Tag: scoliosis

Is observation a treatment for scoliosis?

When first seeking treatment, many scoliosis sufferers are advised that they should “watch and wait” or  “wait and see” how their condition progresses, in the hope that their curve will remain small enough to avoid surgery.  Medically, this approach is known as “observation”.


Is observation ever the right choice?

The argument for observation was once much stronger than it is today – for much of recent history the consensus view has been that surgery was the only effective way to treat scoliosis and since surgery is obviously best avoided wherever possible, observation is the only other choice. Although surgical treatment was once the only option for scoliosis sufferers, this is no longer the case – today non-surgical approaches are highly effective, meaning that observation is probably never the right choice.


Avoiding surgery with non-surgical treatment

Today, non-surgical treatment from scoliosis consists of two major approaches, exercise-based and bracing. Scoliosis braces are the most effective non-surgical method for reducing cobb angle[1]. There are many different kinds of scoliosis brace and the way they work is different, however broadly speaking braces can be classified as active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position).

Exercise methods such as the Schroth method (remove comma) or SEAS focus on teaching the scoliosis sufferer to self-correct their scoliotic position. Schroth and SEAS can both be effective as a standalone treatment for smaller curves and is often paired with bracing for superior results.

In both cases, however, catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the Cobb angle is the key to a successful outcome. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.


Why observation does not work

Simply put, Observation is not a treatment for scoliosis, it is simply the act of watching and waiting, hoping the condition does not worse – however recent research has shown that scoliosis almost never resolves without treatment.[2] While it was once thought that scoliosis would not always progress, modern research has demonstrated, for example, that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery. Curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[i]

Because observation is not a treatment, it most often leads to the patient requiring surgery and does not promise any improvement. By contrast, modern bracing technology allows for highly effective treatment, such that it has now been demonstrated that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[ii]


What should I do if I have been prescribed observation?

If you have been diagnosed with scoliosis but have been advised that observation or “wait and see” is the best approach, the best option is to book a consultation with a scoliosis specialist. Even if your condition is not serious enough to merit bracing, some targeted scoliosis specific exercise can, at the very least, help to prevent the curve from developing further rather than simply allowing it to increase.






[1] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine (2018) [Publish Ahead of Print]

[2] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42

[i] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[ii] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

Does a having a short leg cause scoliosis?

Leg length discrepancy, commonly known as a short leg, and medically known as Anisomelia is a condition in which one leg is shorter than the other, resulting in a limping gait and often chronic lower back pain.  In fact, a small leg length discrepancy is not unusual and is frequently treated by specialists such as a chiropractor – however, Anisomelia is said to occur if there is a difference of over 1cm, and surgery can be necessary for differences over 2cm.[1]

A short leg can cause scoliosis

Leg length discrepancy (LLD) has been observed in between 3–15% of the population[2] and there are two possible types, apparent or true.

True LLD is where the shortening of one leg compared to the other can lead to scoliosis as the body tries to compensate. In this case, scoliosis will usually reduce when the LLD is treated.

By contrast, apparent LLD is a symptom of a problem, not the actual cause. Apparent LLD is a condition in which the legs are actually the same length but appear to be different due to an underlying pelvic or spine disorder. In this case, treating the pelvic and/or spine disorder resolves the LLD.

Because of these relationships, it has long been suggested that True LLD can cause or worsen scoliosis[3] – despite this, there had not been any definitive studies on the relationship between LLD and scoliosis until this year.


How common is LLD in scoliosis patients?

Despite  the fact that many health professionals see a link, information on the exact relationship of LLD to scoliosis has been difficult to obtain and studies have produced mixed results.  One study of 23 young adults[4] suggested that scoliosis was minor in patients with discrepancies of < 2.2 cm. At the other end of the scale, another study measuring the x-rays of 106  patients in a private chiropractic practice showed that those with LLD > 6 mm often (53% of the cases) had scoliosis and/or abnormal lordotic curves.


Does LLD cause scoliosis?

