Scoliosis management and the Charleston Bending Brace®
Many young people who learn that they have scoliosis feel concerned about the nature of this condition and how it might affect their lives. Often, they find comfort in learning that they aren’t alone; over two and a half million Americans today have been diagnosed with this very treatable condition. This brochure offers straightforward answers to some of the most frequently asked questions about scoliosis from patients, their parents and their friends. It also explains how the nighttime-only Charleston Bending Brace can improve this condition and how the orthotist can help patients best benefit from the brace. It probably won’t cover everybody’s personal questions and concerns. That’s why it’s best to speak with an orthotist (Brace maker) and the doctor who prescribed the Charleston Bending Brace.
What is Scoliosis?
Scoliosis is a condition marked by an abnormally curved spine. We don’t understand why, but girls are seven times more likely than boys to have this condition. Since we don’t know what causes scoliosis in most patients, it is called “idiopathic,” or of unknown cause. An x-ray can determine whether the curve is from side to side or “lateral,” which means on one side. Lateral curves, which range from very mild to more severe, may resemble the letter “S” or a long letter “C”. Some young people know about scoliosis from the book “Deanie” by Judy Blume, a popular author for teens. “Patty’s Last Dance,” from the Sleepy Valley Twins series, and “The Bravest Thing” by Donna Napoli also address scoliosis.
For decades scoliosis has been managed with braces (also known as orthosis) traditionally worn 23-hours per day. Bracing proved very successful for children or adolescents who began treatment during their most active growth periods up until the time they reached skeletal maturity. The Charleston Bending Brace, a more recent development in scoliosis management, now provides an alternative to 23-hour bracing.
What are the Benefits of the Charleston Bending Brace®?
Unlike most braces used to treat scoliosis, the Charleston Bending Brace offers a major advantage: It is designed to be worn at night-only (nocturnally), for eight to ten hours while sleeping. This frees the patient from any psychological stigma associated with 23-hour bracing while allowing the freedom to participate in normal daytime activities such as sports, dance, play, beach, water activities, etcetera. Compliance is better; parents and patients are happier.
How Does the Bending Brace Work?
The Charleston Bending Brace® introduces bending forces at certain specific locations on the patient’s spine. Directional bone growth occurs in response to stresses placed on certain pressure points. Over time, outside forces can be applied to manipulate the directional grow pattern of the vertebrae. To help explain the concept envision a crooked young tree being guided by poles and wires as it grows. After years of such “bracing” the tree eventually matures in a straight line on its own. Likewise, the orthotist custom designs a brace to create a mirror image of the spinal curve(s) of the scoliotic patient. The brace may, for example, work to “unbend” a patient’s left lumbar curve by creating a right lumbar curve. Spinal flexibility helps determine the degree of success by the CBB in unbending a curve.
Why is the Bending Brace Worn Only at Night?
Studies indicate that children and adolescents grow in response to the levels of Human Growth Hormone (HGH) in their bodies. The same studies indicate that HGH levels peak at night. We can conclude, therefore, that most growth occurs during sleep. The Bending Brace works on the principle that if the spine can be bent during the time of growth the direction of the spinal curve can be successfully changed as well during the peak time of growth – which is while sleeping.
How Long Must the Bending Brace be Worn?
It’s critical to wear the Bending Brace eight to ten hours each night, seven nights a week, until the patient’s skeleton reaches maturity. A doctor can determine from x-rays when an adolescent is approaching skeletal maturity.
What Determines if the Bending Brace Has Worked?
Bracing is considered successful when the doctor determines that the curve at skeletal maturity has not progressed beyond the degree when bracing began or there has been a slight increase in degrees and/or surgery has been avoided.
Will Scoliosis Curves Worsen Without the Brace?
There are five categories of curves and curve combinations. Each category has its own risk for progression. Since much remains today that we don’t understand about idiopathic scoliosis, we do know that some curves will progress in spite of brace treatment. With proper treatment, however, bracing frequently halts curve progression. Sometimes, in mild cases of scoliosis, a doctor may determine that a minor curve has not progressed enough to justify prescribing an orthosis.
Will the Charleston Bending Brace Prevent My Curve from Getting Worse?
Medical studies conducted in recent decades show the Charleston Bending Brace to be highly effective in managing certain kinds of scoliosis. In many curves, especially single curves under 35º either in the thorax (chest) or lumbar areas (between the pelvis and ribs), the rate of progression with this brace has been as low as that of any of the 23-hour bracing systems. In severe cases, however, 23-hours of brace wear may be indicated either by another brace protocol or a combination of day brace wear and a Charleston Bending Brace at night. Research on the brace continues today.
What Takes Place during Visits to the Orthotist and Doctor?
On the first visit, the orthotist gives a complete explanation about how the Charleston Bending Brace works and how it is tailored to the patient’s spinal curve(s). Also, the orthotist should encourage the patient and family to pose questions. Next he/she evaluates the patient’s x-rays and will take a series of measurements on the patient for use in fabricating the brace.
