Program FAQs
What Types of Spinal Curves Do We Treat?
We treat patients with mild, moderate, and severe scoliosis of varying curve patterns. Dr. Moramarco and the Scoliosis 3DC® team have treated patients with scoliosis Cobb angle(s) starting at 10° and up to 120°. Our patients with kyphosis typically have thoracic Cobb angles ranging from 50°-85° (as measured on a lateral spinal x-ray). We take a proactive approach to treatment while others are ‘watching and waiting.’ That said, it’s never too late to improve the quality of life with scoliosis, manage pain, and halt the prospect of further progression.
Who is a Candidate for Our Schroth Method Treatment?
Adolescents, adults, and some juveniles with idiopathic, congenital, and/or neuromuscular scoliosis may all benefit from our Schroth method program. We also treat patients with kyphosis (with or without scoliosis), Scheuermann’s disease, and post-surgical scoliosis patients (1 year post-operation or with written consent from the surgeon). Scoliosis is not one-size-fits-all, so Dr. Moramarco will recommend the best program for you, your child, or loved one.
Why would a post-surgical patient want Schroth Therapy?
Post-surgical scoliosis patients choose to treat with us when there is pain, they are seeking postural improvement post-surgery, and/or when the spine begins to collapse above and below the spinal fusion(s). Our Schroth therapists can address all three and help improve the quality of life after scoliosis surgery.
Who is a Candidate for our Scoliosis Bracing?
Most small children, adolescents, and adults with scoliosis are candidates for scoliosis bracing. 3D asymmetric CAD/CAM-designed braces are quickly becoming more and more popular. Innovative bracing choices like The Whisper Brace® also offer an exciting new option for patients seeking more mobility when wearing a brace. To determine if you are a bracing candidate, we gather information about your health history, view your X-ray imaging, and do a phone or telehealth session to learn more. Once we know more about a patient’s circumstances we can we can advise accordingly. Part-time bracing for adults may help with stabilization, improved posture, and pain management (on a case-by-case basis).
How Long Does Treatment at Scoliosis 3DC Take?
Our intensive Schroth program usually consists of twelve or seventeen hours of one-on-one treatment according to an individual’s Schroth method curve classification. The typical adolescent and adult with scoliosis will do a twelve-hour program unless scoliosis is severe and the family opts for a seventeen hours program. Once our team can learn more about the adolescent’s circumstances we can help guide you in this regard.
For adults, and/or post-surgical patients, twelve-hour programs are the norm. For patients with juvenile scoliosis (under the age of 10) we start with even fewer hours and take the process more slowly according to the child’s level of maturity. For patients with kyphosis without scoliosis, fewer hours are needed. To learn more, please call us. Once we receive x-rays and learn more about the case we can make our treatment recommendations.
An intensive 17-hour program can be completed in just 4-5 days for long-distance patients (3-4 hours of daily scoliosis exercise instruction). For Boston area scoliosis patients, treatment can be spread out a bit but a condensed, intensive Schroth program for optimal learning and efficiency is usually best. Scoliosis and kyphosis patients come to see us from all over the US, Canada, Mexico and beyond. In fact, we’ve treated patients with scoliosis from all over the world.
In addition to scoliosis exercise rehabilitation treatment, we offer bracing options to be used alone or in conjunction with our Schroth method program. When opting for bracing only, the process takes 4 days minimum, with advance scheduling. When Schroth therapy and bracing are done concurrently, brace measurement and fittings can be completed in the same time frame as the Schroth program. When opting for the Whisper Brace®, it will take longer to receive the brace but the fitting process is faster! Call us for more information on that. While we do not require that patients utilize both treatment options–scoliosis exercise and bracing– those who combine bracing and our specialized approach to Schroth therapy ultimately do have the best outcomes.
Scoliosis Bracing Questions Answered
Why is scoliosis bracing important?
First and foremost, bracing is recommended to reduce the asymmetric load on the spine–a contributing factor to scoliosis curve progression. During the growth phase, it’s critical to have the best spinal brace–one that attempts correction rather than just trying to stop progression.
Bracing is recommended for children and adolescents with idiopathic scoliosis with progressive curves and remaining growth. Research has shown that when an adolescent reaches skeletal maturity with Cobb angles at 30º or less, progression into adulthood is less likely (1). This is why controlling scoliosis progression once scoliosis has been diagnosed is essential. Time is truly of the essence when it comes to treating scoliosis.
