A combined orthotic bracing solution for scoliosis, pectus and rib flare
“I don’t think that wearing a brace is easy but I want people to know that it does pay off in the end and even if it is difficult to begin with it is worth it and you will come out the other end stronger as a result.”, Daisy, aged 14
It was initially in year three of school that Daisy’s mum, Sara, noticed something amiss with her posture. “I’m an orthopaedic physiotherapist, so I recognised that something was not quite right and suspected that we might be looking at scoliosis,” she explains. “Our GP referred Daisy to a consultant at the hospital where I work. They X-rayed her and diagnosed a mild scoliosis of nine degrees. They also confirmed that she had pectus carinatum but advised that, as they considered this a cosmetic issue, we should simply monitor it and take no further action at that time.”
However, by late 2019, when Daisy was in year 7 (now aged 12), she herself started to express concern. “By that time, both the scoliosis and the pectus looked more prominent and also displayed signs of rib flare. Plus, Daisy was starting to say that she worried about the way she looked,” Sara recalls. “So, at that point, I took her into LOC to see whether something could be done to help her. Sam (Sam Walmsley Founding Director at LOC) fitted her for a pectus chest brace in March 2020, Debs (Deborah Tunrbull, Specialised Schroth Physiotherapist at LOC) taught Daisy an exercise regime to help with the pectus deformity, but she was also interested in looking more closely at her scoliosis.”
“At the age of 10, I was diagnosed with mild scoliosis after concerns about my back. I was originally being seen by the NHS and monitored for about 3 years every six months. My scoliosis was slowly progressing but nothing too drastic and my NHS orthopaedic consultant told me that I would likely need bracing but not surgery. One night in winter 2019 my mum asked me whether I wanted to have my pectus carinatum sorted as I had been noticing it and feeling insecure about it for a while at this point. I said yes. I had previously seen a GP about it but they had said it was nothing to worry about; however, I was feeling particularly insecure about it.” Daisy
Above left: Daisy in her Gensingen Brace by Dr Weiss. Middle: Daisy in her Pectus Carinatum brace. Right: Daisy’s scoliosis brace from behind
Debs began by prescribing a programme of exercises that Daisy could do at home, with the aim of monitoring whether these might prevent the scoliosis from worsening, as well as supporting Daisy’s pectus bracing treatment. But, by May 2020, Sara was becoming more concerned and so, on Debs’ advice, she arranged a scan at Harley Street. The results showed a scoliosis that now measured between 20 and 22 degrees, meaning that Daisy’s curvature had more than doubled in 6 months.
“The pandemic meant that I couldn’t be treated on the NHS for my scoliosis so I had an EOS scan done at Harley Street and my scoliosis had almost doubled within 6 months bringing it to 22 degrees. This was still mild; however, it had a very high chance of progression so rather than wait to be treated on the NHS we opted for the Gensingen brace and physiotherapy at LOC.” Daisy
After further assessment at LOC, which showed the scoliosis had a 60% chance of becoming even more acute, Sara and Daisy decided the time had come to fit a scoliosis brace. Given that Daisy was already wearing a brace for her pectus carinatum, an innovative solution was needed to treat both conditions simultaneously.
“I had my brace fitted and I was also given a personalised exercise programme to help with my 3D rotation. Not only was I wearing this new brace but I still had my pectus brace on and the amazing orthotists managed to combine the two so they worked together. I really struggled with this at first; however, I kept going and now I’m really glad I did. My scoliosis overcorrected by 10 degrees and I was able to reduce my scoliosis brace wear to 16 hours a day within 6 weeks.” Daisy
LOC treats scoliosis with the Gensingen Brace by Dr Weiss® – which also has the capacity to address rib flare. Led by our Orthotist, Sally Hews, our manufacturing team created a bespoke solution that enabled Daisy to wear the pectus brace over the top of her scoliosis brace to address both conditions. “Daisy initially wore the bracing for 22 hours a day,” says Sara. “Naturally, that was challenging for her. It’s not the most comfortable experience! But she persevered, as we knew it was important to undergo the treatment whilst her bones were still flexible. LOC offered fantastic support – they were always able to speak to us on Zoom or Skype if we needed advice, and to see us in clinic even during the pandemic. In particular, I was extremely impressed with the Covid-safe measures they have implemented. As a clinician working in a hospital myself, I felt they implemented exactly the protocols that I would expect in a medical environment. That was important to us – and I’m sure to all of LOC’s patients. When you are wearing an orthotic, there are always times when you are going to need to see your clinician face to face to deal with adjustments and that kind of thing. In my opinion, their care was gold standard.”
“I really enjoyed going down to London and the orthotists were all really nice. There I had my pectus brace fitted and the adjustments made it more comfortable. Of course I struggled with wearing that brace and it was uncomfortable in the start. However, I persevered and I eventually stopped noticing it was there and it just became part of my life.” Daisy
Above: Daisy’s Gensingen brace for scoliosis viewed from the side
Daisy’s exercises have played an important part in her treatment. Sara was impressed with the quality of the programme Debs designed, and with her daughter’s tenacity in following the programme. “Daisy picked up on the exercises very quickly. She’s very astute, she could feel when she wasn’t doing the movements quite right and corrected that very quickly. All of the exercises could be performed at home, using things we had lying around the house like a towel rail, so it was feasible to stick to the programme without having to buy lots of expensive equipment.”
Fast forward to July 2020, and Sara and Daisy are thrilled with the results of Daisy’s follow up scan, which showed a slight over correction of the scoliosis. “Daisy was so pleased,” says Sara,” because this meant that Debs and Sally could start to gradually reduce how long she needed to spend in her Gensingen brace each day. By the time she returned to school in September 2020, she didn’t have to wear the Gensingen during the day at all, but she still had to wear her pectus brace for 20 hours per day. At her most recent scan, her scoliosis was back down to 10 degrees, so LOC have completely corrected it. Daisy is much happier with the appearance of her chest as well – her carinatum was very one-sided, but now that asymmetry is hardly noticeable, and she only has to wear her pectus brace at night. The first consultant we saw estimated that she may have to wear a spinal brace until around the age of 18 – which would have been at least another four years. But LOC have achieved outstanding results for my daughter in less than a year. This kind of bracing treatment is not easy – it takes perseverance. But the combination of Daisy’s perseverance and LOC’s outstanding care has given us results we could not be happier with.”
“By February 2021, I was out of my scoliosis brace and only wearing my pectus brace for 16 hours. Currently, I am wearing my pectus brace for 12-14 hours a day and I am very happy with the results of my treatment. I am very grateful to all the amazing people at LOC and I want to thank them for helping me so much. In the year and a half since my treatment started I have come so far and I am incredibly happy with the results and I am incredibly happy that I persevered.” Daisy
Above: Daisy’s scans in May 2020 and February 2021 show just how effective her bracing solution has been in correcting her scoliosis.
If you are concerned that your child may have a condition like pectus excavatum, pectus carinatum, or scoliosis, LOC may be able to help – even with unusual or multiple presentations. Just contact us to arrange an initial consultation with one of our orthotic team.