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Season 1: Episode 11 - The Basics Of Bracing That Every Patient Needs To Consider

Season #1

In this episode, Dr. Mandy explains the basics of bracing such as:

  • The difference between casting and bracing.
  • Front closure bracing v. back closure bracing.
  • Rehabilitation plans and using a brace for physical fitness goals.
  • The most comfortable time of day to wear a brace.
  • How often you need to get a new brace.
  • What to wear under the brace for skin protection.
  • The types of braces we use in our office (it's not just a solution for scoliosis - bracing works for kyphosis and hyperkyphosis patients, too!).

Listen in to find out helpful tips and be sure to check out the links below for more information!

 

*****Resource Links You Need:

 

 *****Transcript*****

ā€ŠThe Basics Of Bracing That Every Patient Needs To Consider

Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Hi, welcome back. This week we are going to talk about the basics of bracing that every patient needs to know about. There's been quite a few questions and just some conversation regarding bracing, and we've covered this in the past a few years ago, but a lot of the protocols and different clinics have changed some of the things that they're doing with bracing.

And even in our own office, we're using bracing differently than we had 10 years ago. So I wanna go through just kind of the basics of: what is bracing, what do we use it for, and what does that look like. I know when patients come into my office, they have a lot of questions. Of course, this is typically something that they haven't been familiar with.

So unless you have a strong family history or you've been through that experience yourself as a parent and now bringing your child in, a lot of these things seem pretty foreign. So the things that I wanna talk about are, what does getting a brace look like? What are the steps involved in that? What are some of the different options and what comes along with it?

So we use bracing in our office. So the ScoliBraceĀ® is very specific. It's a 3D over corrective brace. We make that brace using 3D imaging, so it's an actual 3D image of your body, it's custom to you, and it's made in an over corrective way. What that means is it's very specific, so no brace is the same.

And even if you say had, you know, a thoracic curvature and the next patient has a thoracic curvature, your braces are going to look different because you and your body are different. So it's made specific for you and we have that shipped to us. We have you come in, we do a brace fitting, we tailor that brace, we modify it to make sure that it's more comfortable for you to wear as comfortable as it can be.

And then there's also a lot of other options. So parents that come in talking about brace options have shared some of the experiences that they've had at different clinics. And so I wanna talk a little bit about that because. Just because you have a hard brace doesn't mean that all of those braces are similar or the same, or function the same way.

And so some of the things that come up in conversation are patients that go in, they get casted for braces, so it's like a plaster casting that they'll do at different facilities and then they make a brace off of that casting. Most of the time, then once you get that brace, they'll add some different padding inside of it and things like that.

Sometimes they'll use measurements. So I've had some patients where they've not had to do the, the plaster casting, but they've laid down and, you know, straightened their spine as much as they can. They've taken different measurements on their body and then they've formed a brace based off of that.

And then I have had some patients that have had like the 3D scan in different facilities that have had braces made off of those as well. So a lot of the ways that the brace is utilized and made for a patient is dependent on the provider that's making it. So, for example, you know, if you're casting a patient or if you're doing measurements on a patient, you know, those are a little bit more subjective, so everybody does it a little bit differently.

So the consistency can be a little different depending on, you know, if you're seeing different people when you go or how they're trained or the different types of ways that they may do it in their own facility. And then in addition to that, depending on how they utilize that brace once it's there.

So I'm going to speak mostly about what we do in our office. But all of those are different scenarios that I've heard families and patients talk about, that we've actually seen and, and talked and worked with different, orthotists and rehab people and things like that as well. So some of the questions that come up is about the closure on the brace.

So the majority of our braces that we use, we've actually only had front closure braces in our office, which means that on the front of the brace you've got some Velcro straps. You've got a little guide that goes in and you put the brace on, and then it closes in the front. That way you can take it on and off.

