Physical Therapy for Scoliosis

Physical therapy (PT) for scoliosis may be beneficial to help you relieve pain, improve spinal mobility, and prevent worsening of your lateral spinal curvature. Your physical therapist can work with you to strengthen muscles that support your spine and improve your postural awareness.

What Is Scoliosis?

Scoliosis is defined as an abnormal lateral curvature of the spine. There are many causes of scoliosis, and it may affect anyone at any age. It occurs in between 2% to 3% of the population. There are different types of scoliosis. Three recognized causes of scoliosis include:

• Idiopathic: The lateral curvature comes on for no apparent reason.
• Neuro-muscular: A neurological or muscular problem causes the lateral curvature of the spine.
• Congenital: You are born with a lateral curvature of your spine.

Sometimes, scoliosis develops early in your life, and other times the onset of the curvature is during adulthood. Scoliosis may cause symptoms ranging from mild to severe, and the lateral curvature may limit basic functional tasks like breathing, sitting, bending, or walking.

Symptoms of scoliosis may include:

• Mid or low back pain
• Abnormal sensation in the arms or legs
• Difficulty maintaining upright posture
• Difficulty breathing or shortness of breath

If you are having any of these symptoms, see your healthcare provider right away. They can assess your condition and diagnose your problem.

Diagnosis of scoliosis is simple—in most cases your healthcare provider can simply look at your back and notice a lateral curvature. Bending forward at the waist can confirm the diagnosis, as a lateral curvature of the spine also causes a rotation of the spine. This will make your ribs on one side of your back more prominent while bending. This "rib hump" is a tell-tale sign of scoliosis.

If your healthcare provider suspects scoliosis, they will likely take an X-ray. This picture will show the position of the bones of your spine, and the degree of curvature can be measured. Some people have an "S" curve; their lower lumbar spine curves one way, and their middle thoracic curves the opposite direction. Others have a "C" curve where the lumbar and thoracic spine curve in one direction together.

As your spine curves laterally, the vertebra rotate slightly. Many patients with scoliosis also have straightening of the thoracic spine.

Your healthcare provider can use the X-ray to determine the type of curve you have and the degree of the curvature, known as the Cobb angle. Cobb angles may range from 10 degrees (mild) to more than 60 degrees (severe).

There are many treatments available for scoliosis. Mild cases may simply require watchful waiting and exercise. For moderate curves of more than 20 degrees, bracing may be used. Physical therapy or chiropractic care is often recommended. People with severe cases of scoliosis may require surgery to stabilize their spine.

Many people with mild or moderate scoliosis benefit from physical therapy to help manage their condition.

PT Evaluation for Scoliosis

If you are referred to physical therapy for scoliosis, your first session with a physical therapist will be an initial evaluation. During this appointment, your physical therapist will interview you and ask about your pain, your diagnosis, and what things you have done so far to treat your scoliosis.

They will review your past medical history, and make note of any medication you are taking. Your physical therapist may also want to view your X-rays, so you should bring them with you to the appointment. If you have a brace, bring that as well.

After the interview, your therapist will take various measurements. These may include:

• Postural assessment
• Spinal and extremity range of motion
• Strength
• Balance
• Pulmonary function
• Functional mobility

You should expect to move around quite a bit during this examination, so be sure to wear comfortable clothing to the appointment.

After your physical therapist has gathered information about your impairments, goal setting and treatment can begin. Common goals for scoliosis may include:

• Control pain
• Improve spinal positioning and alignment
• Improve strength
• Improve postural control
• Maximize range of motion in your spine and extremities
• Improve breathing and lung function (The lateral curve of your spine may impede normal diaphragm function, leading to breathing difficulty.)

Physical therapy treatment for your scoliosis may begin during the initial appointment. Most likely, your physical therapist will instruct you in a home exercise program that can be done daily. This exercise program will augment the things that you do in the PT clinic for your scoliosis.

Bracing

If your Cobb angle is 20 degrees or greater, then your healthcare provider may prescribe a brace for you to wear. The goal of the brace is to prevent further curvature of your scoliosis. This may help prevent the need for surgery.

Different types of scoliosis braces include:

• The Boston brace. This brace is used to hold your spine in place and prevent further curvature.
• SpineCore brace. This allows for some motion to take place, but it has not been found to halt the progression of scoliosis.
• The Gensingen brace. The makers of this brace claim that it can be used to correct the curvature and decrease your Cobb angle. One study of the brace found that in 25 users, two had progression of their curve, 12 halted their progression, and 11 study participants experienced decreased curve.

