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? Is doing nothing really 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 acceptable options. 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. 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 and learned the hard way, we found a way to take some control over scoliosis. Since then, we’ve spent nearly two decades educating others about viable scoliosis treatment alternatives. Our purpose is and always has been to provide others with the benefits of our insights. To that end, we’ve created a list of questions/considerations to help you formulate the best plan. Since we have a lot to say on this topic 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 in a timely manner, the right non-surgical approach can be very effective for adolescent idiopathic scoliosis (AIS). Treatment goals are curve-stabilization with the potential for some degree of scoliosis correction and postural improvement. If 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 and strongly favor the Schroth Best Practice methods. Schroth Therapy has the longest history among non-surgical scoliosis exercise methods and the Schroth method – especially Schroth Best Practice – has a growing body of evidence in support of its protocols. Awareness of Schroth has spread rapidly in the US. However, feedback from patients 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. We commend them for their efforts to try and help patients outside the limits of mainstream medicine, however, we do not endorse other methodologies. The reasons are two-fold, most scoliosis treatment alternatives lack long-term evidence and because of our clinical experiences with patients who have tried other methods and experienced progression. Despite that, many of those patients have gone on to achieve some degree of improvement using our protocols. (The likelihood of success 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.
There are some practitioners who recommend ONLY spinal manipulation for scoliosis treatment alternatives. 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 small 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, 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 costly. 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? X-rays should never be taken immediately after scoliosis exercise (this is a common practice at Clear facilities) or immediately after taking off a brace. 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 individual curve and about 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? Will the patient understand how to work 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.
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, video of the process?
Individual vs group instruction? There are pros and cons to each type of instruction. Scoliosis is a highly nuanced condition and no two spines are alike. We prefer individual instruction to streamline the process and for time-efficiency. Individual attention ensures a more 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 many props (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, discover the best way to sit, stand or rest to avoid progression? These are essential components of reducing asymmetrical loading and progression. Not everyone understands the biomechanics of scoliosis or takes the time to address scoliosis in this way.
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.
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 it’s important. The Schroth Method is best learned via immersion because the patient is able to grasp the concepts faster making it less confusing. Moreover, growing adolescents need the skills to combat scoliosis in the present – not over the course of sixteen or twenty weeks. 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.
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 absolutely 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! Alternately, if you suspect there may be a better experience to be had, keep looking. Results are always individual. Curve severity at the start of treatment and compliance will be a factor. 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 in the US. The most current version is Schroth Best Practice (SBP) which comes directly from the grandson of Katharina Schroth. Among its advantages are that it is less confusing to learn, focuses on improved muscle engagement via upright scoliosis exercises as well as including 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 many of the newer, more user-friendly modifications. Teaching is also typically delivered differently (SBP is short-term intensive treatment vs. BSPTS which has shorter sessions over a more extended period of time).
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 scoliosis treatment experience as Schroth is quite nuanced (full-time or part-time scoliosis practice) and also about support services and follow-up. Information upfront will provide the best idea of what to expect. Hopefully, we’ve provided a lot of food for thought to help you to distinguish the protocols/program that will best suit 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, 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, it 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 creating spinal stabilization or giving your child the potential for curve reduction. Fortunately, bracing has evolved and improved in recent years. The 3D Gensingen is a Cheneau – derivate brace which aims to improve the spine in all three planes of scoliosis. It’s a technologically advanced brace designed to help improve posture and Cobb angle, when possible. 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.
Among Cheneau-style braces, the Gensingen brace is the only true Schroth method compatible brace in that it is designed and manufactured according to Augmented Lehnert-Schroth classifications.
In a recent post entitled, Best Back Brace for Scoliosis we outlined the most popular scoliosis brace alternatives and go on to explain why the Cheneau Gensingen is our choice for patients. Some of the considerations to contemplate when deciding on a scoliosis brace for your child, or for yourself, are listed below.
Choosing the Right Scoliosis Brace?
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? What is the track record of the brace? 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 (in the high mild to mid-moderate Cobb angle ranges).
Does the brace aim to improve posture, make a 3D correction?
Only 3D braces that achieve their goal aim to improve the spine and trunk in three-dimensions and positively influence posture. (Some braces claim to be 3D but don’t actually 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 hard density material isn’t necessary (except perhaps for extremely severe, rigid curves of 60º plus). Plastics used for brace making today come in various densities. Nearly all braces we fit use a lightweight, moldable polyethylene in comparison to the material used for other scoliosis braces. Patients who have switched from other braces tell us the material makes a difference in terms of comfort.
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 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, impose into 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.
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 comfort level.
Is the brace standardized or is each brace the creation of an individual practitioner?
Some scoliosis braces are the creation of an individual orthotist and dependent upon their skills and subject to error. Bracing scoliosis is an art as well as a science. Cheneau-Gensingen braces are created via CAD-CAM and used around the world. Results are somewhat patients-dependent, but patients from Asia, to Canada to the United States all achieve excellent in-brace corrections. The practitioner matters.
Does the brace address severe curves?
When scoliosis is severe and the goal is to avoid surgery, the patient needs a brace with a history of successfully bracing severe curves. In general, severe curves are less responsive than mild or moderate curves. The Cheneau Gensingen offers hope for patients with severe scoliosis who prefer to try wearing a brace before consenting to scoliosis surgery.
Does the brace close in the front or the back?
Front closure makes a brace easier to manage independently. This is a must for braces designed to influence/improve the sagittal plane.
How are measurements taken for accuracy and patient comfort?
3D scanning is 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.
Are the developers of the brace leaders or followers?
Cheneau bracing has been in development in Europe since the 1980s while Boston Brace dominated the scene here in the US. It is only recently that Boston Brace unveiled their first 3D brace.
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” the Cheneau-Gensingen brace. If they believe in their brace, why wouldn’t they stand behind their product rather than offer to mimic another brace?
Is the brace compressive making it difficult to breathe or does it allow for easy breathing?
The Cheneau Gensingen brace uses strategically placed voids according to an individual’s spinal configuration to allow for Schroth corrective breathing while wearing the brace.
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 months. The Gensingen Brace system is offered with a fast turnaround.
Is the brace used for adults?
Adults with pain and/or collapse use the Gensingen Brace to reset the spine and gain a chance to improve quality of life with scoliosis.
In our opinion, many kids today are being prescribed outdated braces. Most patients who have pursued care via traditional channels come to see us with braces recommended by orthopedic surgeons. Liability wise, the Boston Brace is still the safest recommendation for doctors to make due to its longevity years of literature to support its use. However, if your child’s scoliosis is getting worse, he/she can’t tolerate their brace, or the spine is not stabilizing or improving in terms of Cobb angle or posture, then all the literature in print is inconsequential. 3D bracing offers 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 the bracing experience can be improved upon. With each “new” brace that comes on the scene bracing becomes a more complicated topic.
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, wasted resources and 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. With the exception of the very severe, 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.