You're able to maneuver that if you need to loosen it after you eat or if you need to. Take it off to use the restroom, things like that. I do know that some braces, they have it close in the back. Those are braces that sometimes, you know, depending on how that works, parents have talked about, um, you know, having to assist to get the braces on and off, which if you have small children that don't wanna wear their brace, obviously that can be a benefit because they might not be able to just whip it on and off and take it off when you're not paying attention.

But it can also be a hindrance too, because if you have a lot of trouble getting it on and off, especially if kids are at school, that can be something that can affect their compliance and whether or not they wear it. So the majority of our braces, when you're coming in, we have front closures. So the brace opens up, you put it on, you, Velcro it shut, and you're able to change that as you need to throughout the day.

So in our braces, so ScoliBraceĀ®, you'll take those braces off when you're active. And so that means anything like, you know, volleyball, basketball, running, if you're biking, you know, any sort of active time swimming, you know, we want you to be active. We want you to be strong. The only time that we have you wear a brace when you're being active is if we're incorporating that into a rehabilitation plan.

And that can actually be really beneficial. But we use it in specific ways and it wouldn't be all of the time. So, for example, I just actually had an athlete come in my office this week and one of her main goals is to be able to continue running and to be able to prevent injury. So we talked about utilizing a brace that corrects her spine, hold her in her correction, but then doing some of those core stabilization exercises.

So she's actually strengthening her body in a corrected position so that she can maintain her strength and help prevent injuries when she doesn't have her brace on. And so sometimes we'll utilize that, even as adults. Um, I've had adult patients that one of their goals would be to, you know, run, run, jog, a half marathon.

And so part of her training would be that we would do part of the walking part of the jogging, in her brace, either on the treadmill. Or down the road for the first mile or two to get her body moving and, and strengthening in those movements in her corrective brace. And then obviously, you know, she's not wearing her brace for a 10 or 13 miles, but once she worked that into her routine, then she would take her brace off and she would complete her training after that.

But that was really helpful to be able to help her body stay in that corrected position and get the maximum benefit of the brace. But essentially you get the time out of the brace to be active. Most patients actually say that sleeping in it is the most comfortable time, which surprised me as a provider.

Obviously I haven't worn a brace, so I'm not exactly sure what it would be like to sleep in it myself, but a lot of the patients that I work with say that the easiest time to wear the brace is when they're sleeping. It takes a little bit to get used to, but over time, that's probably easier because there's not gravity, we're not standing up.

And when you're lying down, your curve's reduced. So it's probably more comfortable. So once you get used to actually having the brace on, the sleeping time can be the easiest time to wear it. The other things that have come up over conversation is how often do we need a new brace? And so obviously that answer depends on the circumstance, but, generally speaking, I'll kind of break it down into like juveniles, adolescents, so like kids that are growing, usually 12 to 18 months you'd have a new brace if somebody is growing really quickly. I did have a couple of patients that needed a new brace, but then 10 months, but they had hit a massive growth spurt, so they had grown a lot in that period of time.

But for the most part, generally 12. 13, 14, maybe 15 months. As long as the brace is still doing what we want it to, you'll get at least a year out of that brace and then potentially, you know, need a new one depending on where your child is at for growth. Now, for adults, that looks a little bit different and it's dependent on what our goals are, what your goals are, and what clinically our goals look like.

I've had some adult patients that have had their braces for three, four years. Over time, they do start to break down. You know, they're made out of materials that aren't meant to sustain 10 years, right? So the material will get a little bit weaker the longer that you wear it, the more that you use it.

But I've had some patients that have gotten a really long life out of their braces. And then in other times too, if we've got a really specific goal, for example, we've got some braces that are made specifically for adults that have a hard time standing up straight. So you've probably all kind of seen people, whether it's at the grocery store or Walmart, where they have to hold onto a cart and try to hold themselves up and push themselves up.

If we've got an adult that is using a brace for that situation, sometimes even in a short period of time, say 12 months or 15 months, we may get really great results and that patient may not need that specific type of brace anymore. And then we might build another brace that may address, say, for example, their scoliosis or some other spinal condition, that was kind of secondary to our original goal. And so sometimes we'll build an additional brace depending on what we're working on.

