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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

Isico Alliance, excellence in spine

Isico’s goal has always been to promote the best therapies for the treatment of scoliosis in the world, and it is precisely from this idea and to give proper answers to the requests we periodically receive that we founded the Isico Alliance.

“ISICO stands alongside the ISICO Alliance Centres to support applying proper braces, organising new activities, and providing better care to their patients—explains Fabio Zaina, physiatrist and one of the project coordinators — taking advantage of the experience and ongoing innovations ISICO realises day by day. In fact, ISICO services mean excellent care for patients and an excellent approach for the centre.” 

There are several advantages from which an Isico Alliance centre can choose, from brace delivery, ISICO takes care of the entire production cycle of the prescribed brace in the workshops in Italy, to brace design, ISICO gives its assistance in designing the brace that will be produced on-site, from the training of a local orthotist to equip them with the skills necessary to manage the entire process of SPoRT (Symmetric, Patient-oriented, Rigid, Three-dimensional, active) braces production, to the opportunity to organise periodically SEAS courses in the local area, up to the use of the best technology for best care thanks to ScoliosisManager, the software developed by ISICO providing a uniform data collection protocol. Other optional services available are the ISICO iOS-Android app featuring specific functions for patients and ISICO practitioners, and Telemedicine services delivered to local patients directly by ISICO for complex or particular cases.

Do you wish to join the Alliance, or do you want to ask for more information? Please visit the websitehttps://isicoalliance.com

Isico launches the second edition of the Sforzesco Course

After a first edition, organised in 2022, that saw participants from 13 countries worldwide, Isico is launching the second edition dedicated to the deepening and construction of its Sforzesco corset.

The combination of theoretical lessons presented by the Isico experts and the practical instructions given by the CPOs who collaborate with Isico are the winning points of this course, which recaptures the knowledge gained over 20 years of clinical practice with more than 10,000 patients wearing our Sforzesco braces.  
This second edition is entirely self-administered by the participants, and you can enrol at any time, without a deadline.
A live lesson will be held in December to summarise the material and address participants’ questions.  

Why joining? According to one of the participants in the last edition: “This training will be the starting point for the new chapter in our facility for the treatment of scoliosis. It will help me implement new strategies in current brace construction about the sagittal profile and in starting construction of the Sforzesco brace“. 
For more information and registration, visit https://en.isico.it/sforzesco-online-course/#top

Free Pelvis Brace works: this is demonstrated by the study presented at Sosort

At the latest Sosort international conference, held a few months ago, Isico presented the study Increasing Brace Comfort, Durability and Sagittal Balance through Semi-rigid Pelvis Material does not change Short-Term Very-Rigid Sforzesco Brace Results.
For years, Isico has replaced plaster cast with the Sforzesco brace, a particular type of very rigid brace for the most demanding scoliotic curves: developed in the Institute itself in 2004, it obtained results equal to casting, highlighted in several published studies.
The Sforzesco brace is a way to avoid casting for severe curves, because of the significant costs involved both at the individual (side effects including cast syndrome, skin problems, significant psychological impact, inability to shower for months, etc.) and social (repeated inpatient treatments) levels.
“In recent years, thanks to the experience with the Sforzesco brace, we have worked to improve our brace – explains dr Francesco Negrini, physiatrist, and one of the authors of the research presented at Sosort – We have therefore recently introduced a particular innovation, the system “Free Pelvis”, which consists of releasing the pelvis corset using a less rigid material at that level, increasing comfort while wearing. The “Free Pelvis” system is a very important innovation, a potentially big step forward in conservative treatment of scoliosis”.
The study presented compared the Sforzesco brace classical version (VRB) versus the Free Pelvis one (FPB): “The results obtained showed us that the Sforzesco “Free Pelvis” has no inferior results to the classic Sforzesco – concludes dr Negrini – furthermore it reassures the effectiveness of the Sforzesco “Free Pelvis”, and allows us to continue with greater confidence and conviction in the process of introducing this new and revolutionary instrument into our regular clinical practice”.

