Bracing for Pain Management in Scoliosis
Bracing is NOT recommended for pain management in scoliosis, as it has no proven role in affecting pain or the natural history of the disease in skeletally mature patients, and its primary indication is curve progression prevention in skeletally immature adolescents with flexible curves under 45 degrees. 1
Primary Indication for Bracing in Scoliosis
Bracing is indicated exclusively for skeletally immature adolescent patients with idiopathic flexible curves less than 45 degrees to prevent curve progression, not for pain control. 1
The goal of bracing is to arrest curve progression during growth, potentially avoiding surgery entirely—this is fundamentally different from pain management. 1
Low quality evidence demonstrates that rigid bracing increases success rates (preventing curves from progressing to 50° or above) at 2-3 years follow-up compared to observation. 2
Evidence Against Bracing for Pain in Scoliosis
In skeletally mature adult deformity patients, bracing has almost no proven role in affecting the natural history of the disease or managing symptoms. 1
Very low quality evidence from prospective cohort studies shows that quality of life, back pain, psychological issues, and cosmetic concerns do not differ significantly between rigid bracing and observation in the long term (16 years). 2
Mild scoliosis is usually asymptomatic, and while it may contribute to musculoskeletal back pain, there is no evidence that it causes disability or functional impairment. 3
Critical Distinction: Lumbar Pain vs. Scoliosis Pain
The evidence you may be thinking of applies to degenerative lumbar spine disease, not scoliosis:
For subacute low-back pain (< 6 months duration) from degenerative disease, lumbar bracing reduces VAS pain scores and improves functional disability at 30-90 days. 4
However, this evidence cannot be extrapolated to scoliotic deformity, which has entirely different biomechanics and pathophysiology. 1
When Bracing May Be Appropriate in Scoliosis
The decision to brace should be based on curve magnitude and skeletal maturity, not pain:
Curves 20-40° in skeletally immature patients: Low quality evidence shows rigid bracing significantly increases success rates (RR 1.79,95% CI 1.29 to 2.50). 2
Curves 15-30° in skeletally immature patients: Low quality evidence shows elastic bracing increases success rates at 3 years (RR 1.88,95% CI 1.11 to 3.20). 2
Curves above 45° in adolescents: Very low quality evidence suggests very rigid bracing may increase success rates (RR 1.79,95% CI 1.04 to 3.07). 2
Important Clinical Pitfalls
Do not prescribe a brace for scoliosis based on pain complaints alone—this misapplies the evidence from degenerative lumbar disease to a structural deformity problem. 1
Bracing does not eliminate spinal motion, which fundamentally limits its utility as a pain management tool in structural deformities. 5
Extended brace use may lead to trunk muscle weakening and learned non-use, potentially worsening functional outcomes. 6, 7
If a patient with scoliosis has significant pain, investigate other causes (degenerative changes, muscle strain, disc pathology) rather than attributing it solely to the curve. 3
Alternative Approaches for Pain in Scoliosis Patients
Scoliosis-specific physical therapy has shown modest benefit for limiting progression in mild to moderate curves, though effects on quality of life were not demonstrated. 3
Address pain through standard musculoskeletal approaches: physical therapy, NSAIDs, activity modification, and core strengthening. 8
Reserve surgical intervention for severe cases (Cobb angle ≥40°) with documented progression, not for pain management alone. 3