Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Biomechanical modeling of brace treatment of scoliosis: effects of gravitational loads


The biomechanics of bracing in adolescent idiopathic scoliosis is still not fully understood. Finite element models (FEM) have been used but the gravity forces were not included and the production of spinal stresses not evaluated. An improved FEM to simulate brace treatment was thus developed. The 3D geometry of the spine, rib cage, pelvis, and of the trunk external surface of five scoliotic patients was acquired using a multi-view X-ray technique and surface topography. A FEM of the patient’s trunk including gravity forces was created. Custom-fit braces were modeled and their installation simulated. Immediate geometrical corrections and pressures were computed and validated. The resulting compressive loads on the vertebral endplates were quantified. The influence of the strap tension, spine stiffness, and of the gravity forces was evaluated. Results showed that the brace biomechanical action was importantly to prevent the scoliotic spine from bending under the gravity forces. The immediate correction depended on the strap tension and spine stiffness. The distribution and amplitude of computed pressures were similar to those measured with the real braces. After the brace installation, the coronal asymmetrical compressive loading on the vertebral endplates was significantly reduced. In conclusion, the model developed presents improvements over previous models and could be used to better understand and optimize brace treatment.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


  1. 1.

    Andriacchi TP, Schultz AB, Belytschko TB, Dewald R (1976) Milwaukee brace correction of idiopathic scoliosis. A biomechanical analysis and a retrospective study. J Bone Joint Surg Am 58:806–815

  2. 2.

    Aubin CE, Dansereau J, de Guise JA, Labelle H (1996) A study of biomechanical coupling between spine and rib cage in the treatment by orthosis of scoliosis. Ann Chir 50:641–650

  3. 3.

    Cheng CK, Chen HH, Chen CS, Chen CL, Chen CY (2000) Segment inertial properties of Chinese adults determined from magnetic resonance imaging. Clin Biomech (Bristol, Avon) 15:559–566

  4. 4.

    Clin J, Aubin CE, Labelle H (2007) Virtual prototyping of a brace design for the correction of scoliotic deformities. Med Biol Eng Comput 45:467–473

  5. 5.

    Delorme S, Petit Y, de Guise JA, Labelle H, Aubin CE, Dansereau J (2003) Assessment of the 3D reconstruction and high-resolution geometrical modeling of the human skeletal trunk from 2D radiographic images. IEEE Trans Biomed Eng 50:989–998

  6. 6.

    Fortin D, Cheriet F, Beausejour M, Debanne P, Joncas J, Labelle H (2007) A 3D visualization tool for the design and customization of spinal braces. Comput Med Imaging Graph 31:614–624

  7. 7.

    Frost HM (1990) Skeletal structural adaptations to mechanical usage (SATMU): 1. Redefining Wolff’s law: the bone modeling problem. Anat Rec 226:403–413

  8. 8.

    Gignac D, Aubin CE, Dansereau J, Labelle H (2000) Optimization method for 3D bracing correction of scoliosis using a finite element model. Eur Spine J 9:185–190

  9. 9.

    Goldberg CJ, Moore DP, Fogarty EE, Dowling FE (2001) Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery. Spine 26:42–47

  10. 10.

    Kadoury S, Cheriet F, Dansereau J, Labelle H (2007) Three-dimensional reconstruction of the scoliotic spine and pelvis from uncalibrated biplanar X-ray images. J Spinal Disord Tech 20:160–167

  11. 11.

    Labelle H, Dansereau J, Bellefleur C, Poitras B (1996) Three-dimensional effect of the Boston brace on the thoracic spine and rib cage. Spine 21:59–64

  12. 12.

    Labelle H, Bellefleur C, Joncas J, Aubin CE, Cheriet F (2007) Preliminary evaluation of a computer-assisted tool for the design and adjustment of braces in idiopathic scoliosis: a prospective and randomized study. Spine 32:835–843

  13. 13.

    Lamarre ME, Parent S, Labelle H, Aubin CE, Joncas J, Cabral A, Petit Y (2009) Assessment of spinal flexibility in adolescent idiopathic scoliosis: suspension versus side-bending radiography. Spine 34:591–597

  14. 14.

    Liu YK, Laborde JM, Van Buskirk WC (1971) Inertial properties of a segmented cadaver trunk: their implications in acceleration injuries. Aerosp Med 42:650–657

  15. 15.

    Mac-Thiong JM, Petit Y, Aubin CE, Delorme S, Dansereau J, Labelle H (2004) Biomechanical evaluation of the Boston brace system for the treatment of adolescent idiopathic scoliosis: relationship between strap tension and brace interface forces. Spine 29:26–32

  16. 16.

    Nachemson AL (1981) Disc pressure measurements. Spine 6:93–97

  17. 17.

