Adult Scoliosis

What Is Adult Scoliosis? Types and Symptoms

Adult scoliosis is a three-dimensional sideways curve of the spine measuring more than 10 degrees in an adult whose skeleton has finished growing. It can be a curve that started in childhood or one that develops later in life as the spine wears.

Here’s a breakdown of the key aspects of adult scoliosis:

• Definition: The spine curves to the side and the vertebrae (spine bones) also rotate. The size of the curve is measured on an X-ray as the Cobb angle. A Cobb angle over 10° in a fully grown adult is considered scoliosis.
• Types:
  • Adult idiopathic scoliosis: a curve that began in childhood or adolescence and continues into adulthood. “Idiopathic” means there is no known cause.
  • Degenerative (de novo) scoliosis: a curve that develops in adulthood, usually in the lower back, as the discs, facet joints (small joints at the back of the spine), and ligaments wear unevenly.
  • Secondary scoliosis: curves linked to neuromuscular conditions, spine differences present from birth, trauma, or previous spine surgery.
• Symptoms:
  • Low back pain, the most common reason adults seek care. Idiopathic curves often cause back pain from around age 30. Degenerative curves usually cause pain from age 50 to 60, and it gets worse with long periods of standing or walking.
  • Buttock and leg pain when nerves are pinched where the spine curves.
  • Posture changes such as a sideways shift of the trunk, an uneven pelvis, one leg appearing shorter, or walking bent forward.
  • Height loss, reported between 4 and 24 cm over time.
  • Reduced breathing capacity with larger curves in the upper back, along with muscle fatigue.
  • Anxiety, low mood, and reduced quality of life linked to ongoing pain and changes in body image.

Anatomy of the Spine: Support and Function

The spine relies on balanced joints, discs, and muscles to hold you upright, and scoliosis changes how load moves through each of them.

• Anatomy
  • Scoliosis affects the spine in three directions: a sideways curve, changes to the normal front-to-back curves of the spine, and rotation of the vertebrae.
  • Intervertebral discs cushion each vertebra, and facet joints guide movement at the back of the spine.
  • Nerve roots exit through openings on each side of the spine. On the inside (concave) side of a curve, these openings can narrow and pinch the nerve.
• Support and Function
  • When the spine curves, weight is carried unevenly. This causes uneven wear of the discs and facet joints, which can increase the curve, which then adds more uneven load. This cycle is how many curves progress.
  • In some cases, one vertebra slides sideways on the one below it (laterolisthesis), most often at L3-L4 or L1-L2. This is strongly linked to severe back pain.
  • Overall balance matters. A trunk shifted more than 4 to 5 cm to the side, or an upper body leaning more than 7 cm forward of the pelvis, is linked to more pain and disability.
  • Part of a curve is fixed in the bones and ligaments, and part is postural collapse, caused by weak trunk muscles that let the spine sag when upright. This postural part can make up to 9° (about 19%) of the curve, and it is the part exercise can target.

Causes and Risk Factors

Adult scoliosis is common and becomes more common with age. Studies report it in 8.3% to 68% of adults depending on age and how it is measured, and in over a third of adults over 60 in one 12-year community study.

• Causes
  • Idiopathic curves carried over from adolescence. About 96% of these are in women.
  • Uneven wear of the spine with age (degenerative scoliosis), sometimes along with osteopenia or osteoporosis. About 59% of these are in women.
  • Other causes, including neuromuscular conditions, spine differences present from birth, trauma, or previous laminectomy or fusion surgery.
• Risk Factors for Curve Progression
  • Curve size: curves over 30° in fully grown adults tend to progress, about 0.82° per year on average for idiopathic curves.
  • Degenerative curves progress faster, about 1.6° to 3° per year, and about 73% progress over five years.
  • X-ray findings linked to faster progression include significant rotation of the vertebrae, a vertebra slipping sideways more than 6 mm, and the position of the lowest lumbar vertebra (L5).
• Other Risk Factors
  • Trunk muscle loss (sarcopenia) is seen in 46.6% of people with degenerative scoliosis and is linked to stooped posture and curve progression.

A Multidisciplinary Approach to Adult Scoliosis

Adult scoliosis involves the bones, joints, nerves, and muscles of the spine, so care that addresses several of these together makes sense. At Vaughan Physiotherapy Clinic, adult scoliosis can be managed with physiotherapy, chiropractic care, and registered massage therapy. Physiotherapy leads with scoliosis-specific exercise, while chiropractic and massage therapy can support pain relief and mobility. The sections below outline what the current research shows for each, including where the evidence is still limited.

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Why Physiotherapy Is Essential for Recovery

Physiotherapy is the foundation of non-surgical care for adult scoliosis. Research shows that scoliosis-specific exercise can reduce pain and disability, and in some cases reduce the size of the curve.

