Understanding the Boston Brace: Benefits and Alternatives

Boston Brace

The Boston brace is a type of thoraco-lumbo-sacral-orthosis, or TLSO brace. In fact, it's the most common TLSO brace in the United States. It’s used primarily for the treatment of children, working to slow the progression of scoliosis in growing spines.

Developed in 1972 by Dr. John Hall and Mr. William Miller of The Boston Children's Hospital, the brace carries the namesake of the city in which it was pioneered. If you’re looking for a visual, it’s a plastic contraption that wraps under the arms and around the rib cage, lower back and hips.

How the Boston Brace Works

While Boston braces aren’t custom-made, certain measures are taken to ensure the brace fits well enough to be successful. There are several variations to account for scoliotic curves at different points in the spine. While wearing the brace, the Cobb angle should be 50% less than without it. Doctors take an x-ray of the patient while they’re wearing the brace and then measure the Cobb angle to ensure it fits correctly.

The Boston brace is meant to force the spine into a straighter position by compressing the irregular curves in the hopes that they grow more slowly. Strategically placed pads put pressure on the scoliotic curve. An area of relief, or a section of the brace without a pad, is opposite those sections with pads. The goal is to correct the curve by placing these areas of relief where the spinal curve would ideally be. The theory is that the spine will move away from the pressure of the pad and into the area of relief. The pads pressing on the curve of the spine are meant to be uncomfortable, so you’ll naturally to try to position your spine to avoid that pressure.

The brace fits snug to the body, so it can be worn under clothes. But those clothes should be baggier in order to accommodate the brace. Once prescribed, most people should wear the brace 18 to 23 hours per day for three to five years. It can be taken off for a few hours each day to bathe, swim, or play sports.

Disadvantages of the Boston Brace

The Boston brace is only a two-dimensional solution for a three-dimensional disease. The brace restricts and weakens the entire abdomen, making it difficult for the spinal discs to regenerate themselves. When the curve is pushed in without first being stabilized and strengthened, the brace may have the opposite effect, actually leading to an overall weakening of the spine over time. Since spinal discs need motion to regenerate, concerns have been raised that the brace may actually increase spinal rigidity.

People wearing a Boston brace often complain about general discomfort underneath the brace. These complaints include:

  • Tight or sore hip muscles
  • Weak abdomen
  • Increased abdominal pressure
  • Sore, red and raw skin
  • Intense discomfort in heat
  • Restricted breathing
  • Inability to bend the torso
  • Difficulty with exercise

There can be serious side effects if the brace is too tight, most commonly an inability to breathe comfortably. Or if the brace is pressing too hard against the ribs, there is a possibility that a bowel obstruction can develop. The owner’s manual for the Boston brace warns that if you become nauseated, you should remove the brace immediately at risk of possible death, an incredibly serious (though very rare) side effect.

Alternative Options

We’re obviously a little biased since we’ve developed an alternative treatment for scoliosis patients that don’t want to pursue bracing or surgery. But if you’d rather try a treatment that doesn’t carry the potential for such cumbersome side effects, we want you to know there are hopeful and holistic alternatives to bracing.

Strengthening and rehabilitating exercises and adjustments can work to actually correct the curve, instead of working to merely slow down the progression of scoliosis. And unlike with the Boston brace, with alternative scoliosis treatments, like the CLEAR scoliosis treatment, the only side effect is a possible muscle soreness, similar to what you’d feel after a good workout.

A personalized, scoliosis-specific routine often achieves better results than a brace. However, all exercises, adjustments, and therapies should be prescribed according to each individual patient’s unique spinal configuration. These exercises are designed to increase strength and mobility in the spine and its surrounding muscles. They improve balance, coordination and achieve a more natural position of the spine.

Knowing all of your options and being able to weigh the pros and cons is always helpful when making a crucial medical decision like this. Think about what’s most important to you, as well as all the possible ways to achieve your spinal health goals. It’s important to talk to your doctor about all of your treatment options and make the decision that’s right for you. While traditional bracing is not a part of the CLEAR protocol, the appropriate type of corrective bracing can compliment CLEAR care very well.

Are you considering the Boston brace as a treatment for scoliosis? Have you worn one in the past? We’d love for you to share your thoughts and experiences with us in the comments below.