For years, bracing had been a controversial topic among scoliosis professionals, and to a certain extent still is. The publication of BrAIST has quieted that debate and professionals who tell you bracing isn’t necessary for progressive curves should be called into question, in our opinion. BrAIST, released in 2013, primarily studied the Boston Brace. State-of-the-art 3D bracing for scoliosis offers patients an even better opportunity for an improved outcome at the conclusion of brace treatment.
Why a Chêneau or the Whisper brace®?
Dr. Moramarco believes that if a child must wear a brace, it should be the most effective scoliosis brace available, and attempt correction. This belief is the result of his experience as the father of a daughter who was braced, and compliant, yet progressed significantly (SpineCor, 2001). His professional experiences as the nation’s most experienced Schroth method provider have put him in the unique position of having treated kids from all over the US, as well as kids and adults from other countries and continents! Like his daughter, adolescents seen at Scoliosis 3DC® have come from every type of practitioner with braces that have proven difficult for the patient to wear, or have resulted in progression. They’ve arrived for care with nearly every type of scoliosis brace, included among them: the Boston Brace, Boston 3D, the Providence Brace, SpineCor, Scolibrace, the Charleston Brace, and other Chêneau-derivate braces created by various practitioners. The common denominator among these patients is that the patients and their parents have all expressed some degree of dissatisfaction with their brace–often due to a lack of comfort or mobility, and progression despite brace wear compliance.
These experiences over the last two decades have allowed our team to gain insights that others may not have. We understand what a brace should do, how it should be designed, and the material patients prefer to facilitate compliance. If a patient can’t tolerate a brace and wear it for the recommended number of hours then how can they attain success while bracing?
A well-designed Chêneau-derivate brace should provide In-brace corrections of 30% to 50% or better. These are now the new industry standard in many locales and are more and more frequently recommended for growing patients. The 30 – 50% improvement not only results in a high rate of patient satisfaction but in our experience, when the patient sees the in-brace improvement it can serve as motivation to wear the brace! The right brace should also help improve spinal asymmetries and re-balance posture.
Dr. Moramarco and his team share the same philosophy: Striving to halt scoliosis progression is not enough when the potential exists for improving trunk asymmetries and Cobb angle reduction. His experiences with bracing goes back to 2013 when he gained his bracing certification in Germany. He is still as passionate about the improved prospects for patients with scoliosis who choose a well-designed scoliosis brace. When the right brace is combined with Schroth therapy patients have the potential to achieve some very impressive results.
Tell me more about in-brace correction?
In-brace correction is the amount (can be expressed in either Cobb angle degrees or as a percentage) that the Cobb angle(s) decrease, as demonstrated by an x-ray, while the patient is wearing their brace. This amount of reduction attained will depend upon several factors, most notably: brace design/fit, spinal flexibility/stiffness, age, curve pattern, and trunk shift.
What is over-correction and why do we strive for it?
Over-correction refers to instances during scoliosis treatment (whether it is curve-pattern specific scoliosis exercise or Chêneau bracing) when the scoliotic curve returns to the center of the back and then into the opposite direction of the curve. We strive for overcorrection during our treatments–more attainable for mild or mildly moderate curves vs. severe curves. Accomplishing over-correction will increase, but not assure, the likelihood of curve improvement. It can also help a patient improve postural symmetry so the patient appears more balanced.
What type of results can be expected?
Scoliosis is an unpredictable condition. Factors such as age, stage of development, gender, spinal flexibility/stiffness, compliance, brace tolerance/fit, and other factors will play a role in determining the outcome at skeletal maturity. Attempting to predict the result of brace wear for a given individual is not prudent. According to the Scoliosis Research Society (SRS), holding progression to <5º in comparison to pre-brace Cobb angle measurement is considered a successful outcome. At Scoliosis 3DC®, we believe our patients deserve more for the sacrifice of wearing a brace during adolescence. In general, bracing outcomes for patients braced at moderate vs. severe levels are more optimistic. That said, at Scoliosis 3DC® we have braced patients with severe curves, beyond the surgical threshold, and some of the results have astounded us, even at later stages of growth.
Our patients have consistently demonstrated spinal improvements. At a minimum, our aim for our young and adolescent patients is to halt progression, but we always want more for your child and we do anything we possibly can to try and help them accomplish that goal!
When should a child be braced for scoliosis?
This is a topic of debate among professionals. We contend that patients with immature spines who are braced earlier will attain a better outcome as we’ve witnessed this clinically numerous times. As stated above, when a patient can achieve overcorrection the potential for excellent results increases dramatically. This is why we think that waiting to brace until a growing child reaches 25º can be something a parent may come to regret. The other mistake is using a poorly designed brace that doesn’t demonstrate an in-brace correction of significance.
