What is scoliosis?

Scoliosis is a condition where the spinal cord curves abnormally in a way that usually resembles an ‘S’ or ‘C’ shape. This condition is primarily diagnosed during childhood and adolescence. However, it can affect people of all ages.

Physiotherapy plays a major role in: 

• Managing the symptoms of scoliosis
• Improving posture
• Reducing pain
• Strengthening the muscles surrounding the spine to prevent further curvature

Types of scoliosis

Scoliosis can be categorised into three main types based on its aetiology:¹ congenital, neuromuscular, and idiopathic. The most common type of scoliosis is idiopathic scoliosis. 

Congenital scoliosis 

Congenital scoliosis occurs when the spine develops abnormally during the gestational period. The skeletal irregularities that are present at birth generally originate from issues that occur with the formation or segmentation of the vertebrae or during development. This improper growth causes a curved spine and may require early intervention to prevent the condition from worsening.¹

Neuromuscular scoliosis

Neuromuscular scoliosis occurs due to issues associated with the nervous or muscular systems. It commonly occurs in people with cerebral palsy, muscular dystrophy, or spinal cord injuries. Such conditions weaken the muscles that support the spine or impact the nerves that control them, causing an imbalance and spine curvature. This form of scoliosis is classified as the most severe and can progress rather quickly, which requires specialised treatment.²

Idiopathic scoliosis

Idiopathic scoliosis is the most common type of scoliosis. The exact cause of idiopathic scoliosis is not known, nor is it related to congenital or neuromuscular conditions. There are several theories that aim to define the cause of idiopathic scoliosis, such as asymmetric growth, muscle imbalance, hormones, or genetics.

However, the exact cause for scoliosis in those individuals remains unknown. It is commonly diagnosed in adolescents during the ages 10 to 18, which corresponds with the growth spurt that occurs at that stage.³ 

Who is affected?

Scoliosis is quite a common condition. According to Scoliosis Support & Research, more than two million people in the United Kingdom have scoliosis. Also, 2 to 3% of children between the ages of 10 and 15 develop scoliosis in their lifetime. A study published in 2024 revealed a higher prevalence (3.1%) of scoliosis in adolescent girls and overweight individuals.⁴

What are the signs and symptoms of scoliosis?

The signs and symptoms of scoliosis are dependent on the severity of the curvature of the spine. Common indicators include:

• Uneven shoulders
• Uneven hips
• Prominent ribs
• Visible curve in the spine
• Uneven waist
• Leaning to one side/being lop-sided
• Back pain
• Muscle fatigue
• Restricted movement

If scoliosis is left untreated, symptoms can worsen and lead to further complications such as increased pain, reduced or limited mobility, and, in extremely severe cases, breathing difficulties can occur due to chest compressions.

Importance of early detection 

How is scoliosis detected?

Scoliosis is usually detected through physical exams, medical history, or X-ray screenings.^1,3 During routine check-ups, doctors assess for asymmetry, particularly physical signs such as uneven shoulders or hips. A physician also obtains medical history to determine whether other conditions could be responsible for spine curvature.

An X-ray screeningallows the healthcare professionals to determine the location and the degree of the spine curve, thereby confirming scoliosis. The angle of the curve is called the Cobb angle. The Cobb angle guides healthcare professionals to determine whether the curve is mild or severe and decide on the best-suited therapeutic options to treat the condition.

While X-rays are the main diagnostic tool for scoliosis, other methods that could be used to assess spine curvatures are MRI, CT, and ultrasound scans.³

Why early diagnosis matters

Early detection of scoliosis is important to avoid worsening the condition, as it allows treatment options to stop or slow down spine curvature that are less invasive, such as wearing braces or physiotherapy.

If scoliosis is diagnosed later in life or remains undiagnosed, more aggressive and invasive treatment options, such as surgery, may be necessary. Hence, it is important to see a doctor as soon as the physical signs and symptoms are observed for further evaluation.

Overview of treatment options for scoliosis

Treatment options for scoliosis are dependent on age, degree of spine curvature, and the predicted course of progression of the condition. This information determines whether it’s likely that the curve would get worse over time and if any treatment is even required. 

Non-surgical options like casting, bracing, and physiotherapy are usually recommended for individuals with mild to moderate scoliosis over surgery.

Casting is the typical treatment for scoliosis diagnosed in younger patients like babies and young children, where they are fitted for plaster casts that are worn all the time to help correct a curved spine. In the case of adolescents with growing bones, bracing is the go-to option to prevent the curve from worsening. 

