Scoliosis Adults: Physiotherapy Treatment & Exercise

Understanding Adult Scoliosis

Scoliosis in adults is characterized by an abnormal lateral curvature of the spine of 10 degrees or more. In adult patients, scoliosis generally falls into two primary categories:

1. Adolescent Idiopathic Scoliosis (AIS) in Adults: Curves that developed during adolescence but progress or become symptomatic in adulthood.
2. Degenerative (De Novo) Scoliosis: Curves that develop in adulthood due to asymmetric degeneration of the intervertebral discs, facet joints, and supporting ligaments.

Unlike adolescents where the primary concern is cosmetic appearance and structural correction during growth, adult scoliosis management focuses on pain control, halting curve progression, preserving breathing capacity, and improving functional independence.

The Role of Physiotherapy in Adult Scoliosis

Physiotherapy is the cornerstone of conservative management for adult scoliosis. Rather than passive modalities alone, active, scoliosis-specific exercises are used to manage the asymmetry. The primary goals are:

• Spinal Decompression: Creating space between compressed vertebrae.
• Muscular Rebalancing: Strengthening weak, elongated muscles on the convex side of the curve while stretching tight, shortened muscles on the concave side.
• Postural Stabilization: Training the deep stabilizing muscles of the spine (multifidus, transverse abdominis) to maintain corrected alignment.

Evidence-Based Scoliosis Exercises for Adults

1. The Schroth Method (Rotational Breathing & Elongation)

The Schroth Method is a widely recognized system of physiotherapeutic scoliosis-specific exercises (PSSE). It utilizes three-dimensional spinal elongation and custom-tailored rotational breathing techniques.

• How it works: The patient is guided into a corrected posture using mirrors and tactile feedback. They then perform deep, directional breathing to expand the collapsed, concave areas of the rib cage while contracting the convex muscles to stabilize the correction.
• Benefit: Improves lung capacity and rib cage symmetry while reducing postural collapse.

2. Core Stabilization (Plank Progressions)

Strong deep stabilizers are critical to prevent further degenerative collapse. Isometric exercises are preferred over dynamic twisting.

• Forearm Plank: Lie face down, lift your body onto your forearms and toes, keeping your spine in a neutral line. Focus on pulling the belly button toward the spine. Hold 20 to 45 seconds. Repeat 3 times.
• Side Plank (Modified): Perform on the forearm with knees bent. This is especially useful for asymmetrical core support. Focus on lifting the lower hip to align the spine.

3. Bird-Dog (Cross-Body Stabilization)

This exercise builds diagonal stability across the posterior chain without overloading the facet joints.

• How: Begin on all fours. Slowly extend one arm forward and the opposite leg backward until they are parallel to the floor. Focus on keeping the hips level. Hold for 3 seconds, then return. Perform 10 repetitions per side, 3 sets.

4. Asymmetric Wall Press

This exercise helps active posture correction in a standing position, helping to translate clinical corrections into daily life.

• How: Stand with your back against a wall. Identify the side where your rib cage collapses. Press that side's arm or elbow gently against the wall to activate the convex-side obliques and latissimus dorsi, pulling the spine closer to the midline. Hold for 10 seconds. Repeat 10 times.

Clinical Guidelines & What to Avoid

• Avoid Heavy Spinal Loading: Avoid heavy back squats, overhead presses, and high-impact jumping exercises that compress the spine.
• Limit Asymmetric Twisting: Avoid repetitive twisting movements or yoga poses that force the spine into extremes of rotation.
• Daily Postural Awareness: The best exercise is maintaining corrected alignment during daily tasks like sitting at a computer, cooking, or walking.

If you are experiencing progressive back pain, consult a specialist for a personalized plan. For more details on spinal therapies, see our guide on traction therapy or explore back pain therapy near me options.

References

• Schreiber MC et al. The effect of Schroth exercises added to standard care in adolescent idiopathic scoliosis. Scoliosis and Spinal Disorders. 2016.
• Negrini S et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and Spinal Disorders. 2018.
• Bettany-Saltikov J et al. Physiotherapeutic Scoliosis-Specific Exercises (PSSE) for Adolescent Idiopathic Scoliosis. Cochrane Database of Systematic Reviews. 2014.