The other conversation is about skin comfort. What do we wear underneath our brace? What does that look like? The braces that we provide in our office, it comes with two shirts that are underneath their skin tight.

They don't have any seams, and they've got little flaps for underneath your armpits that help protect your arms and your skin from the plastic on the brace. They're a material that really helps wick away sweat and mostly really comfortable. I have a few patients that may not like the feel of them, kind of like a sensory problem, where they feel like it feels too much on their skin and so they might choose something else.

But essentially, as long as you're wearing something under the brace that is relatively skin tight and doesn't have a bunch of seams, that works really well underneath those braces to help protect your skin, make it a little bit more comfortable, make it easier to get the brace on and off. One thing that can make it extremely difficult that I've seen in a couple of, you know, younger kids where if they like to wear, say a t-shirt underneath their brace, sometimes that cotton and then it's looser, it'll get kind of balled up around their sides or like maybe underneath their armpits. And there's two things that happen with that.

First of all, it makes it hard to get the brace in the correct place because there's a lot of material that bunches up underneath the brace. But then also if it's, bunched up and like overlaid on each other and then the brace puts that pressure on your skin, you can actually get skin irritation in through there, which can make the skin red and make it itchy. And if it's there long enough, can actually open up the skin a little bit. So we don't recommend big, bulky things underneath the brace, but something more tight fitting. And so a lot of patients will find their own shirts, their own things that they wear underneath that.

So those are kind of the basics of, you know, when we're talking about braces, those are the big things that seem to come up in conversation. But then also, the feel of the brace, how different braces are made, and then the types of braces that we have. So in our office for ScoliBraceĀ®, we use braces for a lot of different things.

Most of the patients that come in, they're diagnosed with a scoliosis, and so we have a ScoliBraceĀ® that we use that addresses a scoliosis. There are quite a lot of patients that have what's called a hyper kyphosis, so that front to back curve. So, people that have too big of a curve where they're bending over in the front.

We also have what's called a Kypho brace to help hold them up and hold them straight and reduce that curve. So that's different than a scoliosis brace. We do sometimes have patients that both have a hyper kyphosis and they also have a scoliosis. And so we have a hybrid brace that we can use for that.

And so each brace has its own intention. The same when we were talking about adults having trouble standing up or maybe their weight is too shifted forward. We have a brace that helps to hold them up and to help give them support so they can stand up straight and they can function and move and walk in a better way.

So they're each specific to their own condition, their own diagnosis, the patient, and it's custom made for the patient. So we can really tailor that in and we can really get that to a place that's helpful for the main goals that we have with that patient. Now, there are a lot of conversations about braces and comfortability. So, as you can imagine, it would be the same as if you are going to the dentist and then you need to go to the orthodontist, right? If you get braces on your teeth, when they initially put them on and they initially tighten them, they don't typically feel the best because they're actually moving your teeth right.

But over time, you start to get used to them and then you might go in, have your braces tightened again. It might be a couple of days of not feeling the best, and then you know, you get past that. So think of scoliosis bracing in a very similar way. So when we are making a custom 3D brace for ScoliBraceĀ®, we're making that brace over- corrective because we actually want to get correction in your spine, meaning that if you've got a 30 degree thoracic curve and a 25 degree lumbar curve, when you get that brace on, we want to bring those curves down so we're not just holding it in that position. We're actually gaining correction when you have the brace on. And then based off of that assessment and that correction, so once you've had the brace on for 30 days, we do an x-ray of you in the brace. See where we're at with our correction, make sure we don't need to modify anything, and then we base our goals of correction off of that.

But we're always aiming for correction, not just keeping you in the same place. So of course with that, when you get a new brace, there's going to be a period of time just like with braces on your teeth where it doesn't feel the most comfortable, but as you wear it and you wean your way into it full-time or part-time or whatever that might be for you, your body starts to get used to it.