Can we be sure that this brace works?

A brace is a tool used to prevent the progression of scoliosis. They can be made of different materials: plastic (with metal parts), partly leather, or entirely elastic and fabric.

Finally, there exist numerous models with different names, such as the Cheneau, Sforzesco, PASB, Lapadula, Maguelone, and so on, not to mention variants of these different models.  

All this adds up to a real maze of terminology that the parents of a child or teenager recently diagnosed with scoliosis or a spinal disorder suddenly find themselves having to try and understand.

Why is it all so confusing?

It is not confusing, it is just that there exist different models, all designed to serve the same purpose, namely, to obtain the best possible alignment of the spine in order to counteract the evolution of the disease, which manifests itself as a progressive misalignment of the vertebrae.

Individual situations and cases vary, and braces are therefore chosen to meet the patient’s specific needs, which are determined by the severity, type and location of the curve.

The shape of the spine, viewed sideways on, is also a crucial aspect to consider when choosing a brace; this sagittal profile shows a series of physiological curves: cervical lordosis, dorsal kyphosis, lumbar lordosis and sacral kyphosis.

If these curves are correctly positioned and well balanced, your back will be strong; if not, it will be weak and vulnerable to the stresses of everyday life.

The type and construction features of the brace must be chosen by a medical specialist after a thorough assessment of the type of problem, the severity of the condition, the risk of progression, and the habit of using one brace compared with another.

One particular feature of the scoliotic spine, which we professionals must seek to address, is the presence of a deformity in the sagittal plane, in other words, a deformity of the spine as viewed from the side.

Indeed, the action of the disease can result in a reversal of the natural pattern of the curves described above. A dorsal scoliotic curve, for example, will have the effect of flattening the back, reducing or even reversing the direction of the natural dorsal kyphosis.

This makes the back look unnaturally “straight” or even causes the spine to curve inwards, creating a dorsal lordosis.

Such a deformity can seriously affect the health of the spine.

Indeed, conserving the physiological pattern of spinal curves in the sagittal plane means keeping the back strong, healthy and working efficiently.

When patients are diagnosed with dorsal scoliosis with this flattening of the back, their parents are often surprised because these youngsters, very erect, appear to have what is classically considered a “perfect” posture.

Most people associate scoliosis with a curved back and round shoulders. After all, as children, we are so often told: “Stand up straight or you’ll get scoliosis!” . Therefore, associating straightness with scoliosis seems something of a contradiction in terms.  But this is not the case at all.

A flat back, caused by dorsal scoliosis, is indeed one of the many forms that scoliosis can take: it is actually quite a frequent form and also one that can be difficult to treat using corrective tools.

Normally, a brace exerts a pushing action, but in these cases, to improve the shape of the back, the brace would need to act as a sort of suction cup, pulling the vertebrae back into position.

Obviously, this is not possible; therefore, in these cases, the brace will be shaped in such a way as to encourage the trunk and shoulders to assume a more “hunched” position so as to try and prevent the spine from becoming “too straight”.

The most worrying and upsetting aspect for parents is precisely this: to see their “straight backed” youngsters assuming, with their brace on, this rounded position with forward slumped shoulders – after all, their posture initially seems to look worse than before!

However, they soon understand the reason for it: these patients are not being asked to “stand up straight”; instead, what they need to do is learn to assist the corrective action of the brace, which is specially designed to promote kyphotic curvature of the upper spine.

In short, it isn’t easy to be sure that a brace is working, especially when, as in cases like these, its action seems to go against traditional aesthetic parameters.

However it is important to understand that, in many cases, certain construction features of the brace are the result of complex biomechanical reasoning.

What should you do if you are concerned? Ask, without hesitation, because exchanges with experts are always useful for learning about the corrective aspects of the treatment.