A curve in the spine is common and usually painless. How scoliosis is checked, when bracing or surgery is needed, and where physio exercises help.
It is often a parent who notices first: one shoulder blade sticks out a little more than the other, a school uniform hangs unevenly, or one hip looks higher when their teenager bends over. Or it is an adult whose X-ray report for back pain mentions a "scoliotic curve".
Scoliosis means a sideways curve of the spine, usually with some twisting of the vertebrae. Most curves are mild and never cause problems; some need monitoring through the teenage growth spurt; a small number need a brace or surgery. This guide explains the types of scoliosis, how it is checked, the treatment options, and where physiotherapy fits — for teenagers and for adults.
At a glance
- What it is: a sideways curve of the spine of 10 degrees or more on X-ray, usually with rotation
- Most common type: adolescent idiopathic scoliosis, affecting roughly 1–3% of adolescents
- Who: mild curves occur in boys and girls; larger, progressive curves are much more common in girls
- Key risk period: the adolescent growth spurt, when curves are most likely to increase
- Treatment: monitoring, scoliosis-specific exercises, bracing during growth, or surgery for large curves
- In adults: degenerative scoliosis is common with ageing and is usually managed without surgery
Types of scoliosis
Adolescent idiopathic scoliosis
"Idiopathic" means no single cause has been found. It accounts for most scoliosis in young people and usually appears between about 10 years of age and the end of growth. A review in the Journal of Children's Orthopaedics estimated it affects around 1–3% of adolescents, with larger curves far more common in girls. Genetics play a part, and it often runs in families. It is not caused by carrying school bags, poor posture or sleeping position.
Other types in young people
- Congenital scoliosis: caused by vertebrae that formed differently before birth.
- Neuromuscular scoliosis: linked with conditions such as cerebral palsy or muscular dystrophy.
- Early-onset scoliosis: appearing before the age of 10, which needs specialist assessment.
Degenerative (adult) scoliosis
A curve can develop later in life as the discs and joints of the lower back age unevenly. A review in the HSS Journal describes it as common in older adults, often associated with back pain and spinal stenosis, and usually managed without surgery.
Functional scoliosis
Sometimes the spine curves because of something else — a difference in leg length, a painful muscle spasm, or a hip problem. When the cause is treated, the curve straightens. This is different from structural scoliosis, where the spine itself is curved and rotated.
Signs to look for
- One shoulder higher than the other
- One shoulder blade more prominent
- Uneven waist creases, or one hip higher
- The body leaning to one side
- A rib hump on one side when bending forward
- Clothes hanging unevenly
The forward bend test
The simplest check is to ask the person to bend forward, letting their arms hang, while you look along their back from behind. A rib or lower back hump on one side suggests rotation of the spine. A physio or doctor may measure this with a small device called a scoliometer, and arrange an X-ray if needed.
“Most curves we see are mild and just need keeping an eye on. The important thing is to notice them early, especially before or during the growth spurt, so a growing teenager can be monitored properly.”
— UpPlus Physiotherapy team
How scoliosis is measured
The curve is measured on a standing X-ray using the Cobb angle — the angle between the most tilted vertebrae at the top and bottom of the curve. A curve of 10 degrees or more is defined as scoliosis. Doctors also consider how much growing the young person has left, because a curve is far more likely to increase during growth.
A review in The Lancet explains that curves that are still small at the end of growth rarely cause problems in adult life, while larger curves — especially those above about 50 degrees — are more likely to keep progressing slowly in adulthood. That is why treatment during growth aims to keep curves below that range.
Treatment for teenagers
Treatment depends on the size of the curve and how much growth remains. International guidelines from the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) describe a stepped approach.
Observation
Small curves are monitored with regular check-ups and X-rays during growth, to catch any increase early.
Scoliosis-specific exercise
Physiotherapeutic scoliosis-specific exercises (PSSE), such as the Schroth method and the SEAS approach, teach the young person to actively correct their posture in three dimensions, breathe into the concave side, and strengthen the trunk in a corrected position. The evidence is still developing:
- A Cochrane review found only low-quality evidence for exercise in adolescent scoliosis, so firm conclusions were not possible at the time.
- More recent randomised trials have been encouraging: an Italian trial found active self-correction and task-oriented exercises reduced curve size and improved quality of life in mild scoliosis, and a Canadian trial found Schroth exercises added to standard care led to better Cobb angle outcomes than standard care alone.
Scoliosis-specific exercise is generally used for mild curves, and alongside bracing for moderate curves.
Bracing
For moderate curves in a growing teenager, a rigid brace worn for many hours a day can stop the curve progressing. The landmark BrAIST trial in the New England Journal of Medicine found bracing significantly reduced the number of teenagers whose curves progressed to the range where surgery is usually recommended — and the more hours the brace was worn, the better the result.
Living with a brace
Brace treatment asks a lot of a teenager, so it helps to know what to expect:
- Hours matter. The brace is usually prescribed for many hours a day, often including overnight. In the BrAIST trial, teenagers who wore it longer did better.
- It is temporary. Bracing continues until growth is finished, then is weaned off under the specialist's guidance.