Your posture starts to settle into it and it gets easier. And that's where when we're talking with parents oftentimes. We'll, notice that, say for example, we had a family that went and they were casted, so they did the plaster casting and they were fitted with a brace. And when they came back, you know, one of the things they said, they were like, oh yeah, this is way more comfortable.

They can wear it. It doesn't bother them. They have, you know, zero symptoms they can put it on. It's like they're not even wearing anything. And upon further assessment, what we realized was, is that that brace wasn't actually changing anything in the spine. It was simply holding them in that position, which makes sense why it was way more comfortable, but it also wasn't doing, at least from a corrective standpoint, it wasn't doing a good enough job to actually correct the spine and hold it in correction. It was simply holding it in the hopes of it not getting worse. So, when we're talking about bracing and that conversation comes up about whether you have soreness or stiffness or you're getting used to that.

Um, and the comfortability. We obviously try to make our braces as comfortable as possible, and most people, once they're used to them. It's no big deal. They put it on, they take it off, they can sleep in them. They can, you know, walk around, go to Walmart, go to Target. Oftentimes, you know, they can even sit in a car for them, you know, as a passenger for a short period of time and not have any issues.

It's just about getting used to it. So that's a big conversation to have when you're talking about braces and what the intent is. And then also too is to make sure that anytime you are dealing with a brace, that they're doing an brace assessment and an x-ray. To make sure that the brace is doing what we want it to do.

So is the goal just to hold it where it's at and prevent progress, you know, prevent it from getting worse? Or is the goal to correct it to actually get correction and try to reduce the curve in the spine and then whatever that goal is, is the brace doing what we're -hoping it will do? And if not, then what do we do with that?

So it doesn't matter the provider that you're seeing. Some of the questions that you can ask them are related to this. Like, what type of a brace -does it open in the front or the back? You know, what are you going to give us that they can wear under it? And then in addition, our braces have, it's a called an eye button, but essentially it's a wear monitor.

So it's this little button that goes in the brace and based off of temperature, it tracks the time that you have the brace on. And this is huge for our patients because oftentimes what we perceive, the time we're wearing the brace and what the actual time is, is different because we get busy in our day.

And so we may be, you know, estimating we're in a brace maybe 16 hours a day, but in reality it might only be 12 hours a day. Or you know, we've had some, somebody that, they're really busy, they're in sports, they're in school, and they're like, gosh, like I really think I'm wearing it 12 hours a day. And then we come in and we pull the monitor, and they're averaging only about nine hours a day. And then when we walk through the reports and we kind of look at the weeks, they're like, oh gosh, yeah, that makes sense. You're right. I am only wearing it for nine hours a day. So that is a huge part of something that we use in our clinic that is really beneficial because we can accurately get the data for how much time you're wearing your brace, and that's really important to know so that we can set realistic goals for what you're going to get out of that brace.

And I don't know right now, I haven't heard of any other facilities that have been able to provide that resource to their patients. I might be wrong in that, but so far I haven't heard of any. But those would be questions that, you know, I would be talking to with your provider as far as, you know, how do they fit their brace?

What does that brace gonna look like? Do you have an ability to track the time that they wear it? What kind of things do you provide for them to wear underneath that? Do you take x-rays? And if you do, at what point in time do you do that? And then based off of those, how do we change the brace moving forward?

So those are kind of like the nitty gritty details of the brace and how it functions, how we make it, what we use it for. Next time we're on, I'm really gonna be diving into the art of bracing. And essentially what that means is. We have bracing and there's some very, you know, set in stone protocols, but there's a whole lot of places in between that, in that gray area that we can use bracing for that's really helpful. And as we've been doing this over the last 10, 11 years, we've seen some really great results in areas where maybe a brace wouldn't have been used previously, and we've had some really great success with that. So the next time we're coming in, we're gonna be talking about that, what that means for you, what that could look like, and just different opportunities that you have.

So until then, you can find us on our social media. We've got our websites linked below. Have a great week, and we'll talk to you next time.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.