Physical Therapy Scoliosis Management

Scoliosis is a condition that affects the normal shape of the spine, altering a person’s back alignment and posture and causing a lateral “s” or “c”-shaped curve in the spine. The abnormal curvature of the spine can place stress on the surrounding muscles and joints, causing loss of strength and flexibility in the spinal and back muscles over time. Physical therapy is an effective, non-invasive treatment method to manage scoliosis, stabilize the scoliosis curve, improve postural alignments, enhance neuromuscular control and muscular strength, and improve overall function in individuals with scoliosis.

What is Scoliosis?

Scoliosis is a condition that affects the normal shape of the spine, altering a person’s back alignment and posture. The spine curves abnormally to the side, forming either a “c” shape [when the lumbar and thoracic spine curve in one direction together] or “s” shape [when the lower lumbar spine curves one way, while the middle thoracic spine curves the opposite direction]. It is most often diagnosed during the teen years and affects men and women equally, though women may experience more progressive scoliosis and require more treatment.

Scoliosis is diagnosed by your doctor who may order an x-ray to assess the spine curvature and the Cobb angle. The Cobb angle is a measurement of the spine’s curvature that determines if scoliosis is present and its severity. A person has scoliosis if the curve is greater than a 10-to-15-degree Cobb angle. Treatment involves a team of doctors: your family doctor, an orthopedic surgeon, an orthotist (bracing specialist), and a physical therapist.

There are four different types of scoliosis:

1. Adolescent idiopathic scoliosis (AIS): AIS is the most common type of scoliosis in children ages 10 to 18. There is no known cause, though about 30% of children with AIS have a family history of scoliosis. Scoliosis is the most common pediatric deformity of the spine.

2. Congenital scoliosis: This type occurs from a defect in the bones of the spine that causes scoliosis at birth. The spinal curve becomes more noticeable as the child grows.

3. Neuromuscular scoliosis: This type of scoliosis can develop from conditions of the nervous system like cerebral palsy or muscular dystrophy, which weaken the muscles that support the spine. The spine has a “c” shape.

4. Early-onset scoliosis: There is no known cause for this type of scoliosis. It occurs in infants and youth, diagnosed between birth and age three. When a child is diagnosed with scoliosis before age 10, it is labeled as Juvenile scoliosis.

Scoliosis doesn’t normally cause pain, but pain can develop due to the abnormal curve of the spine placing stress on the surrounding muscles and joints, causing changes in body alignment, posture, and movement patterns. The muscles that support the spine can become imbalanced and lose strength and flexibility over time.

Common signs of scoliosis can include:

• Uneven shoulder height

• Uneven hip height

• Uneven waistline

• Bony bump on one side of the back

• Appearance of a difference in leg length

• Pain in areas around the spine like the shoulder, pelvis, or hip

• Pain with specific movements and activity

• Sense that the two sides of the body don’t line up/are not symmetrical

Physical Therapy Management for Scoliosis

Physical therapy is an effective, non-invasive treatment method to manage scoliosis, stabilize the scoliosis curve, improve postural alignment, enhance neuromuscular control and muscular strength, and improve overall function in individuals with scoliosis. Physical therapy is a relevant treatment option during all phases of scoliosis. It is particularly effective when scoliosis is diagnosed early on, but also plays an important role in improving function when combined with bracing as well as regaining strength and mobility after surgery.

The aim of physical therapy management of scoliosis is to decrease the side-to-side curvature, slow down the curve progression of the spine, improve breathing function and muscular balance, decrease pain and stress on the back, and improve posture.

Physical therapy management for scoliosis can include:

• Manual therapy: using joint and soft tissue mobilizations, the therapist uses manual therapy to help restore motion to joints and muscles restricted by scoliosis and gently retrain movement patterns.

• Modalities: to manage pain, the therapist may use ice, heat, electrical stimulation, or deep heat ultrasound to relieve back pain.

• Patient education: the therapist provides education on the effect of scoliosis on the body as well as movement strategies to manage the condition and activities of daily living.

• Range of motion exercises: the therapist guides the patient through gentle range of motion exercises, particularly of the spine.

• Targeted strengthening exercises: the therapist specifically targets muscles of the spine to address any muscular imbalances in the back as well as strengthening other body parts that have been weakened by scoliosis like the hips and shoulders.

• Functional training: the physical therapist teaches proper movement patterns and body mechanics and retrains the body for optimal movement and function.

Growing evidence has shown that physiotherapeutic scoliosis-specific exercises (PSSE) provide effective management of scoliosis, particularly adolescent idiopathic scoliosis. Analysis of the latest studies on physical therapy for scoliosis has revealed that physical exercise can stabilize and even reduce the size of the scoliotic spinal deformity.

One of the most popular and well-studied PSSEs is the Schroth method, which utilizes isometric muscle contraction exercise to rotate, lengthen, and stabilize the spine. The Schroth method exercises are customized to the patient’s individual needs and scoliosis condition and have three components: 1) muscular symmetry, strengthening weak and wasted muscles on one side of the back and addressing overworked and prominent muscles on the other side of the back, 2) rotational angular breathing, which involves rotating the spine when breathing to help reshape the rib cage and surrounding soft tissue, and 3) postural awareness, particularly during daily activities for correct body mechanics. Research has shown that after the Schroth program, patients can see visible improvements in the degree of the spinal curvature and reductions in the Cobb angle.  

A randomized controlled trial assessed 110 male and female patients under the age of 10, 55 of whom were assigned to an experimental group who underwent active self-correction, task-oriented spinal exercises, and patient education and 55 of whom were assigned to the control group, who followed conventional spinal exercise rehabilitation. The experimental group showed a decrease in the Cobb angle of the spine by more than 5 degrees, while the control group remained unchanged. Benefits persisted at least a year following the intervention in the experimental group.

A recent 2022 study assessed the effect of PSSE on 52 patients with mild juvenile idiopathic scoliosis, ages 4-9 years. Patients in the PSSE group performed corrective posture exercises daily and over-corrective training based on the Schroth method for 30 minutes each day. After one year of treatment, the Cobb angle in the PSSE group decreased from 15 degrees to 5 degrees, while the Cobb angle in the observation group (no intervention) increased from 13.5 to 16 degrees. The angle of trunk rotation in the PSSE group decreased from 5 degrees to 3 degrees. The PSSE treatment was successful in decreasing the Cobb angle and angle of trunk rotation in scoliosis patients.

Scoliosis is a condition requiring lifelong management. Work with a physical therapist to help you manage the condition and maintain function and mobility safely!