Specialised Physiotherapy & Exercise for Scoliosis in adults

By Emily Brown, Senior Spinal Physiotherapist

PSSE (physiotherapy scoliosis specific exercises) plays a vital role in the Conservative management of adult scoliosis and research has demonstrated improvements in postural symmetry, pain, disability, and quality of life (Monticone et al, 2016)

Put simply, these exercises focus specifically on addressing the resultant spinal malalignment,  postal imbalance, and associated muscle imbalance that occurs from specific spinal curve patterns.

PSSE varies from the traditional more generic physiotherapy exercises, and require therapists to have performed additional specialised training.

Whilst PSSE is also used for paediatric and adolescent scoliosis and spinal deformities, treatment of adult spines requires somewhat of a different approach in order to achieve the best possible outcomes.

Structural spine disorders in adults include idiopathic scoliosis, degenerative (de-novo) scoliosis, Sheurmanns kyphosis, age associated kyphosis, as well as general postural imbalances leading to spinal pain. Treatment for adults with symptoms due to spinal deformities should not be grouped into categories of Non specific low back pain but rather be referred to Physiotherapists with expertise in adult structural spine disorders and expertise in PSSE.

The common characteristics of PSSE include:

1. Active self correction

2. Stabilisation of corrected posture

3. Integration of self correction in ADLs

In adults, one of the main directions of correction is elongation on the spine, together with restoring Lumbar and thoracolumbar extension mobility. Such exercises may be taught in various positions including lying, kneeling, sitting, and standing and may utilise the additions of props initially to assist in achieving the desired effect. When appropriate, resistance may be added to the exercises to further promote gains in strength and endurance of the corrected postures. Such exercises have been reported to demonstrate a good antalgic effect and reduce the postural collapse.

Effects and symptoms:

The very nature of an adult spinal deformity results in spinal and postural imbalance that can lead to muscular imbalance, pain, disability, and reduced quality of life. As part of the assessment process, consideration of both the coronal and sagittal imbalances plays a critical role in determining the best treatment approach and choice of specific exercises. For adults, it is often the sagittal imbalance that has the biggest impact on symptoms.

The goals of PSSE in adult scoliosis and spinal deformities include

1. Prevent and minimise progression

2. Prevent and improve sagittal imbalance

3. Reduce pain

4. Improve function

5. Improve quality of life

A study by Negrini et al 2015, demonstrated an improvement in Cobb in 68% of patients.

The Benefits of Physiotherapy Scoliosis Specific Exercises (PSSE) in Adults with Scoliosis and Spinal Deformity

Introduction

Scoliosis and spinal deformities aren’t just issues affecting children and adolescents—many adults live with the daily challenges these conditions bring. Pain, postural imbalance, stiffness, and reduced quality of life are common concerns. Thankfully, research-backed physiotherapy approaches, like Physiotherapy Scoliosis Specific Exercises (PSSE), offer a conservative and effective pathway to manage these issues and improve everyday function.

In this blog, we explore how PSSE can support adults with scoliosis and other spinal deformities, the key principles behind the method, and why seeking specialised care is essential.

What Is PSSE and How Does It Differ from Traditional Physiotherapy?

PSSE stands for Physiotherapy Scoliosis Specific Exercises—a specialised approach tailored to individuals with spinal curvature disorders. Unlike generic physiotherapy exercises, PSSE targets the specific spinal curve pattern, postural asymmetry, and muscle imbalances associated with conditions like scoliosis, kyphosis, and other spinal deformities.

This method requires advanced training beyond standard physiotherapy education. Therapists skilled in PSSE are trained to understand the complex three-dimensional nature of spinal deformities and how to apply active correction techniques effectively and safely.

Why Is PSSE Important for Adults?

Although PSSE is widely recognised in managing scoliosis in children and adolescents, adult spinal deformities require a modified approach. Adult cases are often more complex due to the presence of degenerative changes, age-related kyphosis, chronic pain, and structural stiffness.

Adult spinal conditions may include:

• Idiopathic scoliosis

• Degenerative (de novo) scoliosis

• Scheuermann’s kyphosis

• Age-related kyphosis

• Postural deformities leading to spinal pain

Crucially, these conditions should not be managed as non-specific low back pain. Instead, they should be assessed and treated by physiotherapists with expertise in structural spinal disorders and PSSE methods.

Core Elements of PSSE

The primary goals of PSSE in adults are to:

• Minimise progression of spinal deformities

• Improve sagittal and coronal balance

• Reduce pain and postural fatigue

• Enhance functional ability

• Improve overall quality of life

The key components of PSSE include:

• Active Self-Correction: Teaching patients how to actively improve their posture and spinal balance and alignment.

• Stabilisation of Corrected Posture: Strengthening and motor control exercises to maintain the improved posture.

• Integration into Activities of Daily Living (ADLs): Applying corrected posture during everyday tasks like sitting, walking, or bending.

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In adults, elongation of the spine and restoration of lumbar and thoracolumbar extension are key corrective goals. Exercises are often performed in various positions (lying, kneeling, sitting, standing) and may begin with the use of props to assist correction. Gradually, resistance can be added to build strength and endurance, reducing postural collapse and relieving pain.

Supporting Adults with Higher Levels of Pain and Disability

For adults experiencing more severe pain or functional limitation, PSSE may be combined with additional interventions to maximise benefit. One such intervention is bracing, particularly during upright functional tasks. Bracing can help support the spine, improve alignment, and reduce pain by offloading stressed structures and preventing postural collapse.

Furthermore, these patients often benefit most from a multidisciplinary approach. Collaborating across healthcare disciplines allows for a more comprehensive and individualised treatment plan. A multidisciplinary team (MDT) may include:

• Physiotherapist (trained in PSSE)

• Spinal Specialist or Surgeon

• General Practitioner (GP)

• Orthotist (for bracing)

• Podiatrist

• Psychologist

• Pain Specialist

Together, the team works to manage symptoms, optimise physical function, and improve quality of life—especially for those with complex needs or significant structural deformity.

Evidence Supporting PSSE in Adults

Research supports the effectiveness of PSSE in improving function and reducing symptoms in adults with scoliosis and spinal deformities. For example:

• A study by Monticone et al. (2016) showed that PSSE can lead to significant improvements in disability, and quality of life.

• Negrini et al. (2015) found that 68% of adult patients experienced improvement in their spinal curvature (measured by Cobb angle) following a tailored PSSE program.

These findings highlight the value of a structured, specific exercise approach over generalised physiotherapy or passive treatments.

Conclusion

Living with scoliosis or spinal deformity as an adult doesn’t mean resigning to pain or postural dysfunction. PSSE offers a proactive and effective way to regain control, reduce discomfort, and improve how your spine functions in daily life.

If you're an adult experiencing symptoms related to scoliosis or a spinal deformity, consider consulting a physiotherapist with specialist training in PSSE. A personalised exercise program could be a transformative step toward better posture, reduced pain, and a higher quality of life.

References:

• Monticone, M., et al. (2016). Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. BMC Musculoskeletal Disorders.

• Negrini, S., et al. (2015). Adult scoliosis can be reduced through specific SEAS exercises: a case-control study. European Journal of Physical and Rehabilitation Medicine.