Living with a Brace

A rigid brace is worn under clothing, and for full-time braces that means most of the day and often the night too, coming out mainly for washing, sport and swimming. It takes a little time to get used to a firm jacket around the trunk. Most young people find that clothes a size larger, seamless vests worn underneath to protect the skin, and a settling-in period of gradually increasing wear all help. Skin can get sore where the brace presses, especially at first, and this is worth reporting, because an orthotist can adjust the fit. With time, wearing the brace becomes part of the routine rather than a constant preoccupation.

It would be dishonest to pretend bracing is only a physical matter. Studies using scoliosis-specific quality-of-life questionnaires show that a majority of young people feel some psychological or social impact from wearing a brace, with self-image and everyday activities the areas most affected, and that this burden does not simply fade with time. These feelings — self-consciousness, frustration, wanting to be like everyone else — are completely normal and should be taken seriously, not brushed aside. Talking about them, with family, with the team, and sometimes with others going through the same thing, genuinely helps. Acknowledging the difficulty openly tends to make it easier to carry.

A brace is not a reason to stop living an active life. Young people in braces can and should stay involved in sport and activity; the brace usually comes off for vigorous sport and swimming, and staying active supports both physical and emotional wellbeing. Keeping up friendships, hobbies and normal routines is part of getting through treatment well, and I actively encourage it.

Here is the part I never soften, because it is the most important. The evidence — above all the BrAIST trial — shows a direct relationship between the hours a brace is actually worn and how well it controls the curve: the more it is genuinely worn, the better it works. Objective sensor studies also show that real wear is often lower than families realise and lower than young people report, not through dishonesty but because a hard treatment is easy to cut short. This is exactly why support, encouragement and problem-solving around wear time matter so much, and why we sometimes use wear sensors — not to police, but to help. Every extra hour genuinely counts towards the goal of avoiding a bigger curve and possibly surgery.

No one should feel they are doing this alone. The orthotist can adjust a brace that rubs or does not fit well; the physiotherapist can help with exercises and posture; the wider team can offer advice on the emotional side; and other families who have been through bracing are often a great source of reassurance. If wearing the brace is becoming a real struggle, the answer is to raise it — there is almost always something that can be done to make it more manageable, and keeping the young person on side is far more valuable than any amount of pressure.

• —Weinstein SL, et al. Effects of bracing in adolescents with idiopathic scoliosis (BrAIST). N Engl J Med 2013. (PMC3913566)
• —Outcome assessment of bracing in AIS using the SRS-22 questionnaire. (PMID 16896864 / PMC2267629)
• —Quality of life and patient satisfaction in bracing treatment of AIS. (PMC6295031)
• —Influence of specific interventions on bracing compliance — systematic review including sensor monitoring. (PMC10490632)
• —My Orthopedic Brace Inventory (MOBI): a questionnaire to identify barriers to brace adherence in AIS. (PMC12227499)
• —Long-term effects of Milwaukee brace treatment on body image and mental health in idiopathic scoliosis. (PMC5825107)