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Lia_s_mom
12-14-2005, 01:48 PM
Hi,

What are the criteria for being through with the brace?

My daughter has been wearing a Boston brace for about 15 months now. She is 13, had her first period over two years ago. She has two curves, 40 on top, 37 below, and they have been stable and do not seem to involve much of a twist (OK, there's a term for that, but this was the simplified explanation.)

Today the doctor said he wanted her to keep wearing the brace for another four months. He didn't check her height for any change from the last visit, didn't xray the growth plates in her hand, just asked if she "seemed" to still be growing. We said no, because she has been very eager to get taller than I am, and has been measuring herself against me for months now with no change.

On our last visit three months ago, it sounded like the Dr. just wanted her to wear the brace a few more months as a "precaution." Now he's added four months on to that.

I understand that a brace does no good once you have stopped growing, but shouldn't he be measuring something to determine that? When we started bracing, he said that they like to have girls out of the brace by 700 days after the start of their first period, and we're way beyond that, too.

Is he being very reasonable and cautious? Are we being unreasonable because we believe that this decision should be based on some observable criteria, not just a hunch that she might grow some more?

I hate to put her through any more bracing if it is not going to be effective, but do now want to do anything that would increase the risk of surgery in the future.

Thanks for listening...

lelc2002@yahoo
12-14-2005, 02:27 PM
Hi Lia's Mom,
Just happened to read your post. I am 46 and wore the milwaukee brace in my teens. It must have been for 2 years or so. It is hard being that age & having that to deal with. My parents did not want surgery for me back then. I never was teased & always wore many a turtleneck to hide the brace at my neck--probably more cumbersome than Boston Brace?? Just let her know that time does go fast & she'll be free of it before she knows it. I know they kept me in it a few months longer at the end too but I did get several hours out of it a day at the end.....
Lynne C.

ihatescoliosis
12-14-2005, 05:14 PM
i got my period the day be4 my brace and i need to wear it till i am 14 and iam 11 and it is not fun i think they can take xrays to see how muck more she will grow

marmyte
12-14-2005, 05:45 PM
i think normally doctors judge by a child's risser sign (their growth plate)... i'm not sure on the exact criteria, i think my surgeon tried to protect me a little by not giving his reasoning when he told me to stop wearing mine (i had my first period when i was 3 months off my 14th birthday, stopped growing just before i turned 17 and wore my brace from when i was 14 until i was almost 16)

i'd be wary of the doctor seeming to use "guesswork" but you are correct to think that there comes a time when braces really cannot help to achieve correction or stability

ScoliMed
02-01-2006, 12:20 AM
The doctor should be using the Risser scale to measure growth. It ranges from 0 to 5, with a 5 meaning growth is complete. Be cautious that he reads them correctly, though, as an incorrect reading for me caused delayed treatment (he though I was almost done growing, when I was in fact only a Risser 2 and the curve progressed quickly). With a curve as advanced as your daughter's, he is probably being cautious because progression at this point could make her a surgical candidate. In that light, a few more months of bracing is nothing in the long run. It's rough, but it beats the alternative. I would ask him to check her growth, though, to be sure.

AILEA
02-01-2006, 03:23 AM
Hi, Liasīmum

They usually uses the Risser sign,and the brace must be worn since at least you get Risser 5. Recently Iīve read some articles and books, written by renowned doctors in Europe, who think that is a mistake to stop bracing at that point; There must be a carefull observation and the brace should be worn, perhaps not "full-time", for several moths or years. They suggest that even in those "post-Risser-5" years there is a risk of progresion in the curves, while there is a possibility for a little more grown.
It is hard to figth with scoliosis, cause itīs a long way and because of the brace, of course. But when you have been dealing with this for so long, a few more months is no too much, and they can help to keep the work your brace has been doing.

Take care

Ailea

scoligirl2025
02-04-2006, 02:27 PM
liasmom~ some doctors don't decide to check growth plates in the wrist because there are also growth plates on the hips. if you look at some of your daughter's xrays, you might see this rim of fluff going around the hips, starting on the outside and working its way into the middle. most doctors divide that rim into five sections and that's how the risser sign is determined- if there's no rim, then she's a risser 0 and still has lots of growing, and if the rim goes all around, then she's a risser 5 with no more growth. (i'm definately not a medical expert, but that's how my orthotist and orthopedist explained it to me)

i would ask your doctor about her risser sign, and ask for an estimate of when bracing will be over. most girls stop growing 2 years after their first period, but i know a girl who is a risser 5, but just got a brace because her curves are in the high 40s, and they want to take every precaution before going straight into surgery.

so..yeah, sorry for the long post! i would just say to ask your doctor for a few more specifics. and if you get the feeling that he really doesn't care, then perhaps consider a second opinion.

good luck!

Bamaro
02-07-2006, 12:29 PM
Generally a brace should be worn until the wearer stops growing.

gerbo
02-08-2006, 04:43 AM
i am sure i picked up somewhere that it is advisable to continue bracing, if only parttime (at night) for at least a year after the end of growth.