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14 comments on “Understanding the Boston Brace: Benefits and Alternatives”

  1. Hi. This may be an odd request, but I wore a Boston back brace for 5 years in my youth and I'm looking for a used / 2nd hand one to show my children. Am looking online, but am not finding the classic brace. Could you tell me where I might be able to locate a classic brace? I wore in the early 80's if that helps. Thanks for any / all help!

    Kind regards,

    Anya S.

    1. Hello Anya,

      We have some old braces here at the CLEAR Scoliosis Institute which might be what you are looking for; send us an e-mail at [email protected], and we'll send you some pictures!

  2. I like how you said a specific and personal routine will often work better than simply having a brace on. This makes a lot of sense because it would allow you to treat your own body which is different than others'. That way you can prevent your own back from getting worse while also having a good exercise routine.

  3. Hi. So this past year I have peen experienceing really bad back pain. So my mom took me for x-rays and I found out that I have scoliosis, it is only a 10% curve, and I've tried massage therapy, and I do exercises at home but it doesn't seem to help me, do you think a brace would help to correct the curve, and to stop the pain? Thanks!

    1. If your back pain is a broad, general, muscle-type ache, this is something that a brace (or chiropractic) might help with. If you are feeling a sharp, stabbing pain in one small, specific area, this could be a sign of something more serious and should be evaluated by a skilled scoliosis specialist.
      Keep in mind that braces are typically only prescribed for curves at 20 degrees or higher, and their purpose is to prevent the curve from getting worse, not to reduce back pain. You could look into a soft brace such as SpineCor (Dr. Marc Lamantia of Scoliosis Systems or Dr. Brett Diaz are two particularly excellent doctors in this field). It's also possible that scoliosis-specific exercises (such as SEAS or Schroth) could help, or movement therapies such as Elise Miller's Yoga For Scoliosis or Karena Thek's ScolioPilates; all of these are advanced techniques created by individuals with advanced training in scoliosis, and are much more likely to help than general exercises or massage therapies that were not created specifically to help people with scoliosis. And of course, CLEAR scoliosis chiropractors are also an option you can explore to see if our methods can identify & resolve the source of your pain. If there is any assistance I can provide in selecting from your various options, please feel free to let me know!

    2. The brace is helping me so far and i have 2 curve. one is 36 degrees and the other is 37. This could be different for you because of the size of your curvature, but you could always try it

  4. My name is Jordan and I just got my brace. The person who fitted me said that the brace is a perfect fit but the armpit piece is stabbing into me and is causing my left arm to raise a good 3 inches taller then my right. It is also causing my arm to fall asleep because of how tall the piece of plastic is. I am kinda upset because i have no idea what to do.

    If you have an answer please feel free to email me at [email protected]

    1. Hello, Jordan,

      I would suggest contacting the doctor who fitted you for the brace to discuss your concerns with them. Best of luck.

  5. My eight yr. old daughter was just diagnosed with scoliosis. She is at 29 degrees. Shriners is wanting to place her in a Boston. I am finding it near impossible to locate stats on the success vs failures in females, 7-9 yrs, with her severity. My wife went through this (Boston Brace) at age 10. Wore it for 3 yrs and still had to have surgery after she reached 47 degrees.
    Can anyone help guide me?

    1. Hello, Jarod,
      I am sorry to hear that. The earlier a scoliosis is diagnosed, the more likely it is to progress, so I would highly recommend being as proactive as possible with some type of treatment. The Boston brace does not have a great success record, especially with juvenile scoliosis. If you are truly wanting to do bracing, the ScoliBrace is a better option. However, we at CLEAR Scoliosis Institute offer another approach to scoliosis treatment that is unique, in that it works with the soft tissues around the spine, not just trying to hold the scoliosis in position. Our treatment involves strengthening the weak muscles and stretching the tight ligaments, as well as chiropractic adjustments to reduce and stabilize the scoliosis. This also helps to lessen progression during puberty, growth spurts, etc. Our care often is complimentary with the ScoliBrace, and many of our practitioners use both of these treatment methods to get the best results for our patients. Studies done with CLEAR Scoliosis Treatment along with the ScoliBrace show results that are much better than either of these treatment approaches on their own. I would suggest a consultation with the CLEAR Scoliosis Institute Doctor closest to you to determine if your daughter would be a candidate for one or both of these treatments. To find the closest CLEAR Scoliosis Institute certified Doctor, please visit our website under "Find a Doctor". Best of luck.

