Some of my readers may have heard of 50% in-brace correction. Maybe you have heard of it but don’t understand what it means. For those still learning, let me start from the beginning and explain what you need to know about the 50% in-brace correction myth, scoliosis brace correction, and the goals of in-brace correction.

What Is Scoliosis and Why is it a 3-Dimensional Condition? 

Scoliosis is a 3-dimensional condition of the spine. The body is affected in all three planes: coronal, sagittal, and transverse. The coronal plane is what we see when we look at the body from the front or back. The sagittal plane is what we see when we look at the body from either side. The transverse plane is when we look at the body from the top or bottom. 

Scoliosis is present when there is a rotation of the vertebral bodies and sagittal/coronal curvature of the spine. Scoliosis brace therapy aims to correctly treat scoliosis by considering all three planes and the whole body to change the spine’s 3-dimensional condition.

Woman dealing with back pain

What are the Goals of Scoliosis Bracing? 

Scoliosis bracing has one ultimate objective: reducing condition progression and improving a patient’s quality of life. 

On a technical level, the goals of scoliosis bracing sound a little more functional. 

  1. Derotate the vertebral bodies
  2. Elongate the spine
  3. Stabilize the spine 

How Scoliosis Goals Are Measured

Doctors can measure progress towards goals of scoliosis bracing in several ways: objectively, with a device called a Scoliometer, with changes in body height, or by assessing the amount of decompensation to a vertical change over time.

My patients often ask me what their physicians mean when they say, “The brace is getting 50% correction.” 

This refers to the unwritten “50% in-brace correction” standard established during the first developments in scoliosis bracing history. It implies that a brace should achieve fifty percent correction immediately after donning to be considered an effective solution for scoliosis. 

For example, if the angle of a person’s thoracic curve is measured to be 36 degrees, the expectation of the brace’s correction would be 18 degrees in-brace.

It is critical to assess interventions and their outcomes for effectiveness. In 2013, Knott published a research study that analyzed in-brace correction retrospectively (1). The research aimed to help develop a standard of expectation to qualify the effectiveness of scoliosis bracing.

However, it is just as important to recognize that the human body is complex. Placing a numerical value on an intervention to represent the mass of individuals within the adolescent group may be helpful or detrimental to different patients.

How Are Scoliosis Goals Helpful?

It is helpful to reach an expected objective outcome so that the orthotist, physical therapist, and physician have confidence that the intervention is accomplishing the intended goals of scoliosis bracing.

It gives patients and parents peace of mind that they are doing everything they can to help improve the condition.

How Can Scoliosis Bracing Goals Be Detrimental?

If a person’s curve is rigid, there is only a certain amount of change that scoliosis brace correction can achieve. The primary goal then becomes to prevent progression – not necessarily to obtain 50% correction. If the contact points are increased, becoming a force on the body with the goal of more correction to a curve that cannot be reduced, and the body cannot move away from this force, Wolff’s Law comes into effect. 

Wolff’s Law states that your bones will adapt based on the stress or demands placed on them. Bones will bend or flatten under force. As a result, the patient’s rib cage can become flattened, and skin may break down or bruise. The deformity is permanent and visible. 

Unfortunately, I see this often. As you might guess, it occurs in the most compliant scoliosis bracing patients – those who wear their brace all day and through the night, doing their best to help avoid potential surgery and improve their self-image. 

Patient getting a Scoliosis brace

Often, these patients come in for a consultation because their current brace is not achieving the correction they hoped for. After evaluating and finding that the curve is rigid, I explain that further scoliosis bracing will not be able to correct a rigid spine and that our goal should not be 50% correction. I help them set realistic expectations, such as improving the body’s balance, working on “perfect” posture, preventing progression, and avoiding surgery.

In addition, if one curve gets overcorrected without controlling the rest of the spine, scoliosis moves either up or down, creating a new curve that may be much more difficult to treat — or worse, goes unidentified.

Finally, if there is an overcorrection of the curve, the vertebrae can over-rotate and cause imbalances and compensatory movements, creating a new problem.

Patients with a flexible spine could see 50% in-brace correction or much more – this is because we can more easily unwind and elongate the spine. Of course, this depends on flexibility, compliance with scoliosis bracing, and the person’s bone maturity. 

My Final Conclusion on 50% In-Brace Correction 

We have found that depending on the flexibility of a person’s spine, bone maturity, and compliance with the brace, correction will vary from person to person. If a person’s body is forced to move in a direction that is unavailable, it will find ways to compensate. So it becomes imperative that Orthotists evaluating patients for scoliosis are well-educated and experienced. 

The human body changes tremendously during adolescence, but the brace does not. Custom scoliosis braces can only accommodate a certain amount of growth/change. Rigo-Chêneau braces can accommodate 2-3 inches of growth and approximately 15 lbs of weight change. Most thermoplastic scoliosis braces have a similar range. Follow-up appointments every three months will allow the Orthotist to evaluate how the body has changed within the brace and ensure it fits appropriately.

I find it upsetting to think that patients could be left with a permanent disability or worsened adult scoliosis due to a lack of knowledge or following the “standard” of yesterday. As clinicians, we have learned so much about bracing for scoliosis and continue to learn more over time. 