Here’s why physiotherapy is essential for recovery:

• Rebuilds Postural Support:
  • Strengthening weak trunk muscles (abdominals, back extensors, and glutes) helps correct the postural collapse part of the curve and reduces uneven pressure on the joints.
• Improves Spinal Balance:
  • Supervised rehab targets alignment side to side and front to back, and reduces protective muscle spasm.
• Reduces Pain and Disability:
  • Specific exercises ease the overload on back muscles and joints, with measurable improvements in pain and disability scores.
• Can Reduce or Stabilize the Curve:
  • In a two-year study of 34 adults with idiopathic scoliosis, 68% saw their curve improve with scoliosis-specific exercise, by an average of 4.6°.
• Supports Breathing and Mood:
  • Rotational breathing exercises are used to expand the chest, and studies report improved breathing measures along with lower anxiety and depression.

Physiotherapy Treatment Approaches

Treatment centres on physiotherapeutic scoliosis-specific exercise (PSSE), supported by manual therapy and education.

• Scoliosis-Specific Exercise:
  • Schroth method: a three-dimensional exercise system that uses rotational breathing, spinal lengthening, and muscle activation to correct the curve in all directions. Studies report reduced pain and smaller Cobb angles, and supervised programs produce better results than home programs alone.
  • SEAS (Scientific Exercises Approach to Scoliosis): focuses on active self-correction, core stability, and building corrected posture into daily activities.
  • Side-shift and side plank exercises: in studies of adults, these helped stabilize or reduce some curves when done consistently over months to years.
  • Active, task-based training: in a trial of 130 adults (average age 51.6), 20 weeks of active self-correction, task-based exercise, and cognitive-behavioural therapy improved disability and curve size more than passive physical therapy.
• Manual Therapy:
  • Joint mobilization, soft tissue stretching, and myofascial release to ease muscle spasm, improve spinal flexibility, and reduce nerve-related pain.
• Education and Posture:
  • Understanding postural collapse and avoiding long periods in uneven postures.
  • Avoiding shoe lifts that haven’t been prescribed. A lift under the lower side of the pelvis can increase spinal imbalance. Instead, you’ll learn active strategies, such as engaging the hip muscles or bending the knee on the higher side when standing.
• Modalities and Supports:
  • TENS, dry needling, and traction may be used for symptom relief, but passive treatments on their own show low long-term success (about 27%) because they don’t address spinal balance.
  • Bracing: in research, rigid braces worn 6 to 8 hours a day slowed yearly curve progression in adults.
  • Hanging exercises are not effective, and spinal unloading devices only reduce the curve while they are in use.

Chiropractic Care for Adult Scoliosis

Chiropractic care for adult scoliosis combines spinal manipulation with rehabilitation tools such as traction, weighting systems, and exercise. It may help with pain and function as part of a broader plan, though the research is still at an early stage.

Here’s what the research shows:

• Pain and function improved in a combined program: In 28 adults who completed a six-month chiropractic rehabilitation program (manipulation, traction, weighting, and rotational exercise), the average curve reduced by 10° and pain and disability improved, with results maintained at 24 months. Curves with two major bends did not reduce, though those patients still had less pain (Morningstar, Journal of Chiropractic Medicine, 2011).
• Long-term case follow-up: A nine-year case series of three family members receiving similar care reported smaller curves and lasting improvements in pain and function (Morningstar et al., Open Journal of Therapy and Rehabilitation, 2017).
• The evidence is limited: These are small studies without control groups, and a small pilot trial found no difference in curve size between chiropractic care and a sham treatment (Rowe et al., cited in Ren et al., Frontiers in Endocrinology, 2022). Promising for pain and function, but more research is needed.

How our chiropractor helps

• Spinal assessment and manipulation or mobilization to address joint stiffness and pain, adapted to your curve type.
• Combining hands-on care with active exercise, since the studies that showed benefit used combined programs rather than manipulation alone.
• Realistic expectations, with care focused on pain and function and coordinated with your physiotherapy program.

Chiropractic care works best as one part of your plan, alongside scoliosis-specific exercise.

Registered Massage Therapy for Adult Scoliosis

Registered massage therapy targets the muscle tension and spasm that often build up around a curved spine. It can be a helpful addition for pain and comfort, but it is not expected to change the curve on its own.

Here’s what the research shows:

• Soft tissue therapy may reduce pain and disability: A review of 17 randomized trials (956 participants) found manual soft tissue therapy reduced scoliosis pain and disability more than medication, and reduced anxiety and depression compared to bracing alone (Ren et al., Frontiers in Endocrinology, 2022).
• Works best combined with exercise or bracing: In the same review, soft tissue therapy added to exercise or bracing produced small additional improvements in curve size and vertebral rotation (Ren et al., Frontiers in Endocrinology, 2022).
• Limits of the evidence: Most of these trials studied Chinese manual therapy (Tuina) in adolescents, not massage therapy in adults, and in case reports massage alone gave only temporary relief (Morningstar et al., Open Journal of Therapy and Rehabilitation, 2017). More research is needed.

