The Rigo-Cheneau style brace for scoliosis – why I recommend this brace for my curvy patients
Rosemary Marchese – Physiotherapist and Certified Schroth Physiotherapist for Scoliosis
When treating a person with scoliosis I am often confronted with similar questions from parents. Questions like ‘Will my child need a brace?’ and ‘Which brace do you recommend?’ are very common in our clinic. Firstly, let me say, I am a Schroth certified Physiotherapist. To even be able to do the Schroth course you must be a practising physiotherapist. And while I am learning new things every day, and will continue to learn, I do not make the braces. I simply recommend the type of brace that I believe fits best with Schroth style treatment, and the brace that I believe will get the best results for my patients. And that is the Rigo-Cheneau system (RCS) brace.
Will your child need a brace?
Bracing is normally considered appropriate for curvy patients with curves over 25 degrees and who still have growth remaining. However sometimes braces can be prescribed in children who have smaller curves, but are progressing quickly or are quite young. Generally speaking, if the child has finished growing then a brace is not usually recommended. However, predicting when a child has finished growing is not a perfect science. In the past growth plate closure over the iliac crest (top of hip bone) – known as a Risser score – was used to help determine how much growth was remaining in a child. We now know that this is likely to be highly inaccurate, and that there is stronger evidence towards using other considerations, such as growth plate closure in the left hand (yes, the hand) – known as a Sanders’ Score, to determine how much growth is remaining. This is not a widely accepted practice in Australia, and is something I am hoping to work towards changing in my patients.
Getting more accurate predictions of how much growth is remaining in a child, can really help us better develop a treatment plan for each child. A Schroth Physiotherapist can work with your orthopaedic specialist, and if necessary, your orthotist (who make the brace) to determine if a brace is suitable, and if so, what type of brace and how long the patient should be wearing it per day.
Why do I recommend RCS brace?
A RCS brace mimics the three-dimensional approach of Schroth physical therapy. Sometimes a patient attends our clinic in another style of brace. I am more than happy to work with these patients but sometimes I will recommend that they reconsider their type of brace. Then the decision is up to the family.
Bracing has been shown to reduce the risk of progression of a curve to the point of needing surgery. Some curves may still progress, even in a brace, however if a child is prescribed a brace, the child has more chance of never needing surgery if they wear it as prescribed. Ultimately that is the goal of bracing, to prevent the need for surgery.
Does your child still benefit from Schroth if they are wearing a brace?
Yes! Schroth and RCS bracing work together. They are both aiming for the same outcomes based on three dimensional de-rotation and elongation. The brace has ‘spaces’ in it to allow for expansion of ‘weaker’ or ‘collapsed’ spaces in the trunk while simultaneously providing de-rotational pressure forces in other areas. Schroth physical therapy provides the patient with the exercises that they can practice to hold this posture and work against the compressive and downwards forces enforced by scoliosis. They are a perfect fit. The Schroth Physiotherapist can check the brace and train the patient to stand in correct posture in the brace and out of the brace. However, the physical therapy sessions are mostly performed out of brace to help strengthen the posture of the curvy patient.
If you have questions some of your options are:
1. Speak to your Schroth Physiotherapist for advice.
2. Contact your orthotist to find out if they make the RCS brace.
3. Find an orthopaedic specialist who is willing to discuss this matter with you.
Feel free to contact us on (02)89140508 to book a Scoliosis Initial Consultation. For those who are not local we can organise intensive sessions to better suit your schedule and travel needs.