Treatment of Scoliosis
You're not alone. Many experience the discomfort and challenges that come with Scoliosis, feeling uncertain about how to improve their condition.
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Scoliosis affects more kids and teens than most people realise, and as such many are living as an adult with scoliosis. In fact, it's such a common spine condition that it has prompted a wide range of treatment options and support communities to help manage it.
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Postural conditions can be congenital (caused by a spinal malformation at birth), idiopathic (caused by asymmetrical/abnormal bone growth), neuromuscular (caused by a condition) syndromic (connective tissue/ hyper-mobility) and can also onset or progress as an adult (degenerative).
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It is important to see a qualified health professional to ascertain the type of postural conditions you may have and the best treatment.
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At QLD Scoliosis & Spine Clinics, we treat all types of postural conditions of the spine and ribcage, in all ages.
Pectus
Scoliosis
Congenital defects
Hyperkyphosis
Adult postural conditions
Changes in ribcage shape Pectus excavatum is where the sternum and ribs grow inwards toward the spine Pectus excavatum is where the sternum and ribs grow outward and bracing is very useful at treating this in growing kinds/teens
Scoliosis, a condition characterised by a curvature of the spine in 3 planes of movement - torsion/ twisting of the spine is the main clinical feature, along with a sideways curvature and often a flat or rounded back. There are different types of scoliosis. Often scoliosis present in one of the growth spurts; infantile, juvenile, or adolescent. 80% of cases are idiopathic are are most likely due to a combination of factors including genetic history, and can progress during any rapid period of growth, or later in life. Some are associated with disorders of the brain, spinal cord or muscular systems that can cause alterations in muscle tone and inability to support usual spinal alignment. Physiotherapy and bracing is effective in most cases at preventing/lessening curvature progression to surgical range, improving rib cage mobility, posture and respiratory function and to prevent/minimise the onset of associated complications.
Congenital defects Abnormal vertebrae growth during foetal development, can cause changes in spine shape and progress during growth spurts.Casting and bracing often aim to lessen progression but often surgery may be needed need to correct. Physiotherapy aims to minimise pain, improve spinal stabilisation, minimise postural collapse, improve aesthetics and maintain function and quality of life.
Scheuermann's disease describes a condition where the vertebrae grow more at the back than the front resulting in wedge shaped of the vertebrae, causing greater than normal kyphosis. Physiotherapy and bracing are effective at limiting progression, treating pain and improving posture and function.
Degenerative Scoliosis and kyphosis More than 60% of adults over 65 years old will have  some type of curvature in their lower spine usually due to asymmetrical degenerative / age related changes in the spine which in turn, leads to an uneven distribution of load and increased wear of other spinal structures - pain is very common due to the resultant stress on soft tissues and bony, neural structures. Physiotherapy can help with addressing pain , improving posture and function and lessening progression.
Stop your curve from progressing and support your scoliosis for a pain free life
​QLD Scoliosis and Spine Clinics offers specialized, evidence-based scoliosis treatment through a broad spectrum of treatments tailored to age, including but not limited to, scoliosis bracing and scoliosis physiotherapy, ensuring a holistic approach to managing this condition. Understanding how scoliosis is treated involves recognizing the importance of a multidimensional treatment plan that may incorporate additional therapeutic options to complement physiotherapy, such as specific bracing techniques or, in certain cases, considering surgical interventions for more severe curvatures.​
Treatment of Scoliosis in Kids and Teens
Treatment is determined based on curve magnitude, probability of curve progression or known curve progression and skeletal and sexual maturity.
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Observation
If scoliosis is structural and mild, and the patient has minimal growth ahead, normally treatment is not required, unless pain is present. Sometimes there is a hidden scoliosis is which case observation is required even with minimal Cobb, if there is lateral deviation and rotation of the vertebrae present. If there is a scoliosis and growth remaining, observation is necessary to assess for curve progression is vital, especially if genetic history of scoliosis. The likelihood of curvatures progressing is dependent on a number of factors, typically curvatures that are at high risk are those with known progression >5 degrees Cobb between scans, as well as those with significant growth ahead with a curve already >20 degrees Cobb, so the younger the child at onset of scoliosis the more likely the curvature is to progress to surgical range, family history of scoliosis is another risk factor as their is genetic predisposition to vertebral deformity.
