Scoliosis is a three-dimensional spinal curvature often treated in growing patients with a brace, a non-surgical method designed to prevent the curve from worsening. The effectiveness of this treatment is closely tied to how consistently and correctly the brace is worn. Learning the precise method for applying and securing your custom-made orthosis is paramount to ensure it delivers the corrective pressure needed to manage the spinal curve. This guide offers practical instructions for properly putting on your scoliosis back brace.
Preparing for Brace Application
Prior to applying the brace, meticulous attention to skin hygiene and undergarment selection is necessary to prevent irritation and skin breakdown. The skin covered by the brace must be completely clean and dry. Avoid applying lotions, creams, or powders, as these products soften the skin and trap moisture, making it susceptible to chafing. Daily bathing with a mild soap helps remove sweat and bacteria, preventing skin problems.
A tight-fitting, seamless undergarment must be worn underneath the brace to create a protective barrier between the skin and the hard-plastic shell. The garment should be smooth and pulled down past the hips, as wrinkles can create excessive pressure points. While 100% cotton is common, specialized moisture-wicking fabrics or blends with stretch are often preferred because they keep the skin drier and are less likely to bunch up.
Before putting on the undergarment, inspect the brace for any signs of damage or sharp edges. The inner foam liner should also be checked for cleanliness, as perspiration can collect there. A clean brace and clean skin surface maintain skin health and maximize wearing comfort.
Step-by-Step Guide to Securing the Brace
The physical process of putting on the brace begins with a specific starting position, often sitting or lying down, depending on the brace type. For many common thoracolumbar sacral orthoses (TLSO), lying on your back is recommended. This position naturally allows the spine to elongate and helps the body settle into the correct posture within the brace. Once the brace is wrapped loosely around the torso, center it on the back, ensuring the spine aligns with the midline of the orthosis.
The brace should be positioned so the waist pads rest in the soft area between the hip bone and the lowest rib. This alignment prevents the brace from migrating up into the armpits or down onto the hips. For front-opening braces, alignment usually happens while lying down; for back-opening braces, it often occurs while sitting or standing.
The sequence for closing and tightening the straps is a precise instruction provided by your orthotist and must be followed exactly. A common method is to secure the middle strap first to hold the brace in place, and then work progressively outward or from bottom to top. Your orthotist will have made specific marks, such as lines or tension indicators, on each strap to show the exact tension required for corrective forces to work effectively.
Pull each strap until the buckle or Velcro aligns precisely with its designated mark, often requiring two or three adjustments to reach full tension. The goal is a snug fit that prevents shifting, but it should never cause sharp pain or restrict normal breathing. A brace worn too loosely will move and rub, leading to skin irritations and reducing the corrective force on the spinal curve.
Checking for Proper Fit and Alignment
After fully securing the brace, check for proper fit and alignment to ensure corrective pressures are applied safely. The brace opening, whether front or back, should ideally have parallel edges with a specific gap, such as the 4 to 5 centimeter space seen with a Boston brace. Check that the top edge rests comfortably without digging into the armpits and that the bottom edge sits correctly on the hips.
A well-fitted brace applies even pressure without causing sharp, localized pain. Confirm that your breathing feels unrestricted; difficulty inhaling or exhaling indicates the brace is too tight or incorrectly positioned. Inspecting the skin immediately after removing the brace is a required daily step to identify potential pressure points.
Minor redness where the brace applies corrective pressure is normal, but this redness should fade within about 30 minutes of removal. If an area remains red, bruised, or discolored for longer than 30 minutes, this indicates excessive pressure and requires an adjustment from your orthotist. If the brace feels crooked or causes persistent, significant discomfort, it signals misalignment or a growth-related change in fit that needs professional attention.
Removing the Brace and Daily Care
To remove the brace, the process is generally the reverse of application, requiring a gentle and controlled loosening of the straps. Fully loosen the straps before removing the brace from the body to avoid undue strain or skin friction. After removal, check the skin for any signs of irritation or pressure-related redness.
Routine maintenance is necessary to maintain hygiene and structural integrity. The hard-plastic shell and inner foam liner should be cleaned daily or several times a week, especially after high activity. A common cleaning method involves wiping the inside with a cloth using mild soap and water or a 70% isopropyl rubbing alcohol solution.
Rinse the brace thoroughly after cleaning to remove any soap residue, which could irritate the skin. The brace must air dry completely before being worn again; a cool-setting hairdryer can speed up this process. Weekly inspections should check the brace for signs of wear and tear, such as cracks, tears, or fraying on the plastic or straps, as damage may compromise support.