This does make sense to me as muscle strength / "core stability" will need building up after so many years of forced inactivity

Lia_s_mom
02-08-2006, 11:42 AM
Hi,
Well, we did check back with our daughter's doctor and his decision was based on the Risser sign. She's a 4, which I believe means that she is probably done growing but that the bone has not completely fused yet.

He wanted her to continue with the brace another three months. We've decided (on our own) to have her wear the brace at night, not to school at this point. Since it seems like more of a precaution, kind of like an orthodontic retainer, AND since our daughter was not likely to be very compliant (she can get out of that brace in about 2 seconds flat) this seems to us like a good compromise. We'll find out at the next appointment.

We're also continuing to encourage her to swim & bike & want to get her back into yoga. It seems like the doctors here are very focused on the bones, not very concerned about strengthening muscles. So we are working on that ourselves, because it seems that exercise is a very important part of having a healthy back.

I'm sure we'll get comment on this! :)

gerbo
02-09-2006, 02:34 AM
Hi,
We're also continuing to encourage her to swim & bike & want to get her back into yoga. It seems like the doctors here are very focused on the bones, not very concerned about strengthening muscles. So we are working on that ourselves, because it seems that exercise is a very important part of having a healthy back.



agree with above, might want to have a look a t this; (post i wrote before)


we are trying to replicate an approach as taken by a Dr Vert Mooney, i.e torsorotation against resistance (if you want to know more, go to www.medxonline.com, > medical rehab equipment >pdf downloads > "role of measured resistance exercises in idiopathic scoliosis". Whether you think his approach makes sense or not,(I do) at least it is an interesting article to read


we have been doing this for the last 4 months, and it surely hasn't done us any harm. I am aware of an orthopaedic consultant who is taking this serious enough to try to repeat the study to see whether he can replicate the results.

The beauty of this particular kind of exercise is that you can isolate the left and right paraspinal muscles, ensuring that they get equal exposure to exercise. Essentially, in torsorotation if you turn left, you use the left paraspinal muscles mainly and if you turn right you use the right. (I worry that in "general" exercise the stronger side might be more dominant, and thereby getting relatively stronger, causing further imbalance)

We found initially that left turning (towards the concave side) was weaker, that has now equalised. Whether this eventually will have a stabilising effect on the spine is impossible to say as there are so many other potential factors, still, it makes sense and that is why we do it.

gerbo

cherylplinder
02-11-2006, 06:19 PM
I am interested in this idea. SO are you saying that when you twist your body clockwise(that is what I think you mean by right), you strengthen the right, and counterclockwise(that is twisting to the left), you strenghten the left back muscles?
Do you do one side (convex) more than the other to begin with?

gerbo
03-10-2006, 09:43 AM
correct re counterclockwise=left, clockwise=right

note (in the article) it isn't just turning, it is turning against measured resistance in a very controlled way

it is actually the concave (hollow) side which we found was weaker, which fit in with what was said in the article, and also in other literature i have seen. We did therefor did initially do twice as much towards concave than towards convex side. We seem to have caught up now, and do equal to both sides, trying to build up number of repetitions and weight "lifted)

note, this isn't easy to do without the proper equipment, we did not have the medx available, (it is available in the US) which appears ideal for this purpose, and had to do with fairly ordinary torsorotation equipment

gerbo

The Slice
03-10-2006, 01:02 PM
Lia's Mom, I would encourage her to stay in the brace as often as the orthopedist says. There are stories posted about kids who were non compliant with their braces, and then forced to have surgery. I would think that having a conference with the Orthopedist re wearing it only at night will give you a good idea of whether this is "safe". Remember that the sequence of growth is the long bones first, and then the spine. She may still be at the point where she is still growing, but it is no longer a significant amount in terms of what can be seen or measured. To understand better what I am talking about, take a look at pictures of either a boy or a girl right around the time they have seemingly stopped growing (height wise), and then 3 or 4 years later. Although their height hasn't really changed, you can see significant changes particularly in their facial features, and sometimes even their body shape, which is more than just weight loss or gain.

Kate B
06-06-2006, 02:11 PM
hi! i had my brace for 4 years (from 10 to 14). i had an xray on my hand, like your daughter and i wore my brace for 6 months after they estimated i'd stop growing.
~kate

cherylplinder
06-08-2006, 05:15 PM
Hi Katy B,
What were your beginning and ending curves? My daughter is 10 and just started growing. Her thoracic curve is somewhere between 30 and 38. Last measurement was 30. Dec '05- 33 degrees, Jan '06- 38 degrees, April '6- 30 degrees. She has been in Spinecor since January. I don't know if it is measurement error with different docs or what.
One doc told us in April that surgery was a sure bet. I just wondered where you started and ended. Her hand x-ray indicated she has not begun her adolescent growth spurt yet.
Thanks,
Cheryl

drummergrl
06-09-2006, 09:40 AM
yeah, I've been in a brace for 8 years now, and my doctor is still saying I have to wear it. I've had my period for 3 year snow, but unfortunatly I grew 1/2 inch since March.... has anyone else been in the same boat?