Adult Scoliosis Physiotherapy

Adult scoliosis is not the same problem as scoliosis in a growing child. Some adults have a curve carried through from adolescence; many have a degenerative scoliosis that develops later in life as the discs and joints wear. In adults, the main issues are usually pain, stiffness, altered posture and sometimes nerve symptoms in the legs — rather than the curve size itself. This matters, because the realistic aim of physiotherapy in adults is to help with pain, function and quality of life, not to straighten an established curve.

For most adults with scoliosis, conservative care — physiotherapy, exercise, activity modification and pain management — is the sensible first-line approach, and the great majority never need surgery. My job is to determine whether your symptoms fit a picture that rehabilitation can help, and to recognise the smaller number of situations where surgical review is warranted: significant or progressive nerve compression causing leg symptoms and disability, a curve that is clearly progressing, or pain and deformity that are no longer manageable conservatively. Physiotherapy and surgery are not rivals; they sit at different points on the same pathway.

Delivered by a physiotherapist, a programme for adult scoliosis is generally aimed at building core and back strength, maintaining flexibility and mobility, improving posture and balance, and keeping you active and functional. Scoliosis-specific exercise methods such as Schroth are sometimes used in adults too. The emphasis is on managing symptoms and preserving function rather than on changing the shape of the spine.

The evidence in adults is more limited than in adolescents, and honesty is important here. Studies of conservative treatment in adult and degenerative scoliosis suggest that, although the curve itself is unlikely to reduce, exercise-based and conservative care can reduce pain and improve quality of life and physical function. Larger-cohort experience with structured scoliosis exercise programmes has reported reductions in pain. The main limitation across studies is adherence — the benefits depend on the exercises being done consistently, and real-world take-up can be low. So the reasonable expectation is meaningful help with symptoms and function for many people, rather than correction of the curve.

• Adults with scoliosis whose main problems are back pain, stiffness or deconditioning
• People who want to stay active and manage symptoms without, or before, considering surgery
• People recovering function and confidence, including alongside pain management or injections
• It is not a substitute for surgical assessment where there is significant or progressive nerve compression, disabling leg symptoms, or a clearly progressing curve

Rehabilitation is low-risk and, for many adults, genuinely helpful for pain and function. It will not reverse an established curve, and it is one part of a broader plan that may also include pain management and, occasionally, injections. As a surgeon, I would encourage you to seek review if you develop worsening leg pain, numbness or weakness, difficulty walking, or problems with bladder or bowel function, or if pain and deformity are becoming disabling despite good conservative care — these are the situations where a surgical opinion becomes relevant.

• —Conservative treatment in adult degenerative scoliosis: a prospective cohort study. (PMC11079735)
• —Physiotherapeutic scoliosis-specific exercise methodologies: an extended literature review. (PMC9368145)
• —SOSORT — Management of spinal deformities and evidence of treatment effectiveness. (PMC5759105)
• —Scoliosis bracing and exercise for pain management in adults — case report. (PMC5011608)
• —NICE — Low Back Pain and Sciatica in Over 16s (NG59)