There has certainly been evidence to suggest that there may be a causal link between LLD and scoliosis. Although a direct link has not been established, it Is accepted that LLD causes pelvic obliquity.[5] Pelvic obliquity simply means that one side of the pelvis sits higher than the other.  Since we also know that 40% to 60% of children with lumbar scoliosis also have pelvic obliquity, it seems reasonable to suggest that LLD may indirectly lead to scoliosis.[6]


Pelvic Obliquity is common in scoliosis patients

LLD and Scoliosis, new research results

With this background in mind, a 2018 study[7] aimed to find out if there is a measurable association between pelvic obliquity, LLD and the scoliotic curve in an adolescent patient or not.  The researchers also wanted to discover whether scoliotic curve progression was linked to different amounts of leg length discrepancy

During the study, seventy-three patients with an average age of 13.3 years at initial examination were given an X-Ray and then had this compared with a later follow up. Scoliosis was confirmed in all 73 patients. At initial examination, pelvic obliquity appeared in 23 (31.5%) patients with scoliosis, and LLD was identified in 6 (8.2%) patients with scoliosis and pelvic obliquity. The majority of the patients in the study were under observation for their scoliosis, allowing the researchers to observe the relationship between scoliosis and leg length.

At a subsequent visit, at an average of 2.8 years later, no significant change in LLD was observed, but a statistically significant increase in scoliotic and pelvic deformity was found.  The study, therefore, concluded that in the adolescent patient population with thoracic or thoracolumbar scoliosis, the LLD remains stable with growth but both the scoliotic deformity and pelvic obliquity continue to progress.[8]


So what is the relationship between LLD and scoliosis?

This most recent study suggests that in adolescent patients at least, LLD stays stable and does not seem to have a direct association with the progression of scoliosis. Having said this, the small number (6 out of 73, 8.3%) of patients with LLD in this study suggests that a larger sample set should be explored before drawing any firm conclusions.

Perhaps most importantly, the authors suggest that future research could focus on younger patients less than 10 years with LLD to detect early-onset scoliosis prevalence and how it changes with growth and treatment since it is entirely possible that LLD may have a more significant impact at this early stage.

For now, it seems advisable to conclude that LLD is just one of a number of conditions which can be associated with scoliosis, and certainly with spinal disorders more widely. If you or a loved one have noticeable LLD, it is advisable to see a spinal specialist.


[1] Steen H, Terjesen T, Bjerkreim I, Anisomelia. Clinical consequences and treatment Tidsskr Nor Laegeforen. 1997 Apr 30;117(11):1595-600.

[2] Gurney B. Leg length discrepancy. Gait Posture. 2002;15:195–206.

[3] Steen H, Terjesen T, Bjerkreim I, Anisomelia. Clinical consequences and treatment Tidsskr Nor Laegeforen. 1997 Apr 30;117(11):1595-600.

[4] Papaioannou T, Stokes I, Kenwright J. Scoliosis associated with limb-length inequality. J Bone Joint Surg. 1982;64:59–62.

[5] Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. J Bone Joint Surg. 1963;45-A:1–14.

Asher MA. Scoliosis evaluation. Ortho Clin North Am. 1988;19:805–14.

Brady RJ, Dean JB, Skinner TM, Gross MT. Limb length inequality: clinical implications for assessment and intervention. J Orthop Sports Phys Ther. 2003;33:221–34.

Burwell RG, Aujla RK, Freeman BJ, Dangerfield PH, Cole AA, Kirby AS, et al. Patterns of extra-spinal left-right skeletal asymmetries in adolescent girls with lower spine scoliosis: relative lengthening of the ilium on the curve concavity & of right lower limb segments. Stud Health Technol Inform. 2006;123:57–65.

Cummings G, Scholz JP, Barnes K. The effect of imposed leg length difference on pelvic bone symmetry. Spine. 1993;18:368–73.

D’Amico M. Scoliosis and leg asymmetries: a reliable approach to assess wedge solutions efficacy. Stud Health Technol Inform. 2002;88:285–9.

[6] Schwender JD, Denis F. Coronal plane imbalance in adolescent idiopathic scoliosis with left lumbar curves exceeding 40 degrees: the role of the lumbosacral hemicurve. Spine. 2000;25:2358–63.

Walker AP, Dickson RA. School screening and pelvic tilt scoliosis. Lancet. 1984;2:152–3.

[7] Avraam Ploumis et al. Progression of idiopathic thoracic or thoracolumbar scoliosis and pelvic obliquity in adolescent patients with and without limb length discrepancy Scoliosis and Spinal Disorders 2018 13:18

[8] Specht DL, De Boer KF. Anatomical leg length inequality, scoliosis and lordotic curve in unselected clinic patients. J Manip Physiol Ther. 1991;14:368–75.