About two weeks later, the patient returns for a fitting of the Charleston Bending Brace, a procedure that takes approximately one hour. The orthotist will then trim and adjust the brace to ensure the best possible function and comfort. A snug fit is the most effective. The orthotist also will draw lines on the straps of the brace to help the patient remember how tightly to wear it. Shortly afterwards, the patient will receive the brace along with instructions on its use and wear.
Upon receiving the brace, the patient next visits the doctor for an x-ray of his/ her spine in the brace. The x-ray should display a dramatic decrease in the curve(s), indicating that the brace works properly. Once the doctor approves x-ray results, the patient may start wearing the brace that night.
Thirty days later, and every three or four months thereafter, the patient will return to the orthotist for further evaluation. About every four months, it is necessary to see the doctor, who will evaluate the status of the scoliosis. For convenience, these visits may be scheduled on the same day.
Will the Charleston Bending Brace be Difficult to Put On at First?
The Charleston Bending Brace should not be worn too tight at first. It’s best to allow a ten-day adjustment period, wearing the brace loose for the first few days and gradually tightening the straps each night. By the time patients reach the lines drawn by the orthotist on the straps, they usually feel reasonably comfortable in just a short time.
What is the Best Way to apply my Bending Brace?
Once a patient becomes familiar with the brace, it’s not too difficult to follow these steps:
- Apply the brace either lying down or standing up. Most wearers prefer to lie down, but it is equally acceptable to apply it while standing.
- Lie down to fasten the straps. Make them a little snug, but don’t tighten them yet.
- Wiggle around inside the orthosis to be sure that it feels in the right place. Then begin to bend your body in those places where you feel the brace pushing. For example, if it is pushing on the left side of your waist, move your waist to the right as if you are trying to move away from the pressure on your left. If the top of the Charleston Bending Brace seems as if it’s trying to bend you to the right, then bend your upper body to the right. Moving your body in the direction that the brace pushes, makes you more comfortable and the brace more effective.
- Tighten the straps, starting always from the bottom up. Tighten the bottom strap a little, the middle strap a little and then the upper strap a little. Then, return to the bottom strap and start all over again, and again and again, until you have tightened the straps to the lines drawn by the orthotist. It is very important to tighten the straps gradually and slowly. It may take as long as 30 minutes each night to arrive at the lines drawn on the strap. The goal is to tighten the Charleston Bending Brace to a point of maximum effectiveness, comfortably.
Is There an Adjustment or Break-in Period for the Charleston Bending Brace?
Yes. You have ten days to reach the lines drawn on the straps. Take your time and wear the brace loosely at first to accustom yourself to sleeping all night while wearing it. After a few nights, begin to tighten the brace a little. Each night afterwards, continue to tighten the straps a little more than you did the night before. Remember, the goal is to stretch the muscles and tendons of your spine slowly, gradually and comfortably. Recall how tight and uncomfortable the brace felt when you first went to the doctor’s office for an x-ray in the brace? After the adjustment period, it will no longer feel that way if you follow the instructions.
How Does the Patient Sleep in the Charleston Bending Brace?
A tight-fitting shirt worn underneath the Charleston Bending Brace, especially a long sleeveless cotton T-shirt that fits snugly and has no seams, makes a good choice. A shirt bought a little too small provides a snug fit. Garments that wrinkle or have thick seams may irritate the skin. A firm mattress that is turned often is best for sleeping. A soft mattress may be firmed inexpensively with a full-size piece of 3” x 8” plywood placed between the mattress and box spring. Sleeping on the back or stomach is the most comfortable position.
For a refreshing effect, patients who don’t normally shower in the morning may wipe their bodies with rubbing alcohol to remove skin oils and perspiration. The same cloth and rubbing alcohol can be used to clean the inside of the brace.
What is the Minimum Time to Wear the Charleston Bending Brace at Night?
The Charleston Bending Brace is designed to be worn during hours of sleep; optimum results are based on a minimum of eight hours per night, seven nights per week. If the patient sleeps longer, it is anticipated the brace would be worn longer. If the patient occasionally attends a sleepover, the brace may be left at home for that one night only. Sometimes, patients start to feel impatient or frustrated with having to wear the CBB seven nights a week. An effective way to arrest this feeling is to consider the much greater inconvenience of having to wear a 23-hour brace.
Does the Patient Have Any Other Responsibilities Between Visits to the Orthotist and Doctor?
It is important to realize that only one opportunity arises in a lifetime to arrest the progress of scoliosis and that time is when a young person is growing. The patients first responsibility is to wear the brace as instructed by the orthotist. Report any problems with the brace, such as pain, rapid growth or an inability to wear as directed. Be aware of how the brace feels. Keep track of any changes in measurements, height and weight. Most patients wear a CBB for a year or longer before outgrowing a brace. Regular visits to the orthotist are imperative to monitoring physical changes so that any necessary adjustments can be made in a timely manner. Patients who follow instruction on wearing the Charleston Bending Brace have every reason to relax with confidence knowing they are doing the very best that can be done for a positive outcome. It is not unusual to awaken in the morning a little damp with perspiration.