5 Tips from a Physical Therapist About Scoliosis in Children and Adults

Is scoliosis serious?

Scoliosis is a relatively common back deformity that manifests very differently from person to person.

• The extent of the deformity varies: scoliosis can be mild, moderate, or severe.
• Associated pain levels vary and are not necessarily correlated with the degree of deformity.

In other words, having a significant deformity does not mean you will necessarily have more back pain related to scoliosis.

According to studies, 1 to 8 out of 10 people with scoliosis experience NO pain [Ilharreborde 2023].

The extent of the deformity DOES NOT worsen over time in some people.

It is more likely to worsen [Lenz 2021]:

• in children under 13 at the time of diagnosis: early-onset or juvenile idiopathic scoliosis (between 3 and 9 years) vs. late-onset, which is more common;
• with a family history of scoliosis;
• with rapid growth of more than 7-8 cm per year;
• depending on the presence of certain radiological criteria such as a Cobb angle greater than 25° and your bone density;
• during pregnancy.

If the deformity progresses too much, complications can occur in some people: lumbar radiculopathy, aesthetic problems (with psychological impact), nerve damage, and more rarely, cardiac and pulmonary consequences [Menger 2023].

Complications can also arise from surgery.

In summary: scoliosis is a relatively common deformity (1 to 3 adolescents out of 100) with minimal consequences for the majority of people. However, a minority may experience medium- to long-term complications, especially if the deformity worsens.

Why do some people have scoliosis and others do not?

Idiopathic scoliosis (without any identifiable cause other than likely genetic) is the most common. It usually appears during puberty.

Several hypotheses are proposed to explain it, but none have reached a consensus [Menger 2023]:

• Hormonal causes
• Asymmetric growth
• Muscle imbalance
• Genetic factors: nearly 3 out of 10 affected children have a family member with scoliosis

There are other types of scoliosis that affect adults or children:

• Congenital scoliosis: present from birth, sometimes associated with other diseases, often of genetic origin
• Degenerative scoliosis: in aging adults, due to vertebral wear and osteoarthritis
• Neuromuscular scoliosis: in individuals with neurological diseases such as cerebral palsy or muscular dystrophy, due to genetic diseases, or problems during pregnancy or birth, especially in the case of premature birth.

What Sport to Practice?

All sports are allowed in cases of scoliosis and are even recommended because they are more likely to have a positive rather than negative impact on the progression of scoliosis and associated pain.

Patients often ask us: “Is swimming good for my back? And what about rugby and judo, are they bad for my scoliosis?”

There is no strong evidence in favor or against any specific sport being worse for the back.

In studies that follow the progression of children and adults with or without scoliosis, nothing suggests that practicing a particular sport will worsen the condition.

If a sport is painful, stopping or reducing the activity seems appropriate. But this applies whether or not you have scoliosis!

The only times when sports might be discouraged are following scoliosis surgery.

During the bone healing period of a few weeks or months, sports with too much impact or those that heavily engage the back muscles (running, combat sports, football, etc.) are not recommended.

Source: Negrini 2023

Does Having Scoliosis Reduce Life Expectancy?

No, the vast majority of people with scoliosis do not have their life expectancy reduced because of this condition.

People with early-onset idiopathic scoliosis (occurring before puberty) and severe forms (with deformities of several tens of degrees) may sometimes have a shorter life expectancy than the general population.

The same applies to individuals with non-idiopathic forms of scoliosis. However, this is more due to associated pathologies rather than the scoliosis itself.

People who undergo scoliosis surgery are exposed to risks associated with anesthesia and the surgical procedure.

Source: Weiss 2016, Helenius 2014

How is Scoliosis Treated?

Several factors determine the treatment approach for scoliosis, including the extent of the deformity, age at onset, personal preferences, and the treatment practices of the healthcare providers involved.

Treatment options range from:

• Regular clinical monitoring (often with X-rays) without any specific treatment, typically when the scoliosis is between 10 and 25 degrees.
• Prescribing physical therapy sessions focused on exercise: exercises, stretching, etc.
• Wearing a custom-made rigid orthopedic brace during the day or at night, often for scoliosis between 25 and 40 degrees.
• Surgery, which can vary in complexity.

The two most extensively studied treatments are orthotic bracing and surgery. However, the impact of physical exercise is increasingly being researched, particularly for its effects on quality of life.

Source: Menger 2023, Ma 2024

What exercises to do for scoliosis?

The Cochrane Collaboration is an international and independent research network. Here are the conclusions they reached after reviewing the scientific literature on physical exercise for adolescent scoliosis [Romano 2024]:

We included 13 studies involving 583 participants. Most participants had mild to moderate scoliosis.

The therapeutic exercises evaluated in the studies varied in type and duration (between 12 and 42 months).

We are very uncertain whether therapeutic exercises are less effective than bracing in reducing curve progression in adolescents with moderate scoliosis or if they slightly improve quality of life.

We do not know if different types of therapeutic exercises make a difference in scoliosis progression, quality of life, and aesthetic issues.

None of the included studies evaluated adverse effects.

Is bracing useful?

Now, here are the conclusions from a Cochrane review on braces for scoliosis [Negrini 2015]:

Two studies have shown that wearing a brace did not change quality of life during treatment (low quality), nor did it affect long-term quality of life, back pain, or psychological and aesthetic issues (up to 16 years) (very low quality).

All included articles consistently demonstrated that wearing a brace prevented curve progression (secondary outcome).

Takeaway: Despite several decades of studies, it is challenging to conclude that wearing a brace or undergoing physical therapy has a significant impact on quality of life or pain in cases of mild or moderate scoliosis.

Is surgery beneficial?

There are no high-quality studies comparing the effectiveness of surgery versus conservative treatment for adolescents with scoliosis exceeding 45° [Bettany‐Saltikov 2015].

In a study following the progression of moderate idiopathic scoliosis (20-45°) in adolescents into adulthood over 40 years without surgery, scoliosis worsened (including those treated with braces), but their autonomy level, quality of life, and low pain were high [Farshad 2022].

Takeaway: The relevance of surgery is highly debated case by case. Over time, fewer adolescents with moderate to severe scoliosis undergo surgery.