Dr. Andrew Strauss has been actively engaged in scoliosis treatment for over 27 years. As the author of The Truth About Adult Scoliosis, Dr. Andrew is an excellent co-host for the topic of adult scoliosis bracing.
Throughout his discussion with Life Beyond the Curve Host Ashley Brewer, you'll learn:
If you're living with adult scoliosis or you know someone who is, we hope you'll tune in and enjoy the show!
For more information visit clear-institute.org.
Article referenced by Dr. Andrew during the show: Effects of Bracing in Adults with Scoliosis: A Retrospective Study.
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Hello, and welcome to the show. I'm Ashley Brewer, your host for episode 20, with Dr. Andrew Strauss. Dr. Andrew has not only been engaged in scoliosis treatment for the past 37 years, but he's also authored two books on the subject, "Your Child Has Scoliosis", and "The Truth About Adult Scoliosis". His book on adult scoliosis, coupled with his clinical experience, makes him an excellent co-host for our topic today, adult scoliosis bracing. When Dr. Andrew isn't spending time with his family or recording podcast episodes with me, he's the director of Hudson Valley Scoliosis Correction Center in New York, and serves as the Vice Chairman of the board of directors for CLEAR Scoliosis Institute. Episode 20, let's go!
You're listening to Life Beyond the Curve, a podcast brought to you by CLEAR Scoliosis Institute. Each week, we interview experts in the industry, answer your pressing questions, and empower you to take control of your scoliosis diagnosis and live life to its fullest. Enjoy the show.
Hello, Dr. Andrew, thank you so much for joining us today on Life Beyond the Curve. It is always great to have you.
Thanks very much, Ashley, uh, today, particularly I'm very excited about this topic, so yeah, let's do it.
Yeah, so today we're going to be taking a little bit of a deeper dive into the topic of adult scoliosis bracing. And so before we started recording, we were talking about how we receive inquiries from the general public at school-- CLEAR Scoliosis Institute on a fairly regular basis. And just yesterday, I was chatting back and forth with somebody and they said they have a 16 year old daughter who has a curvature of around, just around 50 degrees, but she was told because she's 16 years old and she's done growing that she's too old for bracing. So even though 16, maybe technically isn't an adult, she's done growing and too old for bracing. What do you have to say about that?
This is something that I also hear very consistently. Bracing has been validated in the scientific literature for curves up to 60 degrees. So this curve size itself is still amenable to bracing. And secondly, each case has to be viewed on its own. It depends upon what the goals are with this particular person and what the goals of bracing are. It's true that this is no longer a 10 or 11 year old girl who's very flexible, and you're going to be limited in how much curve correction can be achieved through the bracing. But bracing still has a very valid place in a treatment plan for a girl in that situation. And what is it? Well, bracing, for example, is very effective for pain control. It's just as effective as taking tablets or having injection therapy, according to the science. So if that child has pain, right away, we say, okay, bracing has a place.
Bracing also has a tremendous power to improve the person cosmetically. Sometimes we're not able to significantly even reduce the curve. Yet when we look at that child, we can see tremendous cosmetic changes. Their head is no longer shifted to the side. Their shoulders are more equal. Their waist looks more symmetrical. So bracing has a very powerful cosmetic factor. Thirdly, the brace can stop progression. Here you have a 16 year old girl with a 50 degree curve. That's a big curve. We, if that child says, I don't want to have the surgery and her parents agree, we're not having the surgery. Then we have a viable program for her, which consists of exercises in combination with bracing. I think this is a really important point to make. And I'd like to, to say this very emphatically: bracing is never meant to be used by itself. Bracing is always meant to be used in association with a scoliosis-specific exercise program. So in that situation, that girl could very much benefit from bracing, if she's the right candidate for it.
Now, when it comes to the realm of scoliosis bracing, there are so many different types of braces out there. Can you shed some light on the different braces that are out there, how or why you would use them, et cetera?
So here we're using two basic types of adult scoliosis braces. One is a soft brace and one is a hard brace, and they have two different applications. The soft brace is really a lifting brace and it's really only designed for pain control. It will not stabilize the curve and stop progression. It will not change the person cosmetically. It doesn't reduce the size of the curve.
When you say soft brace, what is a soft brace? Like, what is it made of? Is it, is it like clothing, or what is a soft brace?
