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Your brace, an “accessory” that makes you unique

Every era has its own fashion corset, you might say, if you think of the various ways, in which this particular garment has been used over the years.

First created in the sixteenth century, it has always been intended to enhance the female silhouette by the aesthetic canons of the times. Worn under clothes, it modified the shape of the body. It has undergone a continuous process of evolution to the point of becoming, nowadays, an actual item of clothing—a fashion garment that, again for aesthetic reasons, is deliberately left visible.

The well-known TV series Bridgerton, which features women in Regency-style corsets, has brought them back into vogue, so much so that, in the name of gender equality, male models are now even wearing them on catwalks. And, as we saw on the red carpet at the Oscars, corsets appeal both to Gen Z and over-60s celebrities, with Halle Bailey and Jamie Lee Curtis both appearing in Dolce & Gabbana ones.

Although the orthopaedic braces used in the rehabilitation treatment of scoliosis are created with a completely different function in mind, they, too, are worn to achieve a better silhouette. Indeed, one of their purposes is undoubtedly to improve the appearance of the patient’s back, as well as its health, of course.

Whenever we mention corrective braces, the initial response is always one of fear and dismay because the first image that springs to mind is that of some object that is impossible to disguise under clothes. We might think, for example, of the Milwaukee brace (now hardly ever used anywhere in the world), which even has a kind of chin rest that clearly can’t be concealed under clothing. However, thanks to research and continuous efforts to develop treatments that are the least invasive possible, the braces being produced nowadays are not only more and more effective as corrective devices, but also increasingly close-fitting and therefore impossible to see under clothes. One example is the Sforzesco brace, developed by ISICO, which is just as effective as casting.

Familiarity with these somewhat “awkward accessories” has grown in recent years as people are encouraged to regard them (whatever type they are) as objects that are just a part of everyday life and don’t need to be covered up. Actually, plastic braces now even exist that can be customized with different Thermo adhesive designs.

It’s a bit like the situation with glasses: frames have increasingly evolved, following fashion, and today the variety available is so great that there is something for all tastes, particularly eccentric styles. In this way, a person’s glasses are now a fundamental part of their style and identity. Their purely medical function has been combined with a strong aesthetic component, turning them into true accessories.

Similarly, dental braces have become increasingly customisable, and limb prosthetics, in part thanks to athletes, are now part of everyday life too. Indeed, many of those who wear them are happy to show them off as they are part of what makes them unique.

All these are examples of “awkward accessories” that are now a part of everyday life. And why shouldn’t this also be true of the corrective braces worn by young scoliosis patients?  

My next comments are aimed directly at those who wear braces or are about to start doing so.

Just like glasses, dental braces or limb prosthetics, a scoliosis brace should be seen, and treated, as something that sets you apart, but in a positive way, as something that is peculiar to you — something that makes you special, stronger and more self-confident, while also caring for your back. Although this might initially sound impossible, over time you really will come to see it as a strength.

You might think, “it’s easy for the physiotherapist to talk. They haven’t actually gone through this. We patients are the ones who have to wear these things, and only we can really know what it feels like.” 

Well, this is where, as a physiotherapist, I am able to draw on my own experience as a former patient. I lived with a brace for 7 years, wearing it full-time to begin with. And on the basis of that experience, I feel compelled to urge all youngsters who are embarking on, or about to embark on, this journey to use their brace and see it as a distinguishing feature, something to joke about with friends, something that makes you unique and will help you in your adult life (even though I realise that when you’re young it’s hard to think that far ahead).

Erica, former ISICO patient and now ISICO therapist

Twins with the wind in their sails

Mario and Giorgio, 18, are twin boys who have always shared countless passions. They were born and grew up in the Dolomites, close to Lake Garda, and naturally grew to love the range of adventurous activities offered by this spectacular part of the world. 

They spend their free time rock climbing or careering madly along paths on their mountain bikes. But their number 1 thrill is whizzing like torpedoes across Lake Garda, skimming its surface with the wind blowing off the lake in their sails.
Both boys had loved sailing ever since they were children. They were, in fact, already junior champions when they received the unwelcome news that they both had severe scoliosis, which was preventing their spines from developing normally.

