Scoliosis: Causes, Signs & Treatment Options

Written by Leon Mao
Physiotherapist, University of Melbourne
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on March 17, 2022
Contributed by Nikita Mistry
Physiotherapist, Western Sydney University

Woman sitting on the edge of a treatment table being assessed by a physiotherapist

According to the Australian Journal of General Practice, up to 5.2% of the population will develop some form of scoliosis.[1] Females are seven times more likely to develop severe scoliosis compared to males.[1] Usually, scoliosis is diagnosed anywhere between childbirth to adulthood. However, almost 90% of cases will be diagnosed during adolescence.[2]

The word scoliosis comes from the Greek word meaning bent or curved. Not all people with spinal asymmetry will have scoliosis. There is a common misconception that any additional curvature of the spine is a form of scoliosis. The most reliable way to determine this condition is through a physical examination by a health professional and X-ray imaging.

Read on to understand what you should know about scoliosis; the risk factors, treatment options and expected recovery time.

What is Scoliosis?

Scoliosis is a condition where the spine can become rotated and curved in a sideways manner. As a result, people with scoliosis will often present with uneven and asymmetrical posture. Depending on the severity of the scoliosis, people may or may not notice additional symptoms.

What are the symptoms of scoliosis?

Most cases of scoliosis are mild, with minor back pain as the primary symptom. Severe scoliosis can be painful, with symptoms including chest pain and difficulty breathing. People commonly experience uneven shoulder and waist heights, a twisted rib cage and uneven back muscle tone.[1]

Mild symptoms of scoliosis

  • Uneven shoulder blades

  • Uneven hips

  • Uneven waist

  • A noticeable hump on one side of the back when bending forward

  • Back pain and muscle spasms

  • One leg is shorter than the other

Severe symptoms of scoliosis

  • Difficulty breathing or fatigability

  • Issues with mobility

  • Inability to bend forward to full range

  • Difficulty standing up straight

What causes scoliosis?

Scoliosis can occur without an apparent reason. There are several medical conditions that cause scoliosis, including; cerebral palsy, muscular dystrophy, spina bifida, and spinal injuries or infections.

Risk factors associated with scoliosis

  • Neuromuscular conditions (cerebral palsy or muscular dystrophy)

  • Congenital disabilities (spina bifida)

  • Injury to the spine

  • Infection of the spine

  • Habitual posture

How is scoliosis diagnosed?

Scoliosis may be hard to identify during the early stages. Most cases of scoliosis happen during puberty and have a high risk of progression until the age of 21. If there are any signs or concerns regarding scoliosis, then the best approach is to have an assessment from a qualified physiotherapist.

There are several options available when it comes to diagnosing your back pain as scoliosis. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

The gold standard assessment process for diagnosis of scoliosis is measurement using the Cobb angle formula. This measurement looks at the most severe part of the curve (the apex).

From there you must find the two most tilted vertebrae above and below the apex, a straight line is then drawn between those two points with the result being known as the Cobb angle.

The Cobb angle helps determine the severity of the scoliosis, and therefore the best plan for treatment.

Cobb AngleSeverity
0-20 degreesMild
20-40 degreesModerate
40 + degreesSevere

Through years of intensive clinical experience, physiotherapists can accurately diagnose and assess postural deformities like scoliosis. The process of physiotherapy assessment is simple yet comprehensive.

The initial part of the consultation with a physiotherapist is the subjective assessment process, where you will be asked a series of questions to understand the history of your back problems.

After establishing the background of your condition, your physiotherapist will perform specific physical screenings to determine if you have scoliosis and rule out other conditions that may cause problems in your posture.

Following your initial assessment, your physiotherapist will provide you with a tailored treatment plan based on the severity of your scoliosis.

From here, your physiotherapist will give you the details of your treatment program,including:

  • Number of treatment sessions required

  • Techniques on how you can improve your posture

  • List of exercises you need to do at home

  • Overall management plan.

How is scoliosis treated?

There are several options when it comes to treating scoliosis. One of the more common, and the treatment option that is referred by Australian GPs most frequently, is physiotherapy.

Intermittent back pain will come and go, and your posture may be aesthetically affected. Additionally, scoliosis in children has a high risk of progression, making it vital to seek professional help for early intervention.

Postural problems and muscle imbalances can only be addressed by physical intervention.

Scoliosis is a condition that physiotherapists come across regularly, and the process of managing it is straightforward. Following an initial consultation, the physio will be in the best position to determine your treatment plan.

A combination of manual therapy, specific movement exercises and postural training will be given to you by your physiotherapist. Physiotherapists are experts in dealing with postural deformities and muscle imbalances.

Cobb AngleSeverityPlan for treating scoliosis
0-20 degreesMildPhysiotherapy and exercises
20-40 degreesModeratePhysiotherapy, bracing, exercises
40 + degreesSeverePossible surgery, bracing, physiotherapy, exercises

Depending on the severity of your scoliosis, a physio may provide you with a combination of the following types of treatments:

  • Therapeutic Exercises - Gentle exercises to help with imbalances in the spine.

  • Scoliosis Specific Exercises (Schroth Best Practice Exercises) - A specific regime of exercises tailored to the treatment of scoliosis.

  • Manual Therapy - Hands-on treatment to help reduce pain and muscle spasms.

  • Stretching - Specific exercises to try and minimise the imbalances in the spinal curve.

  • Joint Mobilisation / Manipulation - Used to try and reduce the pain/stiffness that may come from scoliosis.

  • Myofascial Release - A strong, massage-like technique used to reduce muscle tension.