It looks like a standard back brace that you might see the luggage handlers carry a whole, uh, use at the airport for example, but it has added to it outriggers. And those outriggers are placed on the pelvis and on the side of the spine which is tipping off to the, to the side and those outriggers will then lift the person into correction. So it's a specifically designed soft brace and it's controlled through two leverage systems. So you can pull on these cables and it'll tighten the brace up either on the top or at the bottom. So for example, if the person wants to sit, they can release the bottom of the brace and still sit comfortably in the brace, keeping the top tight, and then just pull the cord to make it tight, uh, on the bottom when they get up and walk around. So it has a lot of controls, it's customized in its design. So when the person comes in, we have to look at their x-ray and their examination and their posture. And then we will take all the components of the brace and, and apply them correctly for that, for that particular person. So it is a customized brace, but it's a false breakfast.
Okay. That makes sense. And then what's, what are the other types of braces?
Well, the other primary type is a rigid plastic brace and there are many different permutations of that. There's low ones, when the person only has a curve in the lower back; there's higher ones when a curve is in the upper back. So there's many different, uh, designs of these braces, but the rigid plastic brace is the one that really has not only pain control, but also modest curve reductions, cosmetic improvements, as well as slowing or stopping progression of the curve. And this is a very big deal. If you have a curve progression rate, even of, let's say, one degree a year, which is on the low side, could go up to say three degrees a year typically, but let's say you have one degree a year. And let's say that person that comes to us when they're, I don't know, 40 or 50 years old, well, they could ostensibly live into their nineties or a hundred years old. That's not going to be so unusual in our, in our generation. That's a lot of one degrees and that adds up. So if they can have a stopping or slowing, significant slowing of the progression rate, very, very meaningful to people.
So you've hinted at bracing is not used alone. It's used as a part of a more comprehensive treatment program. So in your area of expertise, which is noninvasive scoliosis treatment, how is adult bracing different than adolescent bracing?
Again, it depends upon the goals of the adult. Interestingly, adult scoliosis bracing can be used to achieve a more significant degree of correction, but it requires full-time bracing, just like in the adolescent. And most adults are just not willing to do that. And I can totally understand it. I never push it on people. I tell them it was an option there and every year I'll get a hell--a small handful of people that will say, no, I want to get the maximum correction and they'll go for full-time bracing. Some of them achieve it. Some of them realize that they just can't do it and they go back to part-time racing. But the typical recommendation for an adult with scoliosis bracing is going to be around six hours a day. And that's six hours toward the end of the day. So let's say from three in the afternoon until nine at night, and that, interestingly, can also be divided up. So the person could do two three hour sessions or three two hour sessions in the brace. We seem to get exactly the same results if they divide the dose up. But that is a typical dose.
So you've talked about curve correction. Now, is this scientifically validated?
Interestingly, in recent years, yes. There's a very interesting article that was published in the, um, in the, uh, hang on one second. I'm just looking to, looking to see what it is, in the archives of Physical Medicine and Rehabilitation in 2017, "The Effects of Bracing in Adults with Scoliosis". And this was a study that showed that it very consistently can slow and stop progressions, not only in adults with degenerative scoliosis, but also in adults with adolescent scoliosis. In other words, these are adults who had scoliosis as a child, and now they've aged up and we call that an adult with adolescent scoliosis. So it really is effective in both, in both situations. And yes, it has been validated in the scientific literature.
Well, that's awesome. I'll definitely put the link to that research study in our show notes here. So you've talked about potential curve correction. You've talked about pain management. What are some of the other goals for care with adult scoliosis bracing that would cause you to say, I think this is a good idea with this patient based on their presentation?
The main person that I see as really benefiting from it is the person who has a large curve and their muscle system, even with the best of the exercises, is just not able to deal with the size of the curve. So now you're taking, you're having to put the brace on when they're laying down and their spine will naturally elongate when they lay down. They tighten the brace up and now when they stand up, they're actually can defeat the effects of gravity. And that's why I have them wear it toward the end of the day, because that's when that gravitational strain really becomes intense. And that's why adults with large scoliosis feel very fatigued, very sore at the end of the day. And the brace eliminates that. So large curve, person who's having discomfort, their muscles just aren't able to deal with correction. The brace is a great tool.
And you've talked about most adults typically wearing a brace for about six hours a day towards the end of the day. But then you also referenced that some adults may have more lofty goals and they want to try for correction, and they opt for full-time bracing. So are they sleeping in their brace if that's the case?
