Nonsurgical Treatment Options for Scoliosis
What Are the Treatment Options for Scoliosis?
There are three proven ways to manage scoliosis — observation, bracing, and surgery. The doctor will recommend one of these methods based on the severity of the scoliosis and the child's physical maturity. These features predict how the scoliosis should behave during the child's growing years and as an adult.
What will make the spine go back to being straight again?
A scoliosis curve will not get straight on its own. Bracing will help to keep it from getting worse. Surgery — a spinal fusion — is the only thing that will straighten out the spine, but it will not make it completely straight. Surgery will also stiffen the spine and is therefore reserved for more severe deformities.
What happens if the child has just a slight curve?
Children who have mild curves (less than 20 degrees) will be monitored to make sure the curve is not getting worse. The doctor will check the growing child's spine about every 6 months. If the child is fully grown, they may not ever need more X-rays.
Will having so many X-rays cause future health problems?
X-rays are necessary to follow the progression of the curve. There can be small negative effects with frequent X-rays, but these effects are minimized by using protective shields over certain body parts to protect the child from unnecessary exposure.
What happens if no treatment is done? Will the curve get worse?
Two factors can strongly predict whether a scoliosis curve will get worse: patient age and curve size. Larger curves (greater than 30 degrees) in younger children are the most concerning for progression.
We know from studies that once someone is fully grown, scoliosis curves less than 30 degrees tend to stay the same, while curves greater than 50 degrees can get worse over time, by about 1 degree per year.
Common Questions About Bracing
Do I have to wear a brace if I have scoliosis?
Most people with scoliosis do not have to wear a brace. About 1 out of every 6 adolescent patients shows signs of their curve enlarging during their growth spurt. The larger a curve gets, the more likely surgery may be needed to correct it. Therefore, if you have signs of curve progression, your doctor may recommend you wear a specially designed back brace to try to keep the curve from getting larger as your spine grows.
For what degree curve do you decide to prescribe a brace?
Brace treatment is generally used to prevent scoliosis from getting worse when you have:
- A curve that is moderate in size (20 to 40 degrees) AND
- A small curve that is progressive (has increased by more than 5 degrees) OR
- A curve that is over 30 degrees when first diagnosed AND
- A lot of growing yet to do
Your doctor may consider other factors in recommending a brace, such as if you have additional medical conditions, or have family members with scoliosis.
Does bracing work?
Several research studies show that bracing for scoliosis can keep your spinal curve from growing large enough to require surgery.
Your curve may likely get smaller while it is being held in the brace. When your spine is fully grown and you stop wearing the brace, your scoliosis curve will eventually go back to its original size. In some cases, the curve stays smaller after bracing treatment.
Research confirms that the more time the brace is actually worn, the more effective it is. Wearing the brace just 6 hours a day is nearly useless, while those wearing a brace over 16 hours a day will be less likely to need surgery. However, in some cases, the curve continues to grow larger even though a brace is worn.
What kind of a brace will I need and why?
Your doctor will work with an orthotist (a professional who makes assistive devices like braces) to recommend the best type of brace for you.
The kind of brace you need depends upon several factors, such as:
- Where the curve is located on your spine
- How flexible your curve is
- The number of curves you have
- The position and rotation of some of the vertebrae in your spine
- Any other medical conditions you may have
Your doctor and orthotist will also take into account your activities and lifestyle when suggesting braces. You and your parents can then decide which brace you prefer among the choices given.
The brace only works if you wear it as prescribed, so it is important that you participate in the decision-making process.
What does the brace look like?
There are two major kinds of braces: plastic (rigid) braces and soft (dynamic) elastic braces.
- The more commonly used rigid brace is like a shell that covers the front and back of your upper body generally from under the armpits down to the pelvis. The brace usually fastens with three Velcro straps and can easily be removed to take showers or do other activities.
- The soft braces use elastic straps, Velcro, and various smaller plastic or metal pieces to put the brace into the shape that is best for your type of curve, and help keep it in place as you move around.
Whether you need a plastic or soft brace, your orthotist will customize your brace to comfortably fit your body.
How long will I need to wear the brace?
Can I wear it at night only?
You need to wear a brace until your spine stops growing. This timing varies quite a bit from person to person. Your doctor will check your brace and the status of your growth every 4 to 6 months.
The amount of time each day that you have to wear the brace depends upon several things, including your growth and the type of brace you wear. The most common daytime braces are worn 16 to 23 hours daily.
Some braces are worn only while you sleep, but they do not work for all curve types. Your doctor will advise you about which brace is best for you and the amount of time you need to wear your brace each day.
What will it be like to wear a brace?
It may take some practice to get used to putting on your brace, but soon you will become an expert at it. Clothes in loose-fitting styles will easily cover your brace, making it impossible for others to know you're even wearing a brace.
As long as your doctor approves, you will be able to remove your brace to play sports or do other recreational activities.
What happens if I don't wear the brace?
Wearing a brace is one important way you can try to prevent your scoliosis from getting worse.
A brace will only work if you wear it. Like many things in life, you have a choice, but your choice also has consequences. If your doctor recommends a brace, and you choose not to wear it, you run the risk of your curve getting larger.
Depending on how big your curve gets, you may need surgery to correct it. Or you may choose to do nothing about the curve and run the risk of it continuing to increase. This may cause various medical and quality of life issues later in your life.
Common Questions About Alternative Treatments for Scoliosis
Many patients and their parents ask about the effectiveness of treatment options other than bracing and surgery.
Will physical therapy help my scoliosis?
It has not been proven that physical therapy can help people with scoliosis.
Different physical therapy methods, such as the Schroth method, have been designed to offset the effects of scoliosis and improve the shape and look of your body. There is some scientific evidence to show that physical therapy may help you appear straighter and improve your breathing. However, there is little evidence at present to show that physical therapy alone is effective in stopping the curve from getting worse during growth.
If you have spinal problems such as back pain in addition to your scoliosis, your doctor may prescribe physical therapy to address your specific needs.
Will chiropractic treatment help?
Chiropractic is a controversial method of treatment that seems most effective at treating acute, short-term pain. Chronic conditions do not seem to be effectively managed by long-term chiropractic care.
Patients who have scoliosis and choose chiropractic treatment should be referred to a spinal deformity specialist (orthopaedist or neurosurgeon) if their curves keep increasing. Insurance may or may not cover chiropractic treatment.
Will acupuncture help treat and manage my back problems?
Acupuncture uses fine needles that are intended to stimulate points in the body and supposedly create an energy flow to treat many illnesses. There is no scientific evidence that proves this theory, or that acupuncture helps in treating back problems or back pain. Insurance usually does not cover such treatment.
Will yoga help treat and manage my back problems?
There are many systems of yoga. Basically, most yoga systems are intended to improve muscles through stretching, holding positions, and breathing exercises. Some yoga systems also include meditation. How much it will help with back problems is not proven, but it may help to relieve back pain. Your general health also may improve. Insurance may or may not cover treatment.
How can massage help my back problems?
Massage may help those with back pain.
There are many techniques of massage. Be sure to find out if your massage therapist is licensed by the state in which you live, and where they have been trained. Insurance generally does not pay for massage treatments.
Will pilates make my scoliosis or back problems better?
Pilates exercises focus on strengthening abdominal and back muscles. There also is emphasis on posture and breathing. Exercises should gradually increase in level of difficulty, and should not increase back pain. Pilates exercises are not intended for those with severe back pain. Patients should ask about the training of any instructor.
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.