Adolescent Scoliosis

By: Dr. Rebecca Van Heuklon, DPT, FAFS, FMR

What is scoliosis?

Scoliosis is a deformity of the spine where an abnormal curve is present.  Although commonly thought to only affecting the lateral (side to side) plane of the spine, it actually affects all 3 planes of movement, where it can also cause either excessive straightening or rounding of the back as well as causing abnormal rotation of the spine.  Scoliosis can affect only the upper or thoracic portion of the spine, only the lower segment of the spine known as the lumbar spine, or it can affect both.  There are 2 main types of curves in scoliosis, one that involves a single “C” curve and another called an “S” curve that is made up of 2 “C” curves that come together in opposite directions.  These curves cause asymmetries of the spine, which can then affect the position of the rest of the body, including the neck, rib cage, shoulder blades, pelvic bones, and limbs.

What are the different types of scoliosis?

The most common type of scoliosis is called adolescent scoliosis, which develops between the ages of 10-15 years old.  It typically presents or worsens around puberty during significant growth spurts.  Scoliosis is more common and typically more severe in females than in males.  The majority of cases are idiopathic, which means there is no known cause.  Less commonly, scoliosis can be congenital, where a spine deformity develops in utero and is present at birth, or it can be juvenile, where it develops during early childhood before puberty.  Scoliosis can also be categorized as neuromuscular, where it is caused by an underlying disorder like cerebral palsy, spina bifida, or Ehlers-Danlos syndrome.  Although far less common, scoliosis can also present later in life, when it is called degenerative scoliosis.  In these cases, it is usually associated with degenerative changes caused by osteoporosis, compression fractures, trauma, arthritic changes, and/or muscle weakness that result in asymmetries in the spine.  Finally, scoliosis can be further categorized as either structural in which the deformity is permanent as is caused by a traumatic injury or defect in the spine, or functional in which the curve is modifiable and can be influenced by conservative treatment.

How is scoliosis diagnosed?

There are a number of signs to look for when identifying scoliosis.  One of the most well-known signs is a deformity known as a “rib hump,” which is a prominence on one side of the rib cage that becomes evident when a person flexes forward.  Other signs include one shoulder blade that sits higher or sticks out more than the other, uneven hip height, or what appears to be uneven arm length. In addition, back pain and having difficulty breathing can be common symptoms. 

Scoliosis is first diagnosed through a physical exam by either a physical therapist, doctor, or other medical provider and is further confirmed and quantified using special standing X-rays.  These X-rays allow doctors to determine what is called the Cobb angle of the curve(s), which indicates the severity of the scoliosis and helps to monitor whether the condition is stable or progressing.  If the Cobb angle is greater than 10 degrees, a diagnosis of scoliosis is given.  It is common for X-rays to be taken every 3 to 6 or 12 months to determine the angle of the curve(s), track the progression, and determine if and what type of treatment is indicated.

What treatment options are available for scoliosis?

Whether or not treatment for scoliosis is indicated depends on a number of factors including age, whether the person is still growing, the severity of the curve, and if other symptoms like pain, numbness, tingling, or difficulty breathing are present.  Physical therapy plays a prominent role in treatment at all stages of scoliosis.  Goals for attending physical therapy include optimizing posture; improving breathing and lung capacity; decreasing pain, numbness, and tingling; increasing flexibility, mobility, and strength; and if possible, slow worsening of the curve.  Physical therapists achieve these goals through a variety of methods.  Education is a key component of treatment and can include teaching about posture and ways to improve it, deep breathing techniques and exercises, activity modifications to avoid flaring symptoms, and pain relief strategies.  Treatment for scoliosis commonly requires manual therapy that involves soft tissue work to loosen tight muscles and joint mobilization to improve spine mobility.  It is also vital for treatment to include exercises that work on increasing spine flexibility and mobility moving out of the curve(s), followed by strengthening and stability exercises to help maintain the improved posture and movement patterns.   Overall, these treatment strategies lead to decreased pain and increased function.

Bracing can also be used as a treatment intervention and can be done independently or in conjunction with physical therapy.  It is primarily used in adolescent scoliosis when the Cobb angle has progressed to 25-40 degrees.  Bracing will only help to slow or stop the progression of the curve, but does not reverse a curve that has already developed.  Use of a brace is usually recommended until the adolescent stops growing, as this is the timeframe when the curve will typically progress the most.  One randomized control trial found that bracing for at least 18 hours per day for patients with adolescent idiopathic scoliosis resulted in a 72% success rate in preventing progression to surgery compared to 48% in the control group.¹  The study also highlighted how success was directly related to how compliant the person was in wearing the brace.  Researchers found that the patient needs to wear the brace at least 13 hours per day to have a successful effect and that less than 6 hours per day resulted in no improvement compared to the observation-only group.¹

Surgery may also be considered if more conservative treatment including physical therapy or bracing are unsuccessful at slowing or stopping the progression of the curve.  This option is used when the curve has either progressed beyond 40-50 degrees or is significantly affecting breathing, function, or pain.  The most common surgical approach is to do a spinal fusion using rods and screws.  Which levels of the spine and how many levels are fused with the surgery vary from person to person.  This is determined based on which segments are most involved in the curve, while still leaving some levels mobile for function.  Since a multi-level fusion is a major surgery to undergo and does limit one’s mobility permanently, this option is a last resort when all other conservative measures have failed.  After surgery, physical therapy is an important component to help decrease pain, increase mobility, flexibility and strength, and help regain maximal function.

If you or a family member have been diagnosed with scoliosis and wants to learn more about how physical therapy can help, contact MotionWorks Physical Therapy at 920-215-2050 for more information.


  1. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512-1521.


Photos published with permission.

Photo credits: Three Otters Photography, Appleton