    Nachemson AL, Peterson LE (1995) Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 77:815–822

  18. 18.

    Nie WZ, Ye M, Liu ZD, Wang CT (2009) The patient-specific brace design and biomechanical analysis of adolescent idiopathic scoliosis. J Biomech Eng 131:041007. doi:10.1115/1.3049843

  19. 19.

    Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA (1996) Use of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Joint Surg Am 78:557–567

  20. 20.

    Odermatt D, Mathieu PA, Beausejour M, Labelle H, Aubin CE (2003) Electromyography of scoliotic patients treated with a brace. J Orthop Res 21:931–936

  21. 21.

    Patwardhan AG, Bunch WH, Meade KP, Vanderby R Jr, Knight GW (1986) A biomechanical analog of curve progression and orthotic stabilization in idiopathic scoliosis. J Biomech 19:103–117

  22. 22.

    Pazos V, Cheriet F, Danserau J, Ronsky J, Zernicke RF, Labelle H (2007) Reliability of trunk shape measurements based on 3-D surface reconstructions. Eur Spine J 16:1882–1891

  23. 23.

    Pearsall DJ, Reid JG, Ross R (1994) Inertial properties of the human trunk of males determined from magnetic resonance imaging. Ann Biomed Eng 22:692–706

  24. 24.

    Pearsall DJ, Reid JG, Livingston LA (1996) Segmental inertial parameters of the human trunk as determined from computed tomography. Ann Biomed Eng 24:198–210

  25. 25.

    Perie D, Aubin CE, Petit Y, Beausejour M, Dansereau J, Labelle H (2003) Boston brace correction in idiopathic scoliosis: a biomechanical study. Spine 28:1672–1677

  26. 26.

    Perie D, Aubin CE, Lacroix M, Lafon Y, Labelle H (2004) Biomechanical modelling of orthotic treatment of the scoliotic spine including a detailed representation of the brace-torso interface. Med Biol Eng Comput 42:339–344

  27. 27.

    Perie D, Aubin CE, Petit Y, Labelle H, Dansereau J (2004) Personalized biomechanical simulations of orthotic treatment in idiopathic scoliosis. Clin Biomech (Bristol, Avon) 19:190–195

  28. 28.

    Petit Y, Aubin CE, Labelle H (2004) Patient-specific mechanical properties of a flexible multi-body model of the scoliotic spine. Med Biol Eng Comput 42:55–60

  29. 29.

    Rigo M, Negrini S, Weiss HR, Grivas TB, Maruyama T, Kotwicki T (2006) SOSORT consensus paper on brace action: TLSO biomechanics of correction (investigating the rationale for force vector selection). Scoliosis 1:11

  30. 30.

    Rohlmann A, Zander T, Rao M, Bergmann G (2009) Applying a follower load delivers realistic results for simulating standing. J Biomech 42:1520–1526

  31. 31.

    Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D (1997) A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am 79:664–674

  32. 32.

    Sanders JE, Greve JM, Mitchell SB, Zachariah SG (1998) Material properties of commonly-used interface materials and their static coefficients of friction with skin and socks. J Rehabil Res Dev 35:161–176

  33. 33.

    Stokes IA (2007) Analysis and simulation of progressive adolescent scoliosis by biomechanical growth modulation. Eur Spine J 16:1621–1628

  34. 34.

    Stokes IA, Aronsson DD, Dimock AN, Cortright V, Beck S (2006) Endochondral growth in growth plates of three species at two anatomical locations modulated by mechanical compression and tension. J Orthop Res 24:1327–1334

  35. 35.

    Villemure I, Aubin CE, Dansereau J, Labelle H (2004) Biomechanical simulations of the spine deformation process in adolescent idiopathic scoliosis from different pathogenesis hypotheses. Eur Spine J 13:83–90

  36. 36.

    Wynarsky GT, Schultz AB (1989) Trunk muscle activities in braced scoliosis patients. Spine 14:1283–1286

  37. 37.

    Wynarsky GT, Schultz AB (1991) Optimization of skeletal configuration: studies of scoliosis correction biomechanics. J Biomech 24:721–732

  38. 38.

    Zhang M, Mak AF (1999) In vivo friction properties of human skin. Prosthet Orthot Int 23:135–141

Download references


This study was funded by the Natural Sciences and Engineering Research Council of Canada.

Author information

Correspondence to Carl-Éric Aubin.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Clin, J., Aubin, C., Parent, S. et al. Biomechanical modeling of brace treatment of scoliosis: effects of gravitational loads. Med Biol Eng Comput 49, 743–753 (2011). https://doi.org/10.1007/s11517-011-0737-z

Download citation


  • Adolescent idiopathic scoliosis
  • Brace
  • Finite element model
  • Design
  • Gravity