How our Registered Massage Therapists help

• Soft tissue release of the back, hip, and shoulder muscles that tighten in response to the curve.
• Easing muscle spasm and tension so exercises can be done more comfortably.
• Coordinating with your physiotherapist so massage supports your exercise program.

Massage therapy is best used to support, not replace, the active exercise at the core of scoliosis care.

Prognosis: Healing Timeline for Adult Scoliosis

Adult scoliosis is a long-term condition, so the goal of care is to reduce pain, improve function, and slow or stop progression.

• Without Treatment: About 68% of curves larger than 30° at skeletal maturity continue to progress over time.
• Short Term (3 to 12 Weeks): Studies report noticeable pain relief and better daily function within 3 to 12 weeks of starting scoliosis-specific exercise or manual care.
• Medium Term (About 6 Months): This is the main active treatment phase. In one program, disability scores were cut roughly in half and average curves reduced by about 10° by 6 months.
• Long Term (2 Years and Beyond): A regular home program and periodic check-ins help maintain gains. Improvements in pain, function, and curve size have been maintained at 24 months and longer.
• Factors That Affect Recovery:
  • Curve type and size
  • Consistency with home exercises
  • Whether exercise is supervised
  • Nerve involvement and overall spinal balance

Surgery may be considered if conservative care is not effective, or if there is rapid curve progression, severe spinal imbalance, or significant nerve compression with ongoing leg pain or neurological symptoms.

Preventing Recurrence

Scoliosis doesn’t go away, but progression and flare-ups can often be managed with ongoing care.

• Exercise:
  • Continue scoliosis-specific home exercises, about 30 minutes a day or 3 to 4 times a week.
  • Check in with your physiotherapist 1 to 4 times a year to update your program.
  • Include core and resistance training to maintain trunk muscle, since muscle loss is linked to stooped posture and curve progression.
• Posture and Equipment:
  • Avoid holding uneven postures for long periods.
  • Don’t use a shoe lift unless it has been prescribed.
  • A brace may be recommended for curves that are progressing.
• Monitoring:
  • Standing spine X-rays every 1 to 2 years (less often if stable), taken at a similar time of day, help track changes.

FAQs

• “Can adult scoliosis get worse after I’ve stopped growing?” Yes. About 68% of curves over 30° keep progressing. Idiopathic curves progress about 0.82° per year on average, and degenerative curves about 1.6° to 3° per year.
• “Will exercise reduce my curve, or only help with pain?” Mainly pain and function, but some studies also show modest curve reductions. In one two-year study, 68% of adults saw their curve improve, by an average of 4.6°.
• “Should I use a shoe lift if one hip is higher?” Not unless it’s prescribed. A lift under the lower side of the pelvis can increase spinal imbalance. Your physiotherapist can teach you active ways to level your stance instead.
• “What’s the difference between idiopathic and degenerative scoliosis?” Idiopathic scoliosis starts in childhood or adolescence and continues into adulthood, often causing back pain from around age 30. Degenerative scoliosis develops later, usually from age 50 to 60, from wear of the discs and joints, and is more likely to cause leg pain and stooped posture.
• “Which treatment is right for me?” For most people, a combination. Physiotherapy with scoliosis-specific exercise is the core of care. Chiropractic care and massage therapy can add pain relief and mobility, though their evidence is more limited. Our team will assess your curve and build a plan that fits your needs.

Why Choose Vaughan Physiotherapy Clinic?

Our physiotherapists, chiropractor, and registered massage therapists work together to manage adult scoliosis:

• Comprehensive Assessment: We look at your posture, spinal balance, curve pattern, and symptoms to understand what is driving your pain.
• Personalized Multidisciplinary Treatment Plans: Built around your curve type, goals, and daily activities, drawing on physiotherapy, chiropractic care, and massage therapy as needed.
• Collaborative Care: Our practitioners coordinate with each other and with your physician or spine specialist when needed.
• Home Programs: Scoliosis-specific exercises you can do between visits to maintain your progress.

Meet Our Specialized Team

Our physiotherapists build exercise programs for spinal conditions and work alongside our chiropractor and registered massage therapists to address pain, mobility, and posture. We understand that adult scoliosis is a long-term condition, and we focus on helping you stay active and in control of your symptoms.

Book a Specialist Assessment

Get your adult scoliosis assessed and start a plan built around your spine.

• Phone: 905-669-1221
• Address: 398 Steeles Ave W, Unit 201, Thornhill, ON L4J 6X3
• Online Booking: Book Your Assessment

Serving Thornhill, Langstaff, Newtonbrook, Willowdale, North York, Markham, Richmond Hill, Concord, and North Toronto. Direct billing available.

✅ Reduce back and leg pain

✅ Improve posture and spinal balance

✅ Stay active with a long-term home program

Written by Aylin