The Milwaukee brace, used since 1954, is a neck-to-pelvis orthosis with a neck ring. The Boston brace is an underarm thoracolumbosacral orthosis (TLSO) that replaced it for most curves. Modern braces such as ScoliBrace are custom three-dimensional designs. The strongest bracing evidence, the BrAIST randomized trial, found treatment success in 75 percent of braced patients against 42 percent observed, with better results the more hours the brace was worn. No randomized trial has shown that one modern brace brand outperforms another, and I say that as a certified ScoliBrace provider.
I am Dr. Justin M. Dick, DC, at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. I am a Certified ScoliBrace Provider and SpineCor Certified. Families often arrive having been offered an older-style brace, and this post compares the options on evidence, not branding.
The Milwaukee Brace
Maruyama and colleagues note that the Milwaukee brace was a standard of non-surgical scoliosis care from 1954 and that a 23-hour wearing protocol was the most effective use of it. The neck ring and visible superstructure made it hard to wear, and their 2008 review reports that even patients in less visible TLSO braces wore them for only about 60 percent of the prescribed time. The authors used part-time Milwaukee bracing with physical therapy and argued it still has a role for thoracic or double curves.
The Boston Brace
The Boston brace is an underarm TLSO. Fayssoux and colleagues' history of North American bracing places it among the Milwaukee, Wilmington, Charleston, and Providence braces. Before BrAIST, results were mixed. Vijvermans and colleagues reviewed 151 Boston brace patients treated from 1982 to 1991 and found good results mainly in older, more mature children with smaller curves, the group least likely to progress, and concluded the brace did not clearly alter natural history after age 12 and Risser 2. Katz and colleagues later fitted Boston braces with heat sensors in 100 adolescents and found curves held in 82 percent of those who wore the brace more than 12 hours a day.
What BrAIST Established
BrAIST, published in 2013, enrolled 242 patients with typical bracing indications and stopped early because bracing worked: 75 percent success with bracing against 42 percent with observation. Patients were instructed to wear the brace at least 18 hours a day, and success rose with hours of wear. The trial established that rigid TLSO bracing works when it is worn. It did not compare brace designs.
Modern 3D Braces
Modern custom braces are designed from scans or casts to apply three-dimensional correction and, in some systems, to allow a lower-profile shape that may be easier to wear. The design rationale is sound biomechanically. I did not find a randomized trial comparing ScoliBrace, or any single modern brand, directly against the Boston brace, so I do not claim one is proven superior. What the evidence does support is that wear time drives outcome, so a brace a teen will actually wear has an advantage. My ScoliBrace page and SpineCor page describe those systems, and the ScoliBrace provider directory lists our Charlotte office.
How Dr. Justin M. Dick, DC Chooses a Brace at Clear Life
At our Charlotte office, brace selection depends on curve pattern, sagittal profile, growth stage, and whether the patient will wear it. Wear time is discussed openly, and progress is measured on radiographs. My post on full-time vs nighttime braces covers wear schedules.
Comparison
| Feature | Milwaukee brace | Boston brace (TLSO) | Modern custom 3D brace |
|---|---|---|---|
| Extent | Pelvis to neck ring | Pelvis to underarm | Pelvis to underarm, custom shaped |
| Era | From 1954 | Standard TLSO era | Recent |
| Wear-time evidence | 23-hour protocol most effective (review) | 82% held with over 12 hours/day (Katz 2010) | No head-to-head RCT vs Boston found |
| Randomized evidence for rigid bracing | BrAIST 2013: 75% success braced vs 42% observed; more hours, more success | ||
Research and Evidence
Evidence tiering: BrAIST is a randomized trial; Katz is a prospective sensor-monitored cohort; Vijvermans a retrospective cohort from the pre-BrAIST era; Maruyama and Fayssoux are reviews. Claims that any modern brace is superior to the Boston brace are not supported by randomized evidence I could find.
My own published work includes bracing-era adolescents treated with the CLEAR protocol. The 13-month follow-up case, Reduction of Adolescent Idiopathic Scoliosis: A 13-Month Follow-Up (Cureus, 2025, PMID 40062184), reports one adolescent. It does not compare brace designs.
References
- Maruyama T, Takesita K, Kitagawa T, Nakao Y. Milwaukee brace. Physiother Theory Pract. 2011;27(1):43-6. doi:10.3109/09593985.2010.503992
- Maruyama T, Takeshita K, Kitagawa T. Milwaukee brace today. Disabil Rehabil Assist Technol. 2008;3(3):136-8. doi:10.1080/17483100801904036
- Fayssoux RS, Cho RH, Herman MJ. A history of bracing for idiopathic scoliosis in North America. Clin Orthop Relat Res. 2010;468(3):654-64. doi:10.1007/s11999-009-0888-5
- Vijvermans V, Fabry G, Nijs J. Factors determining the final outcome of treatment of idiopathic scoliosis with the Boston brace: a longitudinal study. J Pediatr Orthop B. 2004;13(3):143-9. doi:10.1097/00009957-200405000-00001
- Katz DE, Herring JA, Browne RH, Kelly DM, Birch JG. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010;92(6):1343-52. doi:10.2106/JBJS.I.01142
- Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512-21. doi:10.1056/NEJMoa1307337
- Dick JM, Spurgeon S. Reduction of adolescent idiopathic scoliosis: a 13-month follow-up. Cureus. 2025;17(2):e78669. doi:10.7759/cureus.78669
Frequently Asked Questions
What is the difference between a Boston brace and a Milwaukee brace?
The Milwaukee brace extends from the pelvis to a neck ring and has been used since 1954. The Boston brace is an underarm thoracolumbosacral orthosis without a neck component.
Is the Milwaukee brace still used?
Rarely. One research group argued part-time Milwaukee bracing still has a role for thoracic or double curves, but underarm braces replaced it for most patients.
Does the Boston brace work?
Rigid bracing works when worn. In a sensor study of Boston braces, curves held in 82 percent of patients who wore the brace more than 12 hours a day.
Are modern 3D braces better than the Boston brace?
They are designed for three-dimensional correction and easier wear, but I found no randomized trial proving a modern brand superior. Dr. Justin M. Dick, DC, a Certified ScoliBrace Provider at Clear Life Scoliosis in Charlotte, NC, explains that wear time drives results.
What did the BrAIST trial show?
Published in 2013, BrAIST found treatment success in 75 percent of braced patients against 42 percent observed, with more success at more hours of wear.
Where can I get a scoliosis brace in Charlotte, NC?
Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, provides ScoliBrace and SpineCor bracing with Dr. Justin M. Dick, DC. Call 980-368-0766.
Service Area
Clear Life Scoliosis and Chiropractic Center sees patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, Fort Mill SC. Families from across the Charlotte region and the South Carolina border communities come to the Rachel Freeman Way office for radiographic scoliosis evaluation with Dr. Justin M. Dick, DC.
Related Pages
- ScoliBrace in Charlotte
- SpineCor in Charlotte
- Bracing for Scoliosis
- What Is ScoliBrace
- Full-Time vs Nighttime Scoliosis Braces
- Wearing a Scoliosis Brace to School
- What a Brace Cannot Do
- When Scoliosis Progresses the Most
- Scoliosis Care Program
- Dr. Justin M. Dick, DC Research
Schedule an Evaluation in Charlotte
If your child has been offered a brace, the design matters less than whether it fits the curve and gets worn. Dr. Justin M. Dick, DC reviews the options with families at our Charlotte office.
Dr. Justin M. Dick, DC
8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278
Phone: 980-368-0766 · Email: office@clearlifescoliosis.com
clearlifescoliosis.com · Book online
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