There’s an app for that – why technology can’t replace clinicians just yet!

A number of the conditions we treat here at the clinic (but most commonly Scoliosis and Kyphosis) are often treated at least in part with an exercise program. In some cases, the exercise program might be a primary line of treatment, whereas in other instances it is used as a support mechanism.

Here at the clinic, we will usually provide an exercise prescription which patients should then undertake each day at home. Sometimes this is the correct approach, but one of the most significant problems posed by this approach is exercise adherence. The simple fact is that programs such as Schroth or SEAS do not work if they are not performed every day and for the correct amount of time.

At the UK Scoliosis clinic, we work to avoid this problem by staying in touch with our patients and scheduling regular check-up appointments, but exercise adherence is still a significant factor in determining treatment success.

In recent years, it has often been argued that either an app or computer program might replace the role of the clinician in encouraging exercise adherence. It’s certainly an attractive idea, however as yet, the research indicates this approach is not practical.


There’s an app for that

There’s no question that augmenting face to face treatment with software-based approaches has great promise, and it certainly stands to reason that apps could have the potential to play an essential role in promoting exercise adherence in the future. Apps can monitor patients remotely, are cheap, can provide reminders, and can enable feedback to patients. Many of us also now use apps for fitness purposes, either as exercise trackers, heart rate monitors or in place of a traditional personal trainer. Despite this, app-based exercise programs have not been widely incorporated in rehabilitation for adolescents with musculoskeletal disorders[1]

So far, research has not suggested that apps have been particularly effective as a replacement for traditional contact with professionals more generally –  a recent systematic review showed limited evidence regarding the effectiveness of using apps to increase physical activity in adolescents[2]. Furthermore, apps aimed at increasing physical activity in adolescents were not effective[3].


Exercise adherence in Hyperkyphosis

Scoliosis and Kyphosis can both be disruptive conditions

One of the conditions we treat at our clinic is Hyperkyphosis. While hyperkyphosis is sometimes seen as less serious than Scoliosis, research shows that adolescents with hyperkyphosis have decreased quality-of-life (particularly the self-image and appearance components[4]. Hyperkyphosis is also associated with back pain in long-term follow-up studies[5]. Hyperkyphosis is often treated with an exercise prescription, either in advance of bracing or as a complementary approach.  Milder cases of Hyperkyphosis have been shown to respond well to exercise-based programs – although the biggest issue is ensuring that patients adhere to their exercise plan.



A Kyphosis case study

Given that few attempts have been made to use apps specifically to treat musculoskeletal conditions, a recent study was set up to assess the potential of an app-based exercise program for adolescents with Hyperkyphosis and back pain[6].

App usage was not impressive in the study

The study focused on 21 participants, between 10 and18. All of the participants were given an initial one-time exercise treatment session and were instructed to continue using an app provided for the study to track and guide their home-based exercise over  a period of 6 months.

After participants logged in to the app, they were shown their prescribed exercises by image and exercise name. To perform an exercise, users only had to click on the exercise, which shows the same picture and written instructions on how to perform the exercise. The prescribed amount of time counts down similar to an interval timer while the participant performs the exercise.

Although the format was relatively simple, and the exercise sessions prescribed only lasted approximately 15 minutes a day, the study shows that most participants did not use the app. One participant did not have a Smartphone or tablet, this participant did participate in the exercise program, and logged exercise adherence on a sheet of paper. One participant complied with the program 100%, but the remaining participants either did not use the app or used it less than once per week. When investigators questioned the participants about their usage, they also indicated themselves that they used the app less than weekly.  Unsurprisingly, the patient’s quality of life scores (measured with the SRS-22 form) did not significantly improve over the 6 months.


What can we learn from these results?

These results serve mainly to confirm what has been suspected for some time – many users just do not stick to their exercise program, absent encouragement and mentorship from scoliosis or kyphosis professional.  For parents of children with kyphosis or scoliosis, the critical question is therefore whether exercise-based approaches are the most suitable treatment, given that adherence to the program is so important. In some instances, parents may prefer to opt for a kyphosis or scoliosis brace, which does not suffer from these same issues.

Does this mean apps are useless in the treatment of musculoskeletal disorders? Almost certainly not  – some apps, such as our ScoliScreen allow users to perform an initial diagnosis of their scoliosis, and monitor their conditions. The study discussed here did also show that the app had a positive effect on the study participant who fully committed to the exercise program, which suggests that a combination of an app and personal encouragement from a clinician may be a superior way forward.  At the UK Scoliosis clinic, we are always researching the best way to give a superior experience to our patients, and apps are a field that we are investigating with interest!