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Physiotherapeutic Scoliosis Specific Exercise
Scoliosis exercises are helpful at any stage of your journey, especially during observation of a mild scoliosis with growth ahead or late phase of growth where bracing is no longer indicated; there are multiple research studies supporting their use, especially during the period of monitoring where they were shown to be superior than monitoring alone in lessening risk of progression. Multiple studies have proven their use for improving posture/ aesthetics, respiration, muscle endurance and quality of life (Schrieber et al 2015). Adding PSSE to bracing has been shown o be superior to bracing alone and is even a recommendation of surgeons under the Scoliosis Research Society (SRS) group for all being managed with bracing for scoliosis treatment (Hong et al 2017).
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Bracing
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Scoliosis bracing is the most common non-surgical treatment often needed for progressive scoliosis especially in younger patients and is often prescribed by your specialist to try and stop the curve progressing and avoid surgery. Night time or part time bracing is sometimes considered in high risk cases, with possibility of increase to full time wear in case of progression. Full time bracing is usually considered for curves 20-45 degrees, and can be used for curves >45 degrees to control the curve and delay surgery to a later age/ allow for growth. According to one high quality study bracing was 70% effective at preventing curve progression to surgical threshold. Bracing success improves further with use of hyper-corrective or asymmetric Cheneau type braces with the rate of success reaching 86-100% in some studies (Lee 2024) / an average success rate of 96.66%. Combing bracing with specialised exercise programs are shown to be more effective than bracing alone (Hong et al 2017).
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Surgery
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Surgery for scoliosis is often considered when the curvature is at risk of progression as an adult and/or significantly impacts the patient's quality of life or poses health risks. The choice between a back brace for scoliosis and surgery depends on multiple factors, including the severity of the curvature, patient age, and potential for growth. ​​​
Treatment of Scheuermann's or age related Hyper-Kyphosis
Treatment is determined based on curve magnitude, probability of curve progression or known curve progression and skeletal and sexual maturity.
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Functional kyphosis does not usually require bracing, and can be corrected with specialised exercise therapy as per Schroth therapy.
Physiotherapeutic Scoliosis Specific Exercise
In a randomised control trial, back exercises in general, and Schroth therapy in particular, is an effective treatment for preventing and significantly improving the thoracic Cobb angle and symptoms in Scheuermann’s patients (Bezalel et al 2019).One study looking at Schroth exercises in young female and male adults with thoracic and thoracolumbar Scheuermann's kyphosis showed improvement in pain with intensive rehabilitation (Weis et al).
Bracing
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Bracing is often used in curves exceeding 55 degrees to stabilise progressive curves or improve posture in some curves. However, Scheuermann's structural kyphosis may need bracing. Bracing may be considered when curves exceed 55 degrees with growth remaining, although angle itself is not the only prognostic factor! The decision also takes into account clinical and radiographic measures, the harmony of spinal curvatures and the absence or presence of pain.​
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Surgery
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Surgery is considered in some cases to stabilise progressive curves or improve posture in some curves, or restore harmony to significant hyperkyphtic curves.
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Treatment of Scoliosis and Postural Conditions in Adults
Treatment is determined based on a broad number of factors, particularly curve magnitude, risk of progression, presence/ absence of symptoms and patient goals.
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Without pain, not at risk of progression - Observation​
With pain and/or risk progression - PSSE, sometimes bracing for pain relief
Progressive curves or pain not responding to treatment- specialist referral
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Curvatures over 50 degrees are known to worsen in adulthood at an average of 0.5 up to 2 degrees per year, this is why surgery is often considered in curvatures exceeding this angle at skeletal maturity. The decision for surgery is one of stabilising the curvatures and could be seen as a preventative measure.
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Physiotherapeutic Scoliosis Specific hands on and Exercise based treatment interventions
Specialised physiotherapy and specific, individualised exercise programs help scoliosis patients to overcome their symptoms and adopt a more balanced posture while also reducing pain/stiffness and stabilising/ lessening the curve’s progression without the need for surgery. Bracing is sometimes used for support and pain relief. One study looking at scoliosis exercises in adults with scoliosis showed improvement in posture and Cobb in 68% of patients, stabilisation and slowed progression in all other patients (Negrini et al 2015).
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Scoliosis - Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study Scoliosis. 2015; 10: 20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537533/
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Effect of Outpatient Schroth Exercises on Thoracolumbar and Lumbar Curves in Adult Scoliosis Patients. http://dx.doi.org/10.5772/intechopen.68183
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Scoliosis conservative management for pain management in adults. J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011608/
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Rehabilitation in adult spinal deformity. Turk J Phys Med Rehabil. 2020 Sep; 66(3): 231–243.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557622/
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The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review; J Neurosurg Spine 26:694–704, 2017 https://pubmed.ncbi.nlm.nih.gov/28291412/
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