The Milwaukee brace is a full-torso orthotic device that extends from the pelvis to the chin and was the first modern brace designed to treat spinal curvature in growing adolescents without surgery. Developed in the late 1940s, it remains in clinical use today, though its role has narrowed considerably as underarm braces have taken over for most curve types. The brace works by applying corrective forces through pads, straps, and an upright superstructure that reaches the neck, and it retains a specific advantage for curves that sit high in the thoracic spine, where shorter braces cannot reach.
How the Brace Works
The Milwaukee brace has three main components: a molded pelvic girdle that fits snugly around the hips, one or more metal uprights that rise from the girdle, and a neck ring with a throat mold and occipital pads that rest near the chin and the base of the skull. Corrective pads are attached to the uprights and positioned to push against the curved portion of the spine. A thoracic strap pulls the pad into the trunk, and adjusting the tension of that strap directly changes how much corrective force the pad delivers.
Biomechanical testing has shown that the relationship between strap tension and the pressure the pad exerts on the body is strong, with a correlation of about 0.84 across different body positions and daily activities. Increasing the strap tension pushes the resultant force in a more lateral direction, while a shorter outrigger, which creates a smaller pulling angle, directs the force more medially. That distinction matters clinically: in patients whose thoracic spine is flattened or lordotic, a shorter outrigger can prevent the brace from worsening the front-to-back alignment of the spine.1PubMed. Biomechanical evaluation of the Milwaukee brace Even body position matters. Lying on the side of the thoracic pad produces the highest corrective force among common lying postures, which may be favorable for preventing curve worsening during sleep.
Clinicians must balance correction against comfort. Excessive strap tension increases discomfort and limits the trunk-shifting exercises that are often part of treatment protocols.2Prosthetics and Orthotics International. Biomechanical evaluation of the Milwaukee brace Because the brace is worn for many hours a day, sometimes for years, getting that balance right is one of the central challenges of Milwaukee brace management.
What Conditions the Milwaukee Brace Treats
The brace was originally designed for adolescent idiopathic scoliosis, the most common form of spinal curvature in teenagers, and that remains one of its applications. It is also prescribed for Scheuermann’s kyphosis, a condition in which the upper back rounds excessively because several vertebrae become wedge-shaped during growth. In both conditions, the goal of bracing is not to straighten the spine permanently but to hold the curve steady during the remaining growth period so it does not worsen to the point of requiring surgery.
A third, less common use involves hybrid configurations for complex cervical and upper thoracic problems. A halo ring can be mounted to the Milwaukee brace superstructure to control the upper spine after certain surgical procedures, offering an alternative to the traditional halo vest while still allowing access to a posterior surgical wound.3PubMed. The halo-Milwaukee brace. Case series of a revived technique
Effectiveness for Adolescent Idiopathic Scoliosis
How well the Milwaukee brace works for scoliosis depends heavily on the size of the curve at the start of treatment and how much growing the patient still has to do. A study of patients with curves between 40° and 55°, which are on the large end for brace candidates, found an overall success rate of about 43%. But that number obscures a meaningful split: patients whose curves measured 40° to 45° had a 57% success rate, while those with curves above 46° succeeded only about 15% of the time.4Neurospine. The Effect of Brace Treatment on Large Curves of 40° to 55° in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study In bracing, “success” typically means the curve did not progress to the surgical threshold, which is often set around 50°.
Skeletal maturity at the time bracing begins also matters. In a study of 60 patients treated with the Milwaukee brace, about three-quarters achieved successful curve control. Those who succeeded were, on average, more skeletally mature at the start of treatment than those who progressed, meaning they had less remaining growth during which the curve could worsen.5PubMed Central. Pelvic tilt and trunk inclination: new predictive factors in curve progression during the Milwaukee bracing for adolescent idiopathic scoliosis That finding cuts both ways. It confirms bracing works better when there is less growth left, but it also highlights the difficulty of timing: start too late and the curve may already be too large; start early and the patient faces years of brace wear during a period of rapid growth.