[1] Madden M, Lenhart A, Cortesi S, Gasser U. Teens and mobile apps privacy. Washington, DC: Pew Internet & American Life Project; 2013. [2015-04-21].

[2] van Sluijs EMF, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ. 2007;335(7622):703.

[3] Direito A, Jiang Y, Whittaker R, Maddison R. Apps for IMproving FITness and increasing physical activity among young people: the AIMFIT pragmatic randomized controlled trial. J Med Internet Res. 2015;17(8):e210.

[4] Petcharaporn M, Pawelek J, Bastrom T, Lonner B, Newton PO. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine (Phila Pa 1976). 2007;32(20):2226–31.

Lonner B, Yoo A, Terran JS, et al. Effect of spinal deformity on adolescent quality of life comparison of operative Scheuermann’s kyphosis, adolescent idiopathic scoliosis and normal controls. Spine (Phila Pa 1976). 2013;38(12):1049–55.

[5] Murray P, Weinstein S, Spratt KF. Natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg Am. 1993;75A(2):236–48.

Ristolainen L, Kettunen JA, Heliövaara M, Kujala UM, Heinonen A, Schlenzka D. Untreated Scheuermann’s disease: a 37-year follow-up study. Eur Spine J. 2012;21(5):819–24.

[6] Karina A. Zapata, Sharon S. Wang-Price, Tina S. Fletcher and Charles E. Johnston Factors influencing adherence to an app-based exercise program in adolescents with painful hyperkyphosis Scoliosis and Spinal Disorders 201813:11

Will scoliosis go away on its own?

When you or a loved one are first diagnosed with scoliosis its natural for your first thoughts to be about the best treatment available – and perhaps whether treatment is even necessary. Indeed, many medical professionals today still believe that a “wait and see” approach is the best way forward in most scoliosis cases. Despite this view, research is clear – scoliosis almost never resolves on its own whereas proactive treatment carries a very high success rate. Left untreated, scoliosis can be a life limiting condition, whereas the majority of patients treated with non-surgical methods today can live a totally normal life and often experience total curve correction.


What’s wrong with wait and see?

“Wait and see” is never the best approach

The “wait and see” approach (often called observation) means simply watching and waiting to see if a scoliosis case gets worse. This approach is based upon the (now outdated) view that surgery is the only effective option for scoliosis treatment. If your doctor or medical professional has recommended “wait and see” this does not mean they are being negligent however – historically surgery was thought to be the only effective treatment for scoliosis but today there are a wide variety of effective non-surgical options.

Non-surgical treatment for scoliosis has been shown to be successful up to 60 degrees cobb angle (cobb angle is the measure of scoliosis curvature), but the best results can be achieved when scoliosis is treated early.  Since the objective of observation is simply to see if the scoliosis progresses to a significant enough curve to require surgery (typically 40 degrees plus) patients are often told to simply keep “waiting and watching” while their opportunity to maximise non-surgical approaches sadly slips away.

It can not be stressed enough that if you have been diagnosed with scoliosis and have been advised to “wait and see” you should contact a scoliosis clinic and schedule a consultation as soon as possible.


What happens if scoliosis is left untreated?

If scoliosis is left untreated, or a policy of “observation” is employed, scoliosis is overwhelmingly likely to continue to progress. In the very small number of cases where scoliosis does not progress it will certainly not reduce – meaning that (at best) the patient spends the rest of their life with symptoms associated with scoliosis.

Research has demonstrated that cases of Juvenile scoliosis greater than 30 degrees tend to progress quickly – studies suggest that 100% of these patients will progress to the surgical threshold. Juveniles with curves from 21 to 30 degrees are more difficult to predict in terms of progression but can frequently end up requiring surgery, or at least are left living with significant disability.[1]

In cases which do not progress to the surgical threshold there are still many common symptoms which scoliosis sufferers will experience throughout their life without treatment. Some of the most common include pain, physical deformity, limited mobility and difficulty breathing during exercise.[2] Some recent research has also suggested that even a small cobb angle can have a significant negative impact upon a person’s ability to be active and keep fit and healthy.[3] Since we understand how important staying fit and active is to long term health, it is also fair to say that left untreated scoliosis could be a predictor for longer term health problems.


