process?

Braces should be custom-fitted to each patient until the fit is perfect. Some practitioners do just one fitting and do not take the time to adjust the brace to the patient’s optimal comfort level.

Is the brace standardized or is each brace the creation of an individual practitioner?

Bracing scoliosis is an art as well as a science and a function not only of design but of fit as well. Chêneau braces are now easily created via CAD-CAM and used around the world. Results may be somewhat dependent on the brace design, the material used to manufacture the brace, and the fitting process. In-brace corrections demonstrate the correction effect on the spine.

Does the brace address severe curves?

When scoliosis is severe and the goal is to avoid surgery, the patient needs a practitioner with a history of successfully bracing severe curves. Many scoliosis doctors in the US won’t brace patients with severe curves because they consider the patient a candidate for surgery. In general, severe curves are less responsive than mild or moderate curves but does that mean patients with severe curves shouldn’t be able to try bracing to stop a curve from progressing? The right brace can offer hope for patients with severe scoliosis who prefer to try scoliosis bracing before consenting to scoliosis surgery. Not everyone chooses surgery, even those with severe scoliosis.

Does the brace close in the front or the back?

Front closure makes a brace easier to manage independently. For braces aiming to influence/improve the sagittal plane, this is a must. ]

How are measurements taken for accuracy and patient comfort?

3D scanning is now fairly standard for scoliosis bracing for the most accurate replication of the patient’s trunk and torso. That said, there are still a few practitioners who create braces from casting.

Is the brace a knock-off? If so, how do you know it’s a good knock-off? 

One of our patient’s moms was recently told by another company providing scoliosis braces that they could “mimic” a Cheneau-style brace for her child. We want to know, If they believe in their brace design, why would they offer to “mimic” another brace and not stand behind their scoliosis bracing product?

Is the brace compressive making it difficult to breathe, or does it allow for easy breathing?

The Cheneau brace style uses strategically placed voids (openings) according to an individual’s spinal configuration to allow for Schroth corrective breathing while wearing the brace. 

The Whisper Brace® is an entirely new concept in bracing that’s not compressive and offers complete mobility.

Where is the brace manufactured and how long does it take for delivery and fitting?

If your child needs a scoliosis brace, they need it fast – not in three or four weeks, or more than a month. We offer bracing with a fast turnaround. 

The Whisper Brace® may take a little longer – about two weeks, but if the increased mobility is important to you/your child then it may be worth that short wait.

Can bracing be used for adults?

We’ve brace numerous adults who are experiencing pain and/or the feeling of collapse, usually mid-day. Scoliosis bracing for adults is used to reset and stabilize the spine and aims to provide the chance for the adult patient to improve their quality of life with scoliosis.

In closing…

In our opinion, many kids today are being prescribed outdated braces. Cheneau derivate braces and the Whisper Brace® are innovative and offer better choices for parents than the braces of the past. Most patients who have pursued care via traditional channels come to see us with braces recommended by orthopedic surgeons. As one parent in the medical device field who brought his two daughters to us from California for a brace, liability-wise, the Boston Brace is still the safest recommendation for doctors to make due to the longevity of years of literature in support of its use. However, if your child’s scoliosis is getting worse, he/she is having difficulty tolerating their brace, or if the spine is not stabilizing or improving in terms of Cobb angle or posture, then all the literature in print is inconsequential. Newer scoliosis bracing concepts offer patients a better experience in terms of comfort, stabilization, and improvement potential. Whether your child wears the Boston, Providence, Wilmington, or Charleston brace, it’s likely that their bracing experience can be improved upon. With each “new” brace that comes on the scene, bracing becomes a more complicated topic and as a parent you will have to discern what the best path is for your child.

One certain thing is that when a growing adolescent is diagnosed with AIS, it’s important to use growth and time to your child’s advantage. Choosing the right scoliosis treatment alternatives will allow time to work in your child’s favor, not against them. While there are never guarantees regarding outcomes, following the wrong philosophy, or practitioner, or choosing the wrong brace, may result in lost time, and wasted resources. Then there is patient burnout. Parents should take care to choose their course of action wisely, from the start. When idiopathic scoliosis (or kyphosis) is managed properly, there is hope. Except for the very severe, with proper management, most patients can avoid scoliosis surgery.

References

Flawed trials, flawed analysis: why CBP should avoid rating itself. Cooperstein R, Perle SM, Gleberzon BJ, Peterson DH. J Can Chiropr Assoc. 2006;50(2):97–102.

Manual therapy treatment for adolescent idiopathic scoliosis. Lotan, Shir et al. Journal of Bodywork and Movement Therapies, Volume 23, Issue 1, 189 – 193. 2019 Jan.

Treatment of Scoliosis-Evidence and Management (Review of the Literature) Hans-Rudolf Weiss, Deborah Turnbull, Nicos Tournavitis, and Maksym Borysov. Middle East J Rehabil Health. 2016 April; 3(2): e35377. Published online 2016 April 23.

Bracing Scoliosis – State of the Art (Mini-Review). Ng SY, Borysov M., Moramarco M, Nan XF, and Weiss, HR. Current Pediatric Reviews, 2016, Vol. 12, No. 1.