Effectiveness for Scheuermann’s Kyphosis
The evidence for the Milwaukee brace in Scheuermann’s kyphosis is genuinely encouraging. In one study of 40 patients, conservative treatment with the brace and physiotherapy halted kyphosis progression in 97.5% of cases. Patients started with an average kyphosis angle of about 63° and ended at roughly 37°, a clinically meaningful improvement. The researchers found the approach effective even in patients with kyphosis up to 90°, provided they had not yet reached skeletal maturity.6PubMed Central. Successful brace treatment of Scheuermann’s kyphosis with different angles
Long-term follow-up data tell a more tempered story. In an earlier study of 62 patients, those who wore the brace for an average of 18 months saw their kyphosis drop from about 62° to 41°. However, more than 18 months after brace wear ended, an average of 15° of that correction was lost.7PubMed. Scheuermann’s kyphosis–long-term results of Milwaukee braces treatment The vertebral wedging did improve slightly, from about 7.9° to 6.8°, suggesting some lasting structural change in the bones themselves. Still, partial loss of correction after the brace comes off is the norm rather than the exception, and patients should be counseled to expect some regression.
Reviews of the broader literature confirm that the Milwaukee brace produces beneficial outcomes for Scheuermann’s kyphosis in long-term studies.8PubMed Central. Brace treatment for patients with Scheuermann’s disease – a review of the literature and first experiences with a new brace design The brace’s ability to extend up to the cervicothoracic junction makes it particularly suited for this condition, since the excessive rounding often centers in the mid-to-upper thoracic spine where an underarm brace would have limited leverage.
How the Milwaukee Brace Compares to Underarm Alternatives
For most scoliosis curves, clinicians today reach for underarm braces like the Boston brace or the Chêneau brace first. These sit lower on the body, are easier to conceal under clothing, and are generally better tolerated by teenagers who are already self-conscious about their appearance. A comparison of the Milwaukee and Boston braces in 244 girls found that the Boston brace was more successful regardless of initial curve size or skeletal maturity.9PubMed. Prognosis of brace-treated scoliosis. Comparison of the Boston and Milwaukee methods in 244 girls That finding, combined with the cosmetic and comfort advantages of underarm designs, has made the Milwaukee brace a second-line choice for the majority of scoliosis curves.
The exception involves curves whose apex sits high in the thoracic spine, above the seventh or eighth vertebra. Underarm braces simply do not extend high enough to push against those curves effectively. The Milwaukee brace, with its superstructure reaching to the neck, can apply force at those levels. Recent research comparing Milwaukee and Chêneau braces for high thoracic curves found that both appeared effective, suggesting that some newer designs may eventually encroach on this last stronghold of the Milwaukee brace as well.10North American Spine Society Journal (NASSJ). Cobb angle outcomes in adolescent idiopathic scoliosis curves above the seventh/eighth thoracic vertebrae: A comparison of Milwaukee and Chêneau bracing techniques For now, though, the Milwaukee brace remains one of the standard options when the curve sits high.
The landscape of bracing for idiopathic scoliosis in North America now includes several distinct designs, including the Milwaukee, Boston, Wilmington, Charleston, Providence, and SpineCor braces, each with somewhat different indications, wearing schedules, and philosophies of correction.11Clinical Orthopaedics and Related Research. A history of bracing for idiopathic scoliosis in North America The Milwaukee brace’s legacy looms large in that history: it was the prototype from which the underarm designs evolved, and many of the principles of corrective bracing in growing spines were developed through decades of Milwaukee brace research.
The Psychosocial Burden of Wearing the Brace
Wearing any scoliosis brace is hard on a teenager, and the Milwaukee brace is especially challenging because its neck ring is visible above the collar line. The psychological impact is not trivial. Research on brace-related stress in adolescents with idiopathic scoliosis has found that those experiencing high stress levels score significantly worse on quality-of-life measures, particularly in emotional and social functioning.12PubMed Central. Brace-Related Stress and Quality-of-Life Parameters in Adolescents with Idiopathic Scoliosis That pattern likely applies across brace types, but the visibility of the Milwaukee brace’s superstructure can amplify the social component.
Compliance is the perennial problem in brace treatment for any condition. The more uncomfortable or visible the brace, the fewer hours a day patients actually wear it. Some treatment centers have shifted to part-time wearing protocols for the Milwaukee brace, prescribing fewer daily hours than the traditional full-time schedule. One center reported that part-time wear combined with physical therapy still produced results better than the natural history of untreated curves.13Disability and Rehabilitation: Assistive Technology. Milwaukee brace today Whether part-time wear is as effective as full-time wear remains a matter of clinical judgment, but it recognizes a practical reality: a brace that sits in the closet half the day because the patient refuses to wear it to school provides zero correction.