How physiotherapy helps with scoliosis

Since each case of scoliosis is unique, physiotherapy takes a personalised approach with exercises tailored to the patient’s specific needs. Physiotherapy is usually a standard in scoliosis treatment plans to strengthen the muscles around the spinal cord and support corrected posture and spine alignment,which prevents the curve from worsening. 

Therapists also incorporate pain relief techniques and exercises that improve flexibility and mobility and manage the back pain and discomfort associated with having scoliosis.⁵

In some extreme cases of scoliosis, breathing is impacted due to the curved spine. Therefore, physiotherapy can also include breathing exercises to improve lung capacity and respiratory functions.⁵

Types of physical therapy exercises for scoliosis

Schroth method

The Schroth method is an approach that focuses on improving spinal alignment through posture-correcting exercises and breathing techniques.⁶ It seeks to restore spinal cord alignment and reduce the curve over time by elongating and de-rotating the spine.

Patients are taught exercises that are tailored to their unique spinal cord curve and encouraged to practise them routinely.

Scientific exercises approach to scoliosis (SEAS)

SEAS emphasises the self-correction and stabilisation of the spinal cord by practising individualised functional exercises.⁷ These exercises aim to strengthen the muscles that help maintain proper spine alignment. Although this method is usually initially taught by a physiotherapist, the exercises can be practised at home to maintain their results.

Global postural re-education (GPR)

The GPR approach targets posture improvement and body mechanics to alleviate chronic back pains.⁸ It aims to retrain the body to maintain proper alignment through stretching and muscle rebalancing, which helps to reduce spinal cord progression and relieve discomfort from scoliosis.

People of all ages use this physical treatment option, including those who experience pain from musculoskeletal and postural disorders like scoliosis.

Physiotherapy exercises 

Physiotherapy exercises seek to strengthen the muscles that support the spine and reduce curvature and alleviate pain associated with scoliosis. A physiotherapist would usually design a treatment plan based on the patient’s age, type of scoliosis, and spinal curve severity. They may use one or a combination of the following core strengthening and posture improvement exercises: 

• Planks: strengthen the core muscles that support the spine
• Bridging: lying on the back and lifting the hips upwards to engage the lower back and abdominal muscles.
• Cat-cow stretch: improves flexibility and stretches the spine by arching and rounding the back
• Side stretch: stretching one arm overhead and gently bending to the side while standing or sitting to elongate the muscles on one side of the body 
• Wall angels: standing against the wall with the arms in the shape of a ‘W’, the arms are slid up and down to improve shoulder and upper back posture
• Pelvic tilts: lying on the back, tilting the pelvis upwards and flattening the lower back to the ground to improve alignment
• Leg and arm raises: suspended on all fours, one arm and the opposite leg are lifted, aimed at improving coordination and balance and strengthening the back muscles
• Standing balance exercise: stand on one leg to increase stability and core control

What to expect from physiotherapy sessions 

In physiotherapy sessions, it is likely that the physical therapist will assess the patient’s posture, spine alignment, range of motion, and any pain or discomfort experienced to design a personalised treatment plan.

Regular sessions would be scheduled exercises for strengthening and posture correction. The frequency of the sessions would vary on a case-by-case basis. Home exercises would also be provided to maintain progress in between sessions.

Lifestyle tips for managing scoliosis 

Physical therapy also helps manage scoliosis in daily life by teaching proper posture for sitting and standing and guiding on lifting heavy loads. When lifting is necessary, it is important to use the legs and bend the knees to reduce back strain.

Regular activities like swimming, walking, or cycling are encouraged, as they strengthen the muscles around the spine, supporting its alignment and reducing the risk of curve progression.

When physiotherapy may not be enough 

While physical therapy is an effective treatment method for managing scoliosis, in some severe cases of the condition, it may not be as effective. Other treatments, such as bracing or surgery, may be the next best option when the condition worsens or there are minimal signs of improvement following physiotherapy. 

Healthcare professionals such as physicians and physiotherapists would work collaboratively to determine the best mode of action to manage scoliosis patients.

Summary

Physiotherapy is an essential part of managing scoliosis, offering non-invasive treatment that can help reduce discomfort, improve posture, and strengthen the muscles supporting the spine. Although it does not completely reverse spinal curvature, it does slow down its progression and offer an improved quality of life for people with scoliosis. For many, it provides a safe, affordable, and effective alternative to more invasive treatments like surgery.