  • Soft Tissue Mobilisation - Physio specific techniques to improve movement and reduce pain.

  • Dry Needling - Similar to acupuncture, dry needling can help reduce muscle spasm and pain.

A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel benefits in just one session.

Next step: Creating a treatment plan for you

Following your initial appointment, the physiotherapist will craft a tailored treatment plan that will highlight the course of action required. This will include what exercises you need to do at home and provide you with a timeline for how long it should take for a full recovery.

Self-care for scoliosis

If you think you have scoliosis, here are the best things you can do and avoid.

Things to do:

  • Maintain proper posture

Scoliosis is a postural problem. Habitual posture may contribute to the progression of your curve. As much as possible, avoid slouching posture when working on a computer or sitting on a chair. Practice keeping a nice standard curve on your lower back (lordosis) in everything that you do.

  • Stretching of the back muscles

Stretching your back can reduce tension in the muscles and decrease your pain. You can also try yoga, but not all stretching exercises and poses are applicable for scoliosis.

Discuss with your physiotherapist what exercises would be beneficial for your curve.

  • Relaxation / Massage

Gentle massage on your back muscles may help decrease muscle spasms and pain. Try to relax and know that you are in control of your body.

  • Practice good posture

Maintaining a good posture will decrease the stress and pressure on your neck muscles and spine. It will also promote overall spinal health, which will help to prevent injuries.

Things to avoid:

  • Avoid activities that worsen the pain

If you feel back pain, take a rest and let the symptoms subside. If you are working on a computer, be sure to take frequent rest in between and observe proper posture.

  • Avoid lifting heavy things on just one side

Scoliosis causes muscle imbalance in your back muscles. Lifting heavy things to just one side of the body can further increase the risk of your curve progression. As much as possible, do not use heavy sling bags or shoulder bags.

You can also ask your physiotherapist for strategies and techniques in coping with scoliosis.

For mild-moderate cases, physiotherapy treatment is sufficient to manage and maintain adequate mobility and strength. In severe cases, you may need additional services to help manage scoliosis.

Do I need a specialist or surgery?

In more severe cases, physiotherapy alone may not be sufficient enough to manage scoliosis. The first thing to do is see your GP, who can then arrange an X-ray to measure your curve (Cobb angle) accurately. This will also determine the classification of your scoliosis (“S” or “C” curve).

X-ray image identifying scoliosis

In severe cases of scoliosis with 40 degrees and above, surgery is an option to prevent compression of the heart and lungs. The surgeon will do a procedure called spinal fusion. In this surgery, the spine is fused using rods and screws to keep the spine straight.

If the scoliosis is diagnosed as moderate, then perhaps a bracing strategy may be used. This is usually used in combination with regular physiotherapy to prevent the progression of scoliosis through specific exercises and treatment.

It is important to note that not all cases of severe scoliosis need surgery. There are extreme scoliosis curves that are managed by Scoliosis Specific Exercises (Schroth Method/Schroth SBP) and supervised by physiotherapists alone.

If your physician determines that your scoliosis is manageable with conservative treatment, they may coordinate with your physiotherapist to provide you with proper treatment.

What is the recovery time / prognosis for scoliosis?

Scoliosis is a permanent deformity of the spine. The best treatment is to manage the curvature, improve your posture and prevent the progression of the scoliosis curve.

You may immediately feel signs of pain-relief after seeing a physiotherapist, however, it is important that you continue with your program to strengthen muscles and correct your posture to prevent curve progression.

Can scoliosis be prevented?

Most cases of scoliosis are of unknown cause (Idiopathic). Studies point to the combination of genetic predisposition and environmental influences as primary risk factors of having scoliosis.

Unfortunately, you cannot prevent idiopathic scoliosis. You can however stop scoliosis from progressing with the right exercises, postural training, and bracing.

  • Exercise: Building strong core and back muscles through regular strengthening exercises can help you stabilise the spine and prevent pain. Not all activities are beneficial for scoliosis. Scoliosis-specific exercises are also proven to improve scoliosis and prevent its progression. Discuss your treatment programs and exercise options with your physiotherapist.

  • Bracing: Proper brace fitting can decrease the scoliosis curve over time. Your doctor, physiotherapist, and orthotist usually collaborate to give you the best bracing options tailored for your curve.

  • Postural Training: Postural training can help you prevent and treat your postural problems. Correcting the muscle imbalances around your spine can significantly improve your posture.

Being mindful of how you sit and stand can go a long way. An optimised posture decreases the stress on the spine and other joints, thus preventing pain and improving overall well-being.

Outlook and the main takeaways

If there is one main take away from this article, it is that there are many causes, symptoms and severities of scoliosis. The most important thing to understand is that scoliosis cannot be magically cured. The best outcomes for patients with scoliosis come from hard work and regular management. Book a time with a local physiotherapist today to begin treatment as soon as possible!

Anatomy of the spine

Your spine consists of 24 separate bones called the vertebrae, together with five fused bones on the lower part of the spine, the sacrum, and four fused vertebrae of the coccyx.

  • 7 Cervical Vertebrae (Neck and Upper Back)

  • 12 Thoracic Vertebrae (Mid Back)

  • 5 Lumbar Vertebrae (Low Back)

Scoliosis usually affects the thoracic vertebrae with secondary compensation of lumbar vertebrae, resulting in double curvature of the spine in the upper back and lower back region.

Written by Leon Mao
Physiotherapist, University of Melbourne
Published on March 17, 2022
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on March 17, 2022
Contributed by Nikita Mistry
Physiotherapist, Western Sydney University
Medical reviewers
Last medically reviewed on March 17, 2022 has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
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