Effects on Breathing
Because the Milwaukee brace wraps around the entire torso and restricts chest wall expansion, concerns about respiratory function are understandable. When the brace is first applied, there is a small but statistically significant drop in the amount of air patients can move in and out per minute. However, the brace does not significantly reduce vital capacity, which is the maximum amount of air a person can exhale after a full breath. More reassuringly, after wearing the brace for an average of about 15 months, patients’ lung function measured without the brace on was not meaningfully different from what would be predicted for their age and size.14PubMed. Effect of the Milwaukee brace on vital and ventilatory capacity of scoliotic patients In other words, the brace temporarily restricts how freely you breathe while wearing it, but it does not appear to impair lung development over the course of treatment.
Dental and Jaw Considerations
One side effect that catches many families off guard involves the teeth and jaw. The throat mold of the Milwaukee brace rests against the chin, and prolonged pressure in that area during facial growth can influence dental alignment and jaw position. Clinical studies evaluating patients after Milwaukee brace treatment have documented changes in cephalometric measurements, which describe the spatial relationships of the skull, jaw, and teeth. These changes have sometimes required orthodontic follow-up to correct the resulting bite issues.15Scoliosis. Scoliosis and dental occlusion: a review of the literature Modified versions of the brace have attempted to reduce chin pressure, but the proximity of the superstructure to the developing face remains an inherent limitation of the design. Families starting Milwaukee brace treatment should discuss this possibility with both the orthotist and a dentist or orthodontist early in the process.
Do Exercises Improve Brace Outcomes?
Specific trunk-strengthening exercises have been a standard part of Milwaukee brace treatment protocols for decades. The idea makes intuitive sense: if the muscles supporting the spine are stronger, they might help hold the correction once the brace comes off. But the evidence is surprisingly thin. A prospective study comparing a closely monitored exercise program combined with the Milwaukee brace against the brace alone found no statistically significant difference in curve improvement between the two groups.16PubMed. Role of exercises in the Milwaukee brace treatment of scoliosis
That does not mean exercise is useless during bracing. General fitness matters for any teenager, and there may be benefits to exercise that were not captured in curve-angle measurements alone, such as trunk endurance, flexibility, and the psychological boost of feeling strong in a body that is strapped into a rigid device. But the expectation that a specific exercise regimen will meaningfully change the angle of a scoliotic curve over and above what the brace itself achieves does not have strong support. If exercise is part of a treatment plan, it should be pursued for overall health rather than with the assumption that it will independently straighten the spine.
The Halo-Milwaukee Hybrid
In certain complex cases, surgeons have revived a technique that combines a halo ring with the Milwaukee brace’s superstructure. This halo-Milwaukee brace is used after surgical procedures involving the upper thoracic and cervical spine, situations where standard postoperative immobilization with a halo vest can be problematic because the vest blocks access to the incision. The hybrid design controls the upper spine through the halo while leaving the posterior wound accessible for monitoring and care. Case series have reported that the orthosis is clinically effective, safe, and well tolerated by patients.17PubMed. The halo-Milwaukee brace. Case series of a revived technique This niche application underscores the adaptability of the Milwaukee brace framework: even as the standard version has lost ground to newer scoliosis braces, its basic architecture continues to serve purposes its original designers could not have anticipated.
Who Still Gets Prescribed a Milwaukee Brace
If you or your child has been told a Milwaukee brace is necessary, it almost certainly falls into one of a few categories. High thoracic scoliosis curves with an apex above the seventh or eighth vertebra are the most common reason, since underarm braces cannot apply force that high on the trunk. Scheuermann’s kyphosis centered in the upper thoracic spine is another, particularly when the rounding is severe enough to warrant aggressive bracing. And postoperative cervicothoracic immobilization in the halo-Milwaukee configuration covers the surgical niche.
For the vast majority of scoliosis patients with curves in the mid-to-lower thoracic or lumbar regions, an underarm brace will be the first recommendation. Families should feel comfortable asking why a Milwaukee brace was chosen over an underarm alternative, since the answer should be specific and anatomical: the curve is too high for anything shorter to reach. If the curve does not sit above the seventh or eighth thoracic vertebra, a second opinion from a scoliosis specialist may be worthwhile, because the psychosocial and cosmetic burden of the Milwaukee brace is substantially greater, and for lower curves the evidence favors underarm designs.
The Milwaukee brace occupies an unusual place in orthopedic history. It was the pioneer that proved spinal bracing could work in growing adolescents and spawned an entire generation of more streamlined successors. Those successors have largely replaced it. But for the specific anatomical situations where the spine needs correction higher than an underarm shell can reach, the original design, neck ring and all, continues to do a job that no other brace does quite the same way.