The London Orthotic Consultancy has been providing bracing treatment for scoliosis since it opened in 2005. For the last five years, LOC has prescribed and fitted derivatives of the Cheneau-Gensingen brace for its scoliosis patients where active intervention was indicated. Dr Jaques Cheneau developed his first brace in 1979. His brace design acknowledged that scoliosis is a three-dimensional condition and focuses on the three-dimensional correction of the spine in the coronal (front), transverse (rotational) and sagittal (side) planes. Goals for brace wearers are stabilization at a minimum but LOC has witnessed first-hand significant spinal corrections in our patients, particularly juveniles and adolescents.
Since its initial development, Cheneau bracing has been intertwined with the Schroth concept for scoliosis. Dr Cheneau visited Katherina Schroth and Christa Lehnert-Schroth at their renowned clinic in Germany. He immediately understood the efficacy of the Schroth breathing concept and incorporated this into his brace designs using the augmented Lehnert-Schroth curve-pattern classifications which for decades have been the basis of Schroth scoliosis treatment.
Today there are several Cheneau-Gensingen derivatives. LOC has been involved with the Cheneau-Gensingen brace over the last 5 years, but more excitingly, we are now able to announce the launch of the UK’s first complete, in clinic, asymmetric brace – the LOC Scoliosis Brace. Based on recurring patient and UK based consultant feedback over the past 5 years, the LOC Scoliosis Brace has been fine-tuned to ensure we are achieving as much skeletal correction as possible in-brace for each individual user, whilst also ensuring that our brace is as comfortable as possible.
The above is only possible because of the strengths of our current team. Indeed the clinical lead of this team oversaw the production, fitting and management of 64% of LOC’s Cheneau-Gensingen braces during the preceding five years. This currently makes her the most experienced Cheneau-Gensingen bracer in the UK. This knowledge, alongside the valuable feedback and thoughts from other clinicians, patients, parents and consultants has allowed us to further develop our approach to bracing. As a clinic, we understand the absolute time-critical nature of treating scoliosis. We understand there can be lengthy delays whilst accessing other services, which can ultimately lead to the progression of scoliosis. That is why we have invested in our manufacturing team so that we are now able to offer an extremely rapid turnaround on scoliosis braces. The custom-made LOC Scoliosis Brace is now available for fitting within hours of the assessment appointment, due to the dedication and process-driven LOC manufacturing team.
The general protocol in the UK on the NHS is, if the Cobb angle is less than 20°, the client is to be monitored. If the cobb angle measures between 20° and 40°, then typically a patient will be referred to an orthotic service for a Boston or a TLSO brace to delay the progression of the curve. According to NHS guidelines, if a curve exceeds 40° then the patient would be advised to have surgery. To slow the progression of the curve during growth spurts, the Boston and the TLSO brace are prescribed on the NHS.
In contrast, LOC uses a published risk of progression formulae – which considers the patient’s chronological age, skeletal age (Risser sign) and the size of the presenting curve. If it is agreed a LOC Scoliosis Brace is required, we can actively reduce the curvature by loading the spinal bones 3 dimensionally to change their shape (thereby reducing the Cobb angle) whilst growth is completed. The LOC Scoliosis Brace also helps with pain management, reduces the need for surgery later in life and improves the cosmetic appearance
The LOC Scoliosis Brace is a much more tailored brace with bespoke 3-point pressure systems. This means that we can keep plastic down to an absolute minimum, making them smaller and more comfortable than traditional NHS Braces. The image below shows a traditional Boston brace which was made for a client on the left and a LOC Scoliosis Brace (for the same client) on the right.
The general protocol in the UK is that if an x-ray is taken in brace, a ‘good’ brace should aim to reduce the original curve by 50%.
At LOC, we often refer patients for a rapid low dose scan to confirm the efficiency of our braces following the fitting. This scan is typically performed at the 2-month mark in other braces, and changes are then made to improve the fit of the brace and the correction in the brace. We have found that a rapid scan gives the clinician a very clear indication as to the correction that will be achieved, whilst ensuring no time is wasted (and therefore correction lost) while waiting for this scan.
Whilst it varies from patient to patient, the LOC Scoliosis Brace offers more than 50% skeletal correction. To the extreme, we have seen corrections exceeding 100% (as below) in the LOC Scoliosis Brace, which is why these braces can be termed ‘over-corrective’. In these instances, it is possible to proceed with reduced brace wearing hours, or if full time bracing is still indicated, the brace can be altered. This ‘over-correction’ gives the wearer the greatest chance at skeletal correction. If for any reason, our clinician is not fully satisfied with the skeletal in-brace correction after receiving the x-ray, the brace will be re-modelled and re-made (free of charge) as part of a multi-colleague meeting – this ensures all our patients are in gold standard braces, whilst not losing any possible corrective time in-brace.
Examples of correction that can be achieved in the LOC Scoliosis Brace are as follows:
Due to the 3-dimensional focus built within the LOC Scoliosis Brace, we expect to see postural improvements within 2 months, which continue to improve with good brace compliance. This can also be true in adult scoliosis patients. This can be in the ‘rib hump’ measure (rotation from the scoliosis), but also in waistline symmetry, shift of the hips and general postural re-balance. If we are able to ensure the weight line coming down from the head is more centralized over the pelvis following treatment, the patient’s overall prognosis is much improved.
Assessment appointment – a recent out of brace x-ray is essential at this stage (so please bring one into the clinic or discuss this with the clinician beforehand). A series of scans, photographs and measurements are taken by one of our scoliosis clinicians. Based on this input, the bespoke LOC Scoliosis Brace is then modelled using CAD/CAM technology and our in-house manufacturing unit then produces the brace.