- Sport continues. Most teenagers take the brace off for sport and physical education, which keeps them fit and social.
- Skin care — a thin cotton layer under the brace and daily skin checks prevent rubbing.
- Exercises out of the brace keep the trunk strong and flexible, and scoliosis-specific exercises are often combined with bracing.
Surgery
For large curves, usually around 45 to 50 degrees or more, a spinal surgeon may recommend surgery to straighten and stabilise the spine. Most young people return to school within weeks and to most sports within months, guided by their surgeon. Physiotherapy after surgery helps with walking, breathing, confidence with movement, and a gradual return to strength and sport.
What does a scoliosis exercise session look like?
People are often curious about what "scoliosis-specific" exercise actually involves. It is quite different from a general gym programme. A typical session for a teenager includes:
- Learning their curve. Using a mirror, photos and their X-ray, the young person learns which way their spine bends and twists.
- Active self-correction. Gently lengthening the spine and shifting the trunk to reduce the curve, then holding that corrected posture.
- Rotational breathing. Breathing into the flatter side of the rib cage to encourage expansion where the ribs are compressed.
- Strengthening in correction. Exercises for the trunk, hips and shoulders performed while holding the corrected posture.
- Bringing it into daily life. Practising the correction while sitting in class, standing, carrying a bag or doing homework.
The aim is a short daily home programme the young person can actually keep up, with regular reviews to progress it. Consistency matters far more than intensity.
Scoliosis in adults
Adults may have scoliosis left over from adolescence, or a degenerative curve that developed later. Many have no symptoms. When symptoms occur, they are usually back pain, stiffness, or leg symptoms from nerve narrowing (spinal stenosis). Physiotherapy for adults focuses on:
- Strengthening the trunk, hips and legs
- Mobility and posture awareness exercises
- Aerobic fitness and staying active
- Managing leg symptoms from stenosis, for example with cycling and flexed-posture activities
- Pain management and pacing
Surgery for adult scoliosis is a significant undertaking and is usually reserved for severe, progressive curves or significant nerve compression that has not responded to other treatment.
Questions to ask at a scoliosis check-up
- How large is the curve, and where is it?
- How much growth is left, and what is the risk of the curve increasing?
- How often should it be rechecked, and will that need an X-ray?
- Is a brace, exercise, or simply monitoring the right plan right now?
- Are there any activities to avoid? (Usually there are very few.)
- What signs mean we should come back sooner?
Writing the answers down, and keeping copies of X-ray reports, makes it much easier to track the curve over time — particularly if you see different health professionals along the way.
Living well with scoliosis
- Sport and exercise are encouraged. Swimming, netball, football, dance, gym — there is no need for a teenager with scoliosis to sit out.
- Strength and fitness help the spine cope with daily life.
- Backpacks do not cause scoliosis, but using both straps is kinder to a sore back.
- Emotional support matters, especially for teenagers wearing a brace. Being involved in decisions helps.
Myths about scoliosis
- "Bad posture causes scoliosis." Idiopathic scoliosis is not caused by posture, bags or sleeping position.
- "Exercise can cure it." Exercise can help manage curves and may reduce progression in some, but it does not make structural scoliosis disappear.
- "Teenagers with scoliosis shouldn't play sport." Activity is encouraged.
- "Scoliosis always causes pain." Adolescent scoliosis is usually painless; significant pain should be assessed.
- "Every curve needs a brace." Bracing is for moderate curves in growing teenagers.
When to see a physio or doctor
- You notice uneven shoulders, hips or a rib hump in a child or teenager
- A teenager has a family history of scoliosis and is entering the growth spurt
- An adult has back pain or leg symptoms and a known curve
See a doctor promptly if a young person with a curve has significant back pain, night pain, numbness, weakness or bladder changes, or if the curve appeared before the age of 10 or is increasing quickly.
How UpPlus Physiotherapy helps
- Screening for scoliosis and referral for X-ray and specialist review where needed
- Exercise programmes for teenagers that complement monitoring or bracing
- Strength, mobility and pain management for adults with scoliosis
- Helping active young people stay in their sport safely
Read more about upper back pain, spinal stenosis and our back pain physiotherapy.
Finding a physio near me for scoliosis
When searching for the best physio for scoliosis, look for someone who checks the curve properly, knows when an X-ray or specialist review is needed, and gives exercise advice that fits the person's age, curve and goals.
Our clinic is at 177 Trimmer Parade, Seaton, a short drive from Woodville, Findon, West Lakes, Grange and Fulham Gardens. No referral is needed, and you can claim on the spot with private health cover.
Physio take-home message
- Scoliosis is common and usually mild and painless.
- The growth spurt is the key time to monitor teenagers' curves.
- Bracing works for moderate curves in growing teenagers.
- Scoliosis-specific exercises are a promising option, especially for mild curves.
- Stay active: sport and strength training are encouraged at every age.
If you are worried about a curve in your own or your child's spine, our physiotherapists can assess it and guide the next steps. Book online or call 0403 907 587.
This article is general information, not a diagnosis or a substitute for an individual assessment. If you are unsure about a curve or symptoms, see a health professional.