For that person? Yes. If they're going to try to get 18 hours a day, which is the dose of full-time dose for an adult is 18 hours a day, they have to sleep in the brace. But interestingly, Ashley, many adults will choose to sleep in the brace. And it's not even a part of the treatment plan. I say to them, you don't need to, because it's not like they're growing and they're outside of gravity. It doesn't, it's not a required part of the protocol. Yet I will find consistently adults will report to me that they're sleeping in the brace. And when I asked them, what do you, what benefit do you get out of that? They just say, I feel so good sleeping in the brace. They, they got over that first week or two of discomfort. And the brace now is very comfortable and they enjoy sleeping in the brace. They feel like it's giving them a better day the next day, they feel taller, they feel stronger, they have less discomfort. So yes, there is a place for sleeping in the brace, but it's not a mandatory part of the protocol.
That's very interesting because obviously I don't have scoliosis, so I've never worn a scoliosis brace, but where my brain goes is I just feel like it would be an uncomfortable thing to have a brace on your body. And what you're describing is actually the opposite. They find comfort in it. They find relief from it. So I think that's awesome. I would like to hear about some of your patients that you've used the brace with.
Okay. Well, let me think of a good one. So I'm thinking of one particular lady, an older woman, she's in her seventies, she has quite a significant curve and she has a very significant postural distortion. So when you look at her outside the brace, she's leaning forward, she's leaning to the side. And this is a woman who used to be a marathon runner. This is a woman who used to be very fit and was used to being super fit. And now she's deteriorated into this terrible posture, and she really doesn't like the way it looks, either. But when we put her into the brace, when you see her in the brace, she's standing tall and she's standing straight. So not only does it give her a good feeling about herself, cosmetically, it also is relieving of the pain and it is slowing down or at least, uh, well, possibly even stopping the progression of the curve. We won't really know that for some time, but we know from the scientific literature that it's, that's, what's happening, at least it's slowing down, likely could be even stopping the progression. So there's a great case, cosmetic improvement, excellent! Pain control, powerful! Slowing the progression of the curve, a great, great asset to the person.
So it's sounding to me like there are many, many reasons why someone would consider or think about using a scoliosis brace, just based off of what you're saying. On that topic, before I ask the final question and we wrap up here, is there just anything else that you want to share with our listeners on adult scoliosis bracing?
Yeah. I think the, the mainstream medical world has not really risen to the, the, the, uh, awareness that there is a role for bracing an adult, even though it has been scientifically validated. I consistently get patients come in who are told, there is no role for bracing an adult, it does not work. Well, uh, maybe 20 years ago, we never saw bracing on teeth for adults. Now, I think it's quite a common thing. We often see bracing on adult teeth and the same way that, that bracing on teeth has changed, bracing on scoliosis has also changed. And there is a very legitimate place for bracing in adults. I would say about 20 to 30% of our adults are going to be getting a brace. Most of them don't need it, but when you have a case that needs it, it is a very, very powerful tool and a very important tool and it should not be neglected.
And I think that brings us almost full circle to where we started with the mom, saying that her 16 year old was told there she was too old for bracing. And what I'm hearing you say today is that's not the case. There are options. And I think that's so important for our listeners to hear. So if someone is listening and has adult scoliosis and they haven't considered bracing, what advice would you give them?
I would say go talk to somebody who's a specialist in bracing adult scoliosis, and talk to them. See, is there a role for bracing in your care plan? Maybe yes, maybe no. Like I said, only about maybe 30% of our adults are going to be getting a brace. So it's not like all of them are getting braces, but in those particular cases where a brace is indicated, it is amazing, amazing as an effective tool. So you just go talk to somebody who understands and uses bracing in adults and ask them, is there a role for bracing in my care plan?
Well, awesome. Thank you, Dr. Andrew, I always appreciate meeting with you and hearing the amount of knowledge that is in your brain about this topic. And I can tell that you love and care for your patients. So it's always great to have you.
Thanks a lot, Ashley. Thank you for the opportunity.
Have a great day.
If you have questions about treatment for adult scoliosis or adult scoliosis bracing, give us a call at (866) 663-7030. Again, that number is (866) 663-7030. We'd love to answer any questions that you have and point you in the right direction. There's more to come next week!