Fitting appointment – the brace is then fitted by one of LOC’s scoliosis clinicians. This is typically 10 working days following the assessment, however, with careful planning, this can be brought forward (and even fitted on the same day as the assessment!) when indicated/required. Please speak to your clinician if you feel this would be of benefit to you or your child.
Reviews – we typically like to review a scoliosis brace 2 weeks after the fitting appointment. This allows us to make tiny adjustments and to ensure the user is settling in well and managing fine at home.
We then plan for the in-brace x-ray and review the correction and adjust the brace as necessary.
Once this has taken place, we monitor each patient's progress with regular review appointments - typically every 2-3 months. We welcome communication from parents and patients throughout the treatment with our clinical team. We are then able to quickly respond to make brace adjustments as a patient grows.
We talk to the father of one of our scoliosis patients Ricarda, a thirteen-year-old horse rider and regional kickboxer, about her experience with adolescent idiopathic scoliosis and treatment with the Cheneau-Gensingen brace ... continue reading ...
In year three of school, 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 ... continue reading ...
LOC recently heard from one of our young patients, Beau, who was diagnosed in 2020 with juvenile idiopathic scoliosis. Beau has embraced her treatment programme wholeheartedly. Her positive outlook and ‘can-do’ attitude are inspiring ... continue reading ...
It is fair to say that Venetia had been through the mill before she came to see us in March. It started about 3 years ago when Venetia kept getting bad cramps at night. Having rejected the quinine prescription suggested by her GP ... continue reading ...
Ariana was examined by LOC clinicians who checked for spinal rotation using a scoliometer device that measures how much a rib hump protrudes - known as ‘angle of trunk rotation’ (ATR) ... continue reading ...
LOC first met 11-year-old Yasmin after she found out she had adolescent idiopathic scoliosis quite by chance; an X-ray taken for a chest complaint revealed she had abnormal twisting and curvature of the spine ... continue reading ...
Motivated Angelina is a thirteen-year-old scoliosis patient currently going through scoliosis treatment, here her mother Paola talks to us about her scoliosis journey and her experience with the brace ... continue reading ...
My results are amazing and unexpected, and I am glad that I received the brace through LOC. I am still wearing the brace 18 months later and my back feels even straighter. Thanks to LOC I realised that I wanted to help people with similar if not the same condition as me, so I am now going to Salford University in September to study Orthotics and Prosthetics so I will hopefully be able to help others with Scoliosis as much as LOC has helped me.
If you say something is going to be easy it will be easy and if you say something will be hard it will be hard. So, I'm just going to say that wearing my brace is easy. And as it turns out, it really is.
LOC have helped remove the stress from our situation. They have given us hope based on their extensive knowledge and expertise.
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.
Don’t wait. It’s about the children because they are more likely to be confident in their late teens if you act quickly and support them. We have been lucky because we understand the condition well. That’s one of the main things, to be honest. It was hard work, but it pays off in the end.
I'd highly recommend LOC to anybody. They’re just so interested, which you don't get at many places because adult scoliosis is actually a huge area but there are very few people interested in it.
The brace is very light. Obviously, the first couple of days we were told it was going to be uncomfortable for her, I bought so many pillows! But although the first night was not very comfortable, the second night she got used to it and then she was wearing it all day long and I thought ‘that’s brilliant!’ She was only taking it off for two or three hours to go out with friends or do the exercises, but she didn’t have any problems really.
The whole experience has been very good. LOC make you feel welcome from the beginning, and you can ask as many questions as you want, and they answer everything. If you have a problem they give you their personal mobile so you can just call them if you have a problem and they’ll solve it straight away. I’m very pleased with the treatment, the people, with everything.
She’s wearing the brace all the time now and she’s doing very well. She’s very good at school too, the brace doesn’t get in the way of anything. It fits underneath her school uniform and you can’t see it. Sometimes I even have to ask her when she’s sitting down if she’s wearing it because I can’t see it! She says ‘of course mummy’ and I say ‘let me try!’ I have to knock through the clothes and only then can I hear she’s wearing the brace!
Obviously, the results speak for themselves. If I were to give any advice [to parents in a similar position] it would be to contact LOC. Ricarda likes it there, she loves the people and felt really comfortable, everything was really relaxed and nice.
He’s been very positive since the first day and this determination has certainly paid off. In just two months, Rares’s Cobb angle has reduced from 52֯ to 24֯ in a brace and his ribcage has de-rotated from 18֯ to 12֯, so the rib hump has significantly improved.
I finally found that I had arrived at the right place and something was actually being done.
My pain levels are hugely improved, my ribs were tender and now they are not. My brace was made individually for me. It’s not one size fits all and, if it is not completely perfect, LOC alters it on the spot. I was so surprised that I could wear the brace under my clothes, I did not need to go and buy anything, I just wear loose tops.
Alex’s scoliosis curve treated successfully in just 6 weeks at LOC
LOC’s Scoliosis Team at SOSORT annual conference in May
Michael has achieved great results for his Pectus Excavatum with our vacuum bell treatment in combination with a specific exercise programme.
LOC welcomes Super Sofia to its Gait Laboratory at Salford University
Meet Jack who joined LOC in January as a Senior Orthotist
Rob can walk again thanks to the Neuro Swing AFO that LOC prescribed and manufactured for him
LOC’s Orthotic Clinic at Salford University’s teaching hospital to re-open on 14th February.
LOC’s first post-operative Sagittal Craniosynostosis patient