Most healthcare providers recommend their patients wear the scoliosis brace for 20 hours per day. This means that you should sleep in the brace and go through your day in the brace. The brace can be removed for bathing and for activities where it may be an impediment to movement. You can still play sports if you have scoliosis. Most practitioners recommend you remain as active as possible.

If you are a teenager who has not reached skeletal maturity, the brace should be worn until your skeleton has fully matured. Your healthcare provider can determine when that is via a simple X-ray.

PT Interventions for Pain Relief

If you have back pain as a result of your scoliosis, your physical therapist may prescribe various treatments to offer relief. These may include:

• Heat. Heat may increase local circulation and relax tight muscles.
• Ice. Ice is used to decrease pain and inflammation.
• Electrical stimulation. Electrical stimulation, like transcutaneous electrical neuromuscular stimulation (TENS) may help decrease sensations of pain.
• Ultrasound. Ultrasound may be used as a deep heating treatment to improve circulation.
• Kinesiology taping. Kinesiology tape may be applied to gently stretch tight muscles and reduce pain and spasm.
• Massage. Massage may be used to decrease pain and spasm in tight back muscles.

Keep in mind that all of these treatments are passive in nature; you do nothing while your therapist provides the treatment. Plus, many of them have not been proven to be effective in treating pain from scoliosis. Still, your therapist may offer these treatments, so it's important to understand them.

The most important treatments for your scoliosis are self-care postures and exercises. This can ensure that you are in control of your condition and have a long-term self-management plan for your scoliosis.

PT Scoliosis Exercises

Exercise should be a daily part of your life if you have scoliosis. The goal of exercises for scoliosis is to:

• Improve breathing
• Improve postural awareness
• Strengthen muscles that support your spine
• Decrease joint pain due to muscular imbalances

Exercises will not necessarily decrease or reverse your scoliosis curve. They are meant to help you gain control of your posture and halt the progression of the curve in your spine. Ultimately, the goal of scoliosis treatment is to try to avoid worsening of your condition and decrease or eliminate the need for surgery.

Exercises that your PT may prescribe may include:

Supine pelvic tilts:

1. Lie on your back with both knees bent.
2. Gently and slowly roll your pelvis backward so your back is flat on the ground.
3. Hold this position for three seconds as you exhale, and then slowly release.
4. Repeat 12 times.

Cat and camel stretches:

1. Get in a position on your hands and knees, like you are crawling.
2. Slowly raise your lower back up, and exhale.
3. Then, allow your lower back to sag as you inhale. Move in slow, rhythmical motions.
4. Repeat the raising and lowering of your back 12 times.

Lateral shift correction with pursed lip breathing:

1. While standing in front of a mirror, place on hand on your hip and one on the opposite shoulder.
2. Press your hip to the side to correct your lateral shift in your lumbar spine, and move your opposite shoulder away. This corrects the position of your thoracic spine.
3. Stand tall, and slowly exhale all the air in your lungs through pursed lips. A slight hissing sound should be made.
4. Once you have exhaled fully, inhale slowly and repeat 12 times.
5. Maintain the lateral shift correction while breathing.

Exercises for scoliosis should be specific to your condition, so you must see a physical therapist to determine the right ones for you to be doing. Do not perform any exercise for your scoliosis unless advised by your physical therapist or healthcare provider.

One popular method of scoliosis specific exercise is the Schroth method. This was developed in 1927 by Katerina Schroth and utilizes exercises and positioning plus breathing methods to help improve postural control.

How Long Should Physical Therapy Take?

Most patients with scoliosis benefit from attending PT once or twice weekly for four to six weeks, and then following up at regular intervals to measure progress and to progress with exercises. Your physical therapist can work with you to develop the right follow up plan for your specific condition.

Prognosis

For most people, the diagnosis of scoliosis means lifelong management. If you have a small curve of less than 20 degrees, you most likely can manage fine with exercises. If your curve is greater than 20 degrees, you will likely benefit from bracing and daily spine specific exercises. If your curve progresses to greater than 50 degrees, surgery may be considered to help stabilize your spine.

Be sure to work closely with your healthcare provider and physical therapist to understand your specific situation and prognosis.

A Word From Verywell

Scoliosis, a lateral curvature of the spine, may cause pain, limited motion, and decreased overall mobility. If left unchecked, surgery may be required to prevent significant spinal deformity and loss of function. By working with a physical therapist for your scoliosis, you may be able to halt the progression of the disease and avoid surgical intervention. That way, you can engage in lifelong management of your condition and enjoy your work and recreational activities.