The most important thing we can do is continue learning, think outside the box, and measure our outcomes. Devoting time to researching is crucial to developing better orthoses for our patients that provide them with the best possible outcome.

After reading this article, please feel free to reach out with any questions or comments. I truly enjoy hearing from readers. I can be reached at julie@scoliosistherapycenters.com.

Julie McCulley

So many times, I think back to my adolescence and I’m reminded of the day I was diagnosed with scoliosis. I was called to the nurse’s office for my physical. When I stood up, she said, “Do you know you have scoliosis?” She sent me home with a piece of paper for my mom. When my mom read it, her eyes bulged out. I got a sinking feeling in my stomach. 

How could there be something wrong with my back? 

My Scoliosis Diagnosis

I asked my mom what scoliosis is, and the nurse said my spine is curved and we must have a doctor look at it. This, of course, raised a few questions that I still haven’t found all of the answers to as an adult with scoliosis: First, how could my spine be curved, and I do not know it? And why didn’t my parents notice it?

I was in disbelief. I immediately went to the bathroom to look in the mirror myself. Nope, my spine is not curved. I was convinced. A few days later, my mom took me out of school early, which was terrible. I did not want to tell other kids I was going to the doctor for a scoliosis diagnosis – doing so would undoubtedly make them think there was something wrong with me. At the doctor’s office, the nurse came into the room and asked me to put on a gown.

Woman getting scoliosis diagnosis

Then the doctor came in, asked me to bend forward and explained that he agreed with the school nurse: I have scoliosis. He explained that my spine is curved, and I would need to wear a Wood Cheneau Rigo brace 16-20 hours a day for the next four years, as well as take part in physical therapy, or the condition could get worse and require surgery to fix. The ultimate goal was to achieve a target 50% in-brace correction. 

But how could it all be? I don’t have any pain. Am I going to have to wear this WCR brace thing at school? What if people see it? How could the scoliosis get worse if I didn’t even know it was there in the first place? I had so many questions. 

My mom and I got back into the car and she asked if I wanted lunch before returning to school. I calmly said that I was not going back to school that day or ever again. And then I began to sob uncontrollably. She tried to calm me down while we drove but agreed I could go home for the rest of the day.

The Scoliosis Bracing Therapy Experience

Two weeks later, we had to go to a place for me to be measured for a brace. This was not fun, either. I had to lay on a freezing cold table while this man called an Orthotist wrapped me in plaster. Then he took about 100 measurements and said he would call when the brace was ready. A few weeks later, we went back, and I held back the tears while he helped me put it on for the first time. I could not even bend or move in it.

The advantages of wearing a scoliosis brace seemed pointless if I had to wear this horrible thing to school. Just thinking about it gave me anxiety. I immediately came to the conclusion that wearing a WCR brace would guarantee that I would never make any friends. And forget ever having a boyfriend! 

A Scoliosis Brace: Who Needs It?

For a while, I refused to wear the WCR brace to school altogether. From what I remember, it was not because the scoliosis brace was uncomfortable – I just decided that without pain, I did not have a reason for it. The doctor was disappointed when my mom told him I refused to wear a Wood Cheneau Rigo brace. He said even if I did not need surgery that I may have pain when I got older. I did not believe that. If the diagnosis did not bother me now, how could it bother me later? 

Man with back brace in bed

Boy was I wrong. Despite being a 45-year-old woman today, I feel like I’m 80. I have a tremendous amount of pain in the middle of my back every day. I cannot tell you what makes it hurt worse or feel better; it is different every day. 

Don’t Make the Same Mistake – Wear your Scoliosis Brace 

I wish I could go back and talk to my younger self and tell that 12-year-old to wear the scoliosis brace. My scoliosis curve has progressed significantly since my initial diagnosis. I began doing a physical therapy called Schroth Therapy about a year ago along with wearing a WCR brace at night. 

The combination of the two effective scoliosis treatment methods have helped me to be able to walk further and be more active – and overall, I have less pain. But I still often wonder what things would be like if I had known the long-term effects of scoliosis bracing and just worn the brace like I was supposed to. Maybe I wouldn’t have any pain at all. 

If I Could Give Advice to Kids, I Would Tell Them the Following:

  1. A diagnosis of scoliosis is not your fault.
  2. Cooperating with Rigo-Cheneau bracing and physical therapy for a few years has the power to improve the rest of your life.
  3. I thought my peers would make fun of me for wearing a scoliosis brace. There’s no promise that they won’t, as there are some really mean people out there. But at the end of the day, if kids make fun of you for receiving the scoliosis treatment you need to live a pain-free life, they are not worth your time.
  4. Scoliosis is not a disease; it is simply a condition that requires treatment.
  5. Getting fitted for a Wood Cheneau Rigo brace is nowhere near as bad as it used to be. In fact, I recently learned that 3D scanners are now used instead of plaster. I went to a local Orthotist to see what it was all about. It is really a cool process – one that’s remarkable if you consider the history of scoliosis bracing treatments. 

Rigo-Cheneau bracing is a fundamental treatment for scoliosis that no child or adult can afford to skip over. Scoliosis Therapy Center helps connect individuals with the cutting-edge solutions they need to thrive. Avoid surgery and claim your best life by contacting us today.