  6. Hi - I recently had a chest xray and the Dr told me that I have a 36 degree curve in my thoracic spine. I am about to turn 60 year old and this is the first I've heard about this. I have always been active and maintain a healthy weight. I also have been doing vinyasa yoga as my primary form of exercise for the past 2 1/2 years. I do have occasional discomfort in my back but have for years. I recently talked to a fellow yogi who is a patient of yours and recommended me to you. However, before I make an appointment and travel the distance to your office, I was curious what the initial consultation involves. Office visit, xrays, etc. I have a pretty substantial annual deductible so I want to be sure seeing someone about my spine is affordable and within what I can afford. I'll wait to hear from you before I proceed.

    1. Hello, Nancy,
      Thank you for reaching out. CLEAR Scoliosis Centers are independently owned by each clinic's doctor and set their own prices for care. If you are looking for costs, you would need to contact the CLEAR Scoliosis Center you are interested in going to in order to find out their individual prices. To find the nearest clinic to you, please visit our website under Find a Doctor and enter your zip code.

  7. Dear Sirs
    I am S.P.JAIN -84 YRS FROM India . My Grand daughter had Juvenile Autoimmune diseases in 2014 The treatment was completed in 2017 except Right leg has become Thinner & shorter as compared non affected left Leg & now diagnosed with Scoliosis Brief details are as follows . Since she had been advised Boston Braces by a Dr , the parents are going ahead with getting a brace made to her size
    I have my apprehensions looking to the disadvantages mentioned by you as well my inability to find a Dr who dealt similar case ie a young Girl Child who had Scleroderma earlier has been diagnosed with Scoliosis
    I request you pl. advise your valuable recommendations
    ,giving brief details as below
    -Grace was found to be Suffering with Juvenile AutoImmune Disease
    Scleroderma ( Morphea ) in 2014

    -By the Grace of God Treatment was completed in 2017 but the left leg has thinned out & is shorter in length (30mm or so ) , but for the physiotherapy exercises undertaken by her religiously during the treatment period she remained very active , joined Ballet Classes , where too she performed very well ..
    As for the diffrence in length of legs ,she was wearing extra pad in rt leg shoe

    - Though we were all the time concerned by her bulging stomach due to
    leg length diffrence but even after seeing the DIGITAL SKIAGRAM WHOLE
    SPINE -AP & LATERAL ( STANDING) VIEW on 6/8/2016 ( PDF ) , Dr advised to
    ignore it & suggested to halt the growth of left leg till it equalises witRt leg by inserting a pad in left leg when she is around 10yrs (In growing children, growth can be arrested by timely surgical intervention blocking the knee-adjacent epiphyseal plates of the longer leg.), done in March 2020 , so
    we were hopeful that with narrowing of diffrence in leg length , her
    movement will become normal . But due to Covid 19 they were confined in Darjeeling only till July 2021 and progress could not be monitored
    On return they followed up with Drs ( as she was walking tilted towards right) ,Dr on examination of X-Rays etc.diagnosed it as SCOLIOSIS
    The problem being faced is that not many Pediatric Spine Doctors
    are available , the one they met has suggested wearing of Brace all the
    time for 24hrs except for bath for 6 mths . I learn wearing the Brace
    all the time will result in weakening of Grace , so will rise to
    another . Also I learn Brace is a solution for halting the deformity in two dimension & but not a cure for three dimensional deformity

    1. Hello, S.P. Jain,
      It sounds as if she has been through a lot. There are obviously many complicating factors to her condition. The focus of the CLEAR Scoliosis Institute treatment methods are to reduce and stabilize the scoliosis as much as possible without the use of surgery. Some of our CLEAR Certified Doctors use an over corrective brace called a ScoliBrace that works with the spine in a more 3D fashion along with the CLEAR Scoliosis Treatment protocols and have shown great results. However, not all braces function the same and yes, some can weaken the spine. Also, occasionally shoe lifts can help on a temporary basis on rare occasions; however, you have to be careful it does not make one curvature better while making another worse. If you are looking into possible treatment options for her, I would suggest contacting a CLEAR Scoliosis Institute Intensive Certified Doctor. We, unfortunately, do not have any in India; however, I would recommend visiting our website to determine which location would be easiest for you to travel to. Please let us know if we can be of further assistance. Best of luck.

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