Industry-wide, the recommendation for bracing for scoliosis is dependent upon a practitioner’s philosophy on bracing which most likely is based on a combination of factors including age, Risser sign, Cobb angle(s), and estimation of progression. Timely brace treatment should occur at the latest when curves approach 25º, or for curves of 20º or greater before the primary growth spurt when diagnosis occurs during the mild phase. Timing depends on the estimation of the stage of growth. A dramatic increase in curvature can occur in only a few weeks during a growth spurt. At Scoliosis 3DC® we’ve treated one patient whose scoliosis increased by 13º in only 26 days, as documented by x-ray.
Is wearing a scoliosis brace painful?
It shouldn’t be physically painful to wear a scoliosis brace. If it is, brace adjustments may be necessary. A well-designed brace corrects scoliosis, as demonstrated on the in-the-brace, to the best possible extent without causing pain or discomfort.
How long will my child have to wear their scoliosis brace?
This is another difficult question since each case of scoliosis is different. Length of wear is a function of skeletal maturity and curve severity. In our office, we recommend kids continue to wear their braces right through skeletal maturity and then begin the “weaning off” process for the best results. It has been our experience that for girls especially this is not necessarily the philosophy adopted by some physicians, many telling girls at Risser 4 that they can discontinue brace wear.
Will my child need more than one brace?
Growth in children is unpredictable, so the answer to this question is dependent upon a variety of factors. If your child is 10-years-old and is a Risser 0, the answer is most likely yes for a Chêneau-style brace. If your child is fit in their brace at a Risser stage 3 or 4, then perhaps one brace will be all that is necessary, but maybe not. Much will depend on growth and changes in girth.
One advantage of the Whisper Brace® is that the brace doesn’t need replacement as frequently as Chêneau-style braces since the brace can be adjusted as the child grows requiring fewer braces.
As we all know, during puberty, kids tend to grow taller, and often wider. Growth can come early for some kids and later for others. The answer to this will depend on several factors which no one can predict.
Keep this in mind: when a brace doesn’t fit properly, it can’t work optimally. Managing scoliosis is a process.
Do you brace adults?
Yes. Absolutely. While it is not realistic for adults with scoliosis to expect that brace wear will result in Cobb angle reduction (although we do have x-rays demonstrating some reduction in a couple of our adult patients), adults who choose bracing report improvement from a variety of symptoms of scoliosis. These include pain relief or reduction, postural improvements, and most appreciate the spinal support a brace can offer.
Other than bracing, what else can be done for AIS?
In addition to bracing, our intensive Schroth-based pattern-specific-scoliosis exercise program is designed to educate and empower the patient while providing the skills and tools needed to manage scoliosis, for life. We teach Schroth principles and how to incorporate those principles into daily activities. It is our goal to make fighting curve progression second nature.
Our patients re-learn sitting, standing, lying, and other positions used during daily activities. Instruction is always according to individual curvature. We also teach patients how to modify postural habits such as carrying, walking, and more during daily activities. Our back school addresses scoliosis from the sagittal plane, too. We incorporate spinal mobilizations and include other exercises, in addition to more traditional Schroth exercises. It’s comprehensive!
Our goal is to educate and empower patients and show them how to avoid feeding into curve progression as per the Vicious Cycle (2). Our two-pronged approach (scoliosis bracing and Schroth scoliosis-specific exercise, at one facility, offers patients, both adolescents and adults, the best chance for successful scoliosis management in the long term.
What constitutes successful brace treatment?
When the Cobb angle of a high-risk curve is stabilized within the limits of the accepted margin of error (+/-5°) through skeletal maturity, this is generally regarded as a successful brace treatment. We strive for more! We attempt to improve curvature (to some degree) as well as postural appearance. Success will most likely depend upon the amount of growth remaining at the time bracing commences, in-brace correction, and patient compliance. When bracing takes place in a skeletally immature patient, as early as possible in the growth process, the prognosis is often excellent. Some degree of curve correction is even possible when the brace is worn full-time during residual growth.
For more information see trunk remodeling paper below. Please consider that each individual is different and bracing success is dependent upon timing, individual spinal flexibility, and compliance, among other factors.
It is always our goal to offer patients the absolute best in conservative management for scoliosis. Please feel free to call us with additional questions.
(1) http://www.ncbi.nlm.nih.gov/pubmed/12578488
(2) http://www.ncbi.nlm.nih.gov/pubmed/8727190?dopt=Abstract&holding=f1000,f1000m,isrctn
