Fig. 16

The counter-rotation pad (component 2 of the proximal pad), in all the braces with a classical proximal pad, has to be perpendicular to the transversal plane when observed from the side. The brace is physiological in the middle sagittal plane but on the left side (for right thoracic/left lumbar) the sagittal profile is hyper-lordotic at the lumbar region, hyper-kyphotic at the main thoracic region, and flat and vertical at the proximal, with the counter-rotation pad acting as stopping point. Many orthotists build Chêneau-type brace with this point tilted to ventral, like shown in the figure, but this is a wrong design. When this wrong design is used in a Chêneau-type brace with its classical lumbar lordotic and ventral shapes, the sagittal configuration of the spine shall not be normalized like it is pretended with this proximal pad inclination, but contrary, the main thoracic spine will become even more lordotic and failing in the counter-rotation effect, it will appear a structural proximal curve, which will become rapidly hype-kyphotic. According to our observations, using this wrong design is associated to kyphotization of the proximal thoracic region and the thoracolumbar junction. Inclination of the upper part of the brace, looking for a kyphotization of the main thoracic scoliotic spine, has been used by other concepts, and it could work properly when combined with different forces, but not with the forces provided with a classical Chêneau-type brace