Braces – Practical Guidelines for Use

Back Brace – Indications

The main indications for wearing a back brace are kyphosis, scoliosis, and, in rare cases, spondylolisthesis. Bracing is typically recommended for scoliosis curves between 20° and 40° and kyphosis angles between 55° and 70°, as seen on standing X-rays. Braces are most effective when there is remaining skeletal growth, meaning when the child is still growing. The purpose of the brace is to keep the spine aligned during growth to prevent the need for surgery.

Which Type of Brace is Preferred?

The most commonly used braces are Boston-type braces, which are underarm braces that do not extend to the neck. These braces typically open at the back and are made of lightweight plastic, customized to fit the patient’s body.

Inside the brace, pressure pads are placed to apply corrective forces on the spinal curve. Braces are worn under clothing. Although other types of braces exist, none have been proven to be superior in effectiveness or comfort.

One brace type from Canada uses straps and has shown promising results according to its manufacturers. However, independent studies have not been able to replicate these results or demonstrate its superiority over traditional Boston braces. Similarly, nighttime braces (e.g., Charleston braces) are only suitable for a limited number of scoliosis cases.

How Long Should a Brace Be Worn?

A back brace should be worn until the child stops growing. Growth is monitored by examining hip bones, the iliac crest, humerus, and rib heads. As skeletal maturity approaches, these growth centers begin to solidify.

Girls generally complete their growth around 15 years old.
Boys reach full skeletal maturity around 17 years old.

Once it is determined that a child has reached full skeletal maturity, the brace can be gradually discontinued.

How Many Hours per Day Should a Brace Be Worn?

The general recommendation is 21 hours per day, although this depends on the child’s after-school activities. The brace should be removed for extracurricular activities, especially sports, to prevent damage.

The Texas Scottish Rite Hospital recommends a 16-hour daily regimen, which has been shown to be just as effective as the 21-hour regimen.

Brace Fitting and Adjustment

Wear the brace after showering, ensuring the skin is dry.
Apply talcum powder to absorb sweat.
Put on a 100% cotton, sleeveless undershirt to prevent skin irritation. It should be smooth without wrinkles.
Change the undershirt at least twice daily to maintain hygiene.
Fasten the brace as tightly as possible to prevent it from rubbing against the skin and causing irritation.

If skin irritation occurs, the brace should be removed for a few days until the irritation resolves. A well-fitted brace will be less visible under clothing and cause fewer issues.

Brace Cleaning

The brace should be cleaned daily, preferably with rubbing alcohol.
Velcro straps should also be cleaned regularly.
If the brace becomes dirty or does not fit properly, contact the orthotist for adjustments.

Physical Activity & Scoliosis Management

It is essential for the child to engage in regular physical activity to maintain good physical fitness. This helps improve tolerance to the back brace.
A Schroth physical therapy program is recommended, as it has been shown to be highly effective when combined with bracing.
The child is free to participate in any form of exercise they enjoy. There are no specific sports (such as swimming) that are officially recommended for scoliosis.

Scoliosis Monitoring

Scoliosis progression is monitored through regular X-rays at intervals determined by the doctor. The brace should be removed the night before the X-ray to ensure an accurate assessment of the spinal alignment.

Final Removal of the Brace

Brace use is gradually reduced as the child approaches skeletal maturity, which is determined by:

Iliac crest ossification (Risser sign).
Menstrual history (girls typically reach skeletal maturity about 6 months after their first period).
Cessation of height growth.

Gradual Weaning Process

Reduce brace wear by 2 hours every 2 months.
Take an X-ray to check if the spine remains stable.
If the spine remains stable, continue reducing brace time by 2 hours every 2 months until complete discontinuation.
If scoliosis worsens at any stage, return to the previous wearing schedule.

This careful step-by-step approach ensures that the spine remains stable after discontinuing the brace.

Frequently Asked Questions about Back Braces

Are back braces worn by adults?

A back brace for scoliosis and kyphosis is recommended when there is growth remaining, that is, when the child is still growing. Its aim is to keep the spine straight and avoid surgery. In adults, a simple belt can help relieve symptoms, for example in spinal stenosis, together with limiting activities. After surgery, most patients do not need a brace; when one is given, it is to remind the patient not to bend, twist or lift weights.

Which types of scoliosis need a brace?

A brace is usually recommended for curves of 20° to 40°, as measured on standing X-rays, and for kyphosis of 55° to 70°, while the child is still growing. The most common braces are the Boston type: they sit under the arms, are made of light plastic, are shaped to fit the body closely and are worn under clothes.

Is the brace worn during sleep?

Yes. The general advice is to wear it 21 hours a day and take it off during sports, while a 16-hour program is equally effective. Getting used to it takes 10 to 15 days: if the child finds it hard to sleep, the brace is taken off and put on again the next night, until it is fully tolerated. Night-time braces of the Charleston type are used only for a small number of curves.

Is a back brace used for kyphosis?

Yes, kyphosis is one of the reasons for using a back brace, usually for kyphosis of 55° to 70° in a child who is still growing. In Scheuermann’s kyphosis, as long as growth is not complete, the brace can prevent the curve from getting worse, but it does not fully correct it.