Understanding How Bracing and PSSE Work Together
When a child or adolescent is diagnosed with scoliosis and prescribed a brace, families often have many questions. One of the most common is whether scoliosis-specific exercises are still necessary when bracing is already part of the treatment plan. The answer is yes; because Physiotherapeutic Scoliosis-Specific Exercises (PSSE) and scoliosis bracing are designed to work together as part of comprehensive, non-operative scoliosis care.
Bracing plays a critical role in the management of adolescent idiopathic scoliosis, particularly during periods of rapid growth. A scoliosis brace is prescribed to reduce the risk of curve progression by applying external corrective forces to the spine and trunk. When worn as recommended, bracing has strong evidence supporting its ability to slow or prevent worsening of spinal curves and reduce the likelihood of surgical intervention.
However, scoliosis bracing is inherently a passive treatment. The brace holds the body in a corrected position, but it does not teach the patient how to actively control their posture, breathing, or spinal alignment. This is where PSSE becomes essential.
PSSE is a specialized form of scoliosis-specific physical therapy that focuses on three-dimensional correction of the spine. Through PSSE, patients learn how to actively participate in their treatment rather than relying solely on the brace.
When PSSE and bracing are combined, each enhances the effectiveness of the other. The brace creates an opportunity by positioning the spine and trunk in a more optimal alignment, while PSSE helps patients recognize, reinforce, and maintain that correction. Over time, this active engagement improves body awareness and allows patients to better support their alignment both inside and outside of the brace.
This combined approach can also improve brace tolerance and compliance, which are critical factors in treatment success. Patients who understand how their brace works and how exercises support their goals often feel more confident and comfortable wearing it. Education and movement help patients work with the brace, rather than feeling restricted by it, which can make long-term brace wear more manageable.
Another key benefit of integrating PSSE with scoliosis bracing is the ability to transfer correction and integrate the changes into daily activities. Braces are not worn forever, and posture does not automatically improve once brace wear is reduced. PSSE helps patients apply corrective strategies during everyday movements such as sitting, standing, walking, and participating in sports. This is especially important during brace weaning, when maintaining spinal alignment without external support becomes a primary goal.
Best-practice scoliosis management emphasizes a collaborative, interdisciplinary approach that includes the physician, orthotist, PSSE-trained physical therapist, and the patient and family. Professional organizations such as SOSORT support combining scoliosis-specific exercises with bracing whenever appropriate, recognizing that passive and active treatments address different but complementary aspects of scoliosis. While every scoliosis treatment plan is individualized, the goal remains consistent: to reduce curve progression, support healthy movement, and empower patients with long-term tools for spinal health.
Ultimately, PSSE and bracing are not competing treatments. The brace provides external structure and guidance, while PSSE develops internal control, awareness, and functional carryover. Together, they form a comprehensive, evidence-informed approach to non-operative scoliosis treatment designed not only to manage scoliosis during growth, but to support patients well beyond the bracing years.
