Scoliosis Night Bracing

Although Hyper corrective bracing is the gold-standard treatment pathway for scoliosis, new evidence is beginning to emerge surrounding nighttime bracing that presents it as an effective alternative treatment for children with Scoliosis who cannot tolerate a brace during the daytime.

Night time bracing can be a particularly successful alternative for those children who struggle with the physical and emotional demands of wearing a rigid daytime brace for the required 20 hours. Nighttime braces are designed to be worn in bed for between 8 and 10 hours per night, it is recommended the brace is worn for at least an hour prior to going to bed, to ensure the muscles are adequately stretched and ready for a good night's sleep.

What is a nighttime brace made of?

Our night time braces are made of a rigid plastic outer shell that provides support and correction, in combination with plenty of padding to provide comfort to the wearer during the night.

How does nighttime bracing work?

Night time bracing provides an excellent opportunity to correct your child's spine, without the pressures of gravity. When your child is stood upright in their daytime brace, considerations have to be made for the effects of gravity on the spine - as gravity is pushing down through the spine from top to bottom. When your child is laid in bed, this gravity is instead acting in a more evenly distributed way - holding the spine in place, rather than acting against it.

The brace uses the same hyper corrective principles as delivered by a daytime brace to provide over-correction of the spinal curve during the night. Where nighttime bracing differs from daytime bracing is in how much correction can be comfortably delivered, the elimination of gravity when laid down means that a greater angle of over correction can be comfortably achieved. Night time bracing means that the maximum angle of over correction can be delivered, without the pressures of gravity being at play, and without bracing during the day.

While your child is sleeping, they are also releasing growth hormones and maturing skeletally. Nighttime bracing capitalises on the opportunity to hold them in an over corrected position while this growth is happening, encouraging the spine to grow in a straighter position.

How will my child’s nighttime brace look?

If your child has previously had a daytime brace, you may see that there may be quite a few observable differences that are apparent between their old brace and their new night time brace. For example, you might observe that their nighttime brace is very asymmetrical - this is totally normal, they are designed like this to allow the brace to apply pressures to the spine precisely where needed for optimum correction. This asymmetry will also likely result in their posture being changed in quite an extreme way once the brace is on, again, this is totally normal. This is because the premise of the brace is that it ‘over corrects’ in-order to offer the maximum possible curve reduction, so this is going to be apparent once your child is in the brace. You may also see that there is more padding on the inside, making the brace slightly bulkier but also more comfortable to sleep in.

What is the process of having a nighttime brace made?

The first step is to book an assessment appointment to see one of our experienced Orthotists. The Orthotist will obtain a relevant medical history plus review any X-ray images, MRI reports and consultant letters you have available for your child. Please bring all available documentation to the first clinical appointment. If you are interested in having both a daytime and a nighttime brace made - please do let us know at the time of booking your appointment and we will be able to combine the assessment appointment for you.

If the most recent X-ray is out of date or unsuitable, then another X-ray will need to be organised. Please note X-rays will have to be provided by a third party provider as we are unable to offer you this service at this time.

If a hyper corrective brace is deemed the most appropriate device, then specific measurements and a number of 3D scans will be taken using a handheld scanner - this is a radiation free process. If your child is not found suitable for this type of bracing, other - more suitable options will be discussed at this point.

The brace will then be customised using the data collected from the X-rays, measurements and clinical scans. How the brace looks can also be personalised, your child will be able to choose from a wide selection of colours and patterns - they are sure to find an option that suits their style.

Braces take on average 2-3 weeks to be manufactured (this can vary slightly depending on manufacturers lead times), at which point you and your child will be invited back into the clinic to have it professionally fitted and receive advice on breaking in the device.

Please note the above is a guide, your child's needs may vary from this, your Orthotist will provide each child with their own review process after the first fitting based on their specific needs.

Frequently asked questions

Is night time braces supported by evidence?

Night time bracing as a stand alone treatment is a relatively new pathway for scoliosis in the UK, however in both the USA and Australia it has been a popular treatment method for some time now. These countries have been delivering nighttime bracing for long enough that large scale evidence is emerging, providing more encouraging information and building confidence that clinically supports nighttime bracing as a viable treatment option. Whilst corrective movement bracing is still the gold standard of scoliosis bracing in the UK, Night time bracing offers an alternative for those who cannot tolerate a standard corrective movement brace, providing a second chance at halting curve progression without surgical intervention.

How long is the brace worn for each night?

The night brace needs to be worn for at least 8 hours per night, and it must be put on at least one hour before getting into bed to allow your child's body to stretch and adjust to being held in this position. There is no upper limit to how long the brace can be worn for - and we would encourage as much use of the brace as possible. If your child is willing to wear the brace around the house after school, or for longer periods of time during the day on weekends, then this will really benefit them

What if I am worried my child won’t tolerate the brace?

In order to get the best out of their treatment, it is imperative for your child to be able to build up to at least 8 hours of wear during the night. The best way for your child to become accustomed to wearing the brace is by gradually building up wear consistently, for short periods of time. This can be done little by little, starting out with just resting in it in the evenings before gradually building up to a full night of sleep in it. It may also help to build a night time routine around the brace.

How long will my child need bracing for?

Once the treatment starts, it will continue until the skeleton is skeletally mature enough that we are confident the curve has stabilised. X-rays of the growth plates of the pelvis or hands can confirm this. Most commonly, once growth has stopped the brace treatment will stop.

How many braces will be required in total?

This will depend on how much your child grows - the brace will require replacement if a child has grown to the extent that the forces being applied to the body are no longer in the optimum place to maintain spinal correction.

Is the brace worn under or over clothing?

Each brace comes with a specially designed vest, and additional vests are available to purchase if you should want them. This will not only keep your child's skin safer by introducing a barrier between them and the brace, but it will also help to keep the brace clean by wicking away sweat. The brace should always be worn over a garment, if not one of the specifically designed vests, opt for a cotton rich material with no patterning, embellishment or buttons. A plain pyjama T-shirt will do.

Does wearing a corrective Brace cause pain?

A hyper corrective night brace has to be broken in gradually, this is to prepare the spine to its new posture and to allow the skin to adapt to the pressure. There can be some initial discomfort in the first few weeks as the spine adjusts to its new posture but this will settle down with time. Once a child has adjusted to life in the brace they tend to find support the brace offers comfortable.

What other treatments are available for my child from Children’s Orthotics?

Children’s orthotics work as part of a wider multidisciplinary team - we can offer you access to specialist Scoliosis Physiotherapists who can help your child to achieve the best outcome possible from their treatment. Our physiotherapists will be able to teach your child the corrective movement patterns which help straighten their spine and compliment the braces provided by your Orthotist - if you’re interested in finding out more about physiotherapy for Scoliosis, please click here (LINK)

How do I arrange an assessment for a night brace?

To get in touch or arrange an appointment, you can call us at 0330 088 3949 or email office@orthotics.co.uk.