The earliest known diagnosed case of scoliosis is visible in the mummy of the Egyptian pharaoh Tutankhamen. Hippocrates labeled scoliosis around 400 BC, using the Homeric word okoniow, meaning “to bend or to twist.” Later this term was changed to the Greek skoliosis, meaning crooked; either Hippocrates or Galen of Pergamon (130-200 AD) was credited with the creation of this new term. The earliest known forms of treatment involved traction, spinal manipulation, and crude attempts at bandaging or immobilizing the patient’s spine. These methods were universally unsuccessful, as they were based primarily on the theory that scoliosis was a dislocation or malposition of the bones.
In 650 AD, Paul of Aegina in 650 AD suggested bandaging with wooden strips, and 500 years later, Albukasis stated that “no one could cure curvatures to the side,” but generally very little consideration was devoted to the condition of scoliosis for almost several hundred years, until the time of Ambroise Pare (1510-1590). Pare was credited with developing the first organized system of orthopedic bracing. In order to stabilize the spine in an attempt to prevent the progression of the disease. The iron corset he developed in 1575 remained in use for over one-hundred years. Today, the braces used include the Wilmington brace, the Cheneau brace, the Milwaukee brace, the Boston brace (also known as a TLSO brace, which stands for Thoraco-Lumbo-Sacral Orthosis), the SpineCor brace, and the Copes brace.
The Boston brace was developed in the early 1970’s by Dr. John Hall and Mr. William Miller of the Boston Children’s Hospital. It is the most common form of the type of brace referred to as a TLSO, underarm, or low-profile brace. These types of braces tend to be less bulky than other examples, such as the Milwaukee brace, and consist of hard plastic components that are custom-molded to the patient’s body.
Another example of a TLSO brace is the Wilmington brace, also known as the DuPont brace. It was developed by Dr. G. Dean MacEwen in 1969 at the Alfred I. DuPont Institute in Wilmington, Delaware.
The Providence brace and the Charleston Bending brace are designated as part-time braces because they are designed to be worn only at night, typically for a period of 8-10 hours. The Charleston brace was developed by Dr. Frederick Reed and Ralph Hooper in 1979 and forces the patient to laterally bend to the convexity of the primary curve during the eight hours it is worn. The Providence brace is custom-made with a computerized system and does not create a position of lateral bending when worn, as with the Charleston brace.
The Milwaukee brace was the earliest modern brace, originally designed in 1945 by Dr. Walter Blount and Dr. Albert Schmidt of the Milwaukee Children’s Hospital, although modifications were made to it over the course of three decades until it reached its present design in 1975. Primarily used for thoracic curvatures, it consists of a plastic pelvic girdle connected to a neck ring via metal bars, against which additional pads are positioned depending upon the patient’s individual scoliotic configuration. The Milwaukee brace is the least commonly used brace today.
The Rigo-System Cheneau brace (or RSC brace, commonly known as the Cheneau “light” brace) was developed by Dr. Cheneau in France. It is usually made from plastic and is commonly used with the Schroth method of scoliosis rehabilitation.
The SpineCor brace is defined as a dynamic corrective brace, to be used in the treatment of mild idiopathic scoliosis ranging from 15 to 50 degrees, and worn for 20 hours each day. It may be prescribed in conjunction with a physical therapy program, commonly the Global Postural Reeducation (GPR) system. It uses elastic bands which may be affixed in a variety of ways to the trunk, pelvis, and/or thighs depending upon the patient’s spinal configuration, and may also involve the use of a shoe lift. The SpineCor brace was developed at the Sainte-Justine Hospital in 1992.
Another example of a dynamic brace is the Copes brace, developed by Arthur Copes. This brace uses a system of air bladders (technically called Pneumatic Force Vector Units, or PFVU’s), which are gradually inflated on a monthly basis. The Copes brace is used in conjunction with the Scoliosis Treatment Advanced Recovery System (STARS) developed by Arthur Copes.
The Scoliosis Activity Suit is not a brace but an actual therapeutic wrap similar to a neoprene brace that is wrapped around an individual’s body to trick the body into presenting a mirror image posture all day. No long-term research has been done on this brace and was created in the chiropractic field.
Until recently, chiropractic care for scoliosis patients has been effective only in treating the symptoms of scoliosis. However, in 2004 CLEAR Institute™ began implementing a protocol to help stabilize and correct the global spinal alterations caused by scoliosis. They continue today to be the leader in research and development in this field. CBP™ (Chiropractic BioPhysics) is following closely behind with less time consuming and similarly effective treatments. With very few chiropractors specializing in this field in the United State, there is a growing demand for this field to expand.
The Cobb angle is the gold standard used to measure the severity of scoliosis and is determined by measuring the angle between the top and bottom most tilted vertebrae on an Anterior/Posterior Thoracic X-Ray. The medical field recommendations, which have remained unchanged for decades, are an observation of the Cobb angle from 10 to 25 degrees, bracing from 25 to 40 degrees, and then a surgical consult for anything over 40 degrees. When a brace is prescribed its only purpose is to stop the growth of the curve. However, it is rarely effective and often causes many problems physically, mentally, and socially when worn for the recommended 23 hours a day.
When surgery is recommended a combination of metal rods, wires and screw are used to fuse segments of the spine and prevent them from moving. Unfortunately, this surgery can have many significant complications and negative effects. The typical results of the surgery include reduction of the lateral curves by about half. However, the important forward curves in the neck and low back, as well as the backward curve in the mid-back, are always damaged with this surgical “correction”. It is also important to understand that the improper lateral curves will slowly return over several years despite the metal implants. A chiropractic treatment protocol is a safer and more effective option for treating and stabilizing scoliosis while still maintaining spinal function and mobility.
Corrective Chiropractic currently provides chiropractic adjustments in conjunction with physical therapy, mechanical traction, and soft tissue management that will aid in the correction and stabilization of the patient’s spine. With training in both CLEAR™ and CBP™ methods, Dr. Bret Wickstrom has seen several scoliosis cases with a positive long lasting reduction in Cobb angles. The brilliance of these innovative chiropractors have made a difference in debilitating disease and have provided the knowledge so that many of Greenville NC can benefit from this type of chiropractic care.