In both cases, the curve was so marked that there was no alternative: the medical prescription was to wear the brace full time for the first year of treatment, meaning 24 hours a day.

It was immediately apparent that, with a brace on, one particular sailing action would be impossible: during rapid turns, the boys would not be able to squeeze along the bottom of the boat to pass under the boom.  

However, with the help of their trainer and the support of their sailing club, they found a solution: the boys were given a new boat to use together, one in which, due to its particular structure, the boom was positioned higher. 

Although, for this reason, the boys had to switch to a new category, they could continue training and competing successfully.

By the second year of the treatment, Mario and Giorgio were already permitted to leave their braces off for part of the day, long enough to start training and competing unbraced, thus entering other categories compete with other crews as well. 

In 2021, Giorgio and his racing partner Isotta were invited to be part of the Italian national team competing in the Youth World Cup in Oman. There, he attained an excellent eighth place and this, together with a third-place medal in the team event, more than made up for all the sacrifices he has had to make. Although Giorgio was brace-free when competing in Oman, both boys still have to brace up at night. As for us, we are proud to think that one of our Sforzesco braces has been worn not only during Giorgio’s free time and travels but also (when he was not competing) under his Italy kit!

Well done, lads, keep on chasing that dream: you never know, one day we might see you aboard the Luna Rossa winning the America’s Cup for Italy!

Can scoliosis be treated with exercises?

The answer is yes, and they are indeed fundamental, but sometimes exercises alone are not enough. Whether or not an exercise-based treatment is sufficient depends, above all, on the severity of the curves and the evolutionary potential of the scoliosis itself, which is partly determined by growth.
Therefore, exercises sometimes need to be combined with another treatment, such as bracing. Rigid  brace wearers always need to do specific exercises in order to minimse the side effects of the brace and maximise its corrective impact.
Patients prescribed the Spinecor wrapping system, a dynamic brace, do not need to do any specific exercises since this device allows movement and therefore guarantees the natural trunk muscle strengthening  that favours correction of the spine. 

Scoliosis treatment can be likened to climbing a mountain; a true climber is well aware that the path ahead of him will present obstacles, but he  is confident he will be able to overcome them in order to reach the top.
That is his goal and he is determined to achieve it, whatever it takes and however long it takes him, because he already anticipates the enormous satisfaction he will feel on finally reaching the summit .

The various treatment options can be seen as different steps on a ladder, where the lowest is the one that has the least impact on the individual, but is also the least effective; instead, the highest step represents the very most that can be done in terms of treatment, and the treatment that will have the greatest impact on the youngster’s daily life. 

The ideal therapy is one that allows the best possible results with the least possible impact.

The first step on the treatment ladder is simple observation; at this level the patient needs to attend frequent medical check-ups in order to keep the scoliosis monitored, and the physician needs to be ready to intervene if the need arises.
The next step involves exercises alone, which are sufficient to control scoliosis of mild and mild-medium severity.
At the next level, patients are offered braces consisting of soft bands, and then, if the condition warrants it, braces made of more or less rigid materials.

Sometimes parents immediately want a therapy that, in their view, gives greater guarantees of success, regardless of the impact on their child.
This attitude is generated by the mistaken belief that opting for  the most aggressive therapy will allow the worst outcome to be avoided, and also by the idea that bracing is more convenient .
To return to the metaphor of the mountain, this amounts to starting the ascent running, in the hope of getting to the top more quickly, but it is an approach that may see the climber paying a very high price in terms of his health and even ending up having to end his career early.

Since scoliosis is an evolving disorder, the treatment, too, needs to be constantly evolving: the best strategy is to be ready  to introduce timely changes in response to emerging needs.

It is important to see the treatment from a global perspective: a patient who starts off simply doing exercises, and does them well for a certain number of months, before then being obliged to wear a brace  will at least have avoided some months of brace wearing, which is certainly a good thing.
Changing treatment does not mean that the previous one was unsuccessful, it simply means that it has become apparent that a  stronger method is needed order to win the struggle (like an arm wrestling contest!) with the scoliosis.