Bracing for Adolescent Idiopathic Scoliosis and Hyperkyphosis

When a child or teenager is diagnosed with Adolescent Idiopathic Scoliosis (AIS) or Hyperkyphosis, one of the first treatment options often discussed—especially during growth spurts—is bracing. While hearing that your child needs to wear a brace can feel overwhelming at first, understanding the purpose of bracing and what to expect can help you navigate the journey with confidence and clarity.

What Is Bracing?

Bracing is a non-surgical intervention designed to slow or stop the progression of spinal curvature during periods of rapid growth. It involves wearing a custom-made orthopedic brace that fits snugly around the torso and applies 3D corrective pressure to the spine.

For children and adolescents with scoliosis or hyperkyphosis, bracing does not "cure" the condition, but it can prevent worsening to the point where surgery becomes necessary.

Over the past couple of years scoliosis has become more understood, and with this understanding has come the innovation and development of different brace types and models. This can cause some confusion, as each brace comes with unique benefits suited to different curve types and presentations. We therefore recommend you consult with your therapist to ensure you choose the best type for you! 

When Is Bracing Indicated?

Bracing is most effective during skeletal growth, which is why it’s often recommended for children and adolescents.

For Scoliosis:

Bracing is generally indicated when:

• The Cobb angle is between 20° and 45°, and

• The child has substantial growth remaining, often indicated by a Risser sign of 0–3 or pre-menarche in girls

• While awaiting surgery to prevent progession and allow for the spine and torso to grow before surgery is considered

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According to the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), brace wear significantly reduced the risk of curve progression to the surgical threshold (≥50°) (Weinstein et al., 2013).

For Hyperkyphosis (e.g., Scheuermann’s Disease):

Bracing is recommended when:

• The kyphotic curve exceeds 60–70°, and

• The patient is still growing.

Studies have shown bracing can reduce kyphosis angles by up to 15–30 degrees in motivated patients who are compliant with wear time (Rigo et al., 2003).

What to Expect When Wearing a Brace

1. Fitting and Customisation

After diagnosis, a specialist (usually an orthotist) will take a 3D scan or cast of your child’s torso to fabricate a brace that matches their body and curve pattern.

2. Wearing Schedule

Most treatment plans recommend 18–23

hours per day, removing the brace only for:

• Bathing

• Physical therapy or sports (as directed)

• Specific social or psychological situations (when deemed necessary)

Full-time wear provides the greatest chance of treatment success.

3. Physical and Emotional Adjustment

The first few weeks are often the hardest. Children may experience:

• Discomfort or skin irritation

• Self-consciousness, especially in social or school settings

• Limitations in wardrobe choices

However, with support and gradual adaptation, most children adjust well. Many braces are low-profile and can be hidden under clothes.

4. Monitoring Progress

Bracing requires close monitoring:

• Regular follow-ups with an orthopedic specialist

• Periodic X-rays to assess curve progression

• Adjustments to the brace as the child grows

Supporting Your Child Through Bracing

• Physiotherapy: Bracing in conjunction with physiotherapy has been recommended as best practice when treating a growing spine with scoliosis (2016 SOSORT -Society on Scoliosis Orthopaedic and Rehabilitation Treatment), through actively strengthening the  postural muscles, helping to maintain posture when the brace comes off.

• Normalise the experience: Connect with other families or online communities.

• Encourage compliance: Bracing only works if it's worn consistently.

Final Thoughts

Bracing for scoliosis or hyperkyphosis can be a life-changing intervention—one that can help children avoid surgery and preserve spinal function into adulthood. While it presents some challenges, with education, support, and a personalised approach, most families find that their children thrive despite the temporary inconvenience.

References:

1. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine, 369(16), 1512–1521. https://doi.org/10.1056/NEJMoa1307337

2. Rigo M, Villagrasa M, Gallo D. (2003). A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis, 5(1), 1-9.

3. Katz DE, Herring JA, Browne RH, Kelly DM, Birch JG. (2010). Brace wear control of curve progression in adolescent idiopathic scoliosis. Journal of Bone and Joint Surgery, 92(6), 1343-1352.