How can scoliosis be treated?

Today (while surgery remains and option for severe cases) most scoliosis patients can be treated non-surgically, although the sooner treatment is sought the better the prognosis and the simpler the treatment program required. Whereas “wait and see” can result in as much as 100% of patients progressing to the surgical threshold, through modern bracing technology it has been demonstrated that conservative treatment with a brace can reduce the number of patients requiring surgery to as low as 4.9% – in addition the vast majority of patients can active complete curve correction.[4]



[1] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[2] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041

[3]  SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018

[4] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

Does scoliosis cause back pain? Research update

For some time, it has been thought that adolescent idiopathic scoliosis (AIS) does not necessarily cause back pain – however research is now beginning to indicate that in fact, scoliosis does most likely cause pain especially in patients with larger curves.


Scoliosis and back pain, current opinion

scoliosis back pain

Research is unclear, but many believe scoliosis causes back pain

For some time, it has been suggested that scoliosis might be responsible for back pain. Although the issue has been debated, some evidence suggests there is a link – A recent study of almost 2000 patients less than 21 years-old referred for a spine evaluation reported that when an underlying condition was identified as the cause of the pain, the most frequent diagnosis was scoliosis (1439/1953), followed by Scheuermann’s kyphosis.[1]

Although this evidence suggests there may be a link, other studies which have considered the issue have produced mixed results. On the one hand, Ramirez et al. reported on more than 2400 subjects with AIS. Of these, 23 % reported back pain at the time of diagnosis – a substantial number. An additional 9%, initially free of pain and managed with observation alone, developed pain during follow-up[2].

Sato et al. examined more than 30,000 adolescents with various spinal issues and concluded that the subgroup with scoliosis had an approximately 3 to 5 fold increased risk of back pain in the upper and middle right part of the back[3].

On the other hand, Lonner et al. compared three groups of adolescents including 894 with AIS and 31 control individuals without, when considering pain score using the SRS pain score method, they found that the differences between the AIS and control group were not significant. [4]

With this mixed picture in mind, one 2016 review concluded that while back pain in adolescents is quite common, especially in girls – pain does not seem to be a major problem for the vast majority of adolescents with an idiopathic form of scoliosis.[5] This is the view which tends to prevail amongst most scoliosis practitioners today.

Despite this conclusion, however, there have been a number of studies which have suggested much more strongly that back pain is a common issue amongst scoliosis sufferers. Research has indicated that chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than the one seen in adolescents without scoliosis (33%)[6]. Furthermore, Clark et al. reported that participants who were diagnosed with AIS at age 15 were 42% more likely to report back pain at age 18.[7]


New evidence

The regions of the spine

The most recent research is a Canadian study by Théroux et al.  It considered 500  patients from the orthopedic scoliosis outpatient clinic from the CHU Ste-Justine Centre, a university-teaching paediatric hospital with a view to exploring the relationship between scoliosis and back pain more accurately.

The conclusions from this study were of great interest. The study showed that spinal pain was a frequent problem for the AIS sufferers included in the study.  Overall, 68% of the participants reported pain. Furthermore, pain intensity increased with scoliosis severity in the main thoracic and lumbar regions – the degree of disability caused by pain was also positively associated with scoliosis severity in the proximal thoracic, main thoracic and lumbar regions.[8]

Perhaps of most interest for us as a clinic, the results showed that spinal bracing was associated with lower spinal pain intensity in the thoracic and lumbar regions. Bracing was also related with lower disability for all spinal areas. [9]


Does scoliosis cause back pain?

More research will be needed before a definitive answer can be provided to this question – however it seems reasonable to suggest that back pain is associated with scoliosis in a good number of cases, given our own experience and the foregoing evidence, we would suggest a repetitive figure for the risk of back pain associated with scoliosis is likely to be  40 – 50% , with factors such as curve location being key factors.

Thankfully research and our own experience clearly indicates that proactive scoliosis treatment, whether with bracing or (ideally) a combined bracing and exercise program can be highly effective in reducing back pain in scoliosis cases.






[1] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[2] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8.

[3] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9.

[4] Lonner B, Yoo A, Terran JS, Sponseller P, Samdani A, Betz R, et al. Effect of spinal deformity on adolescent quality of life: comparison of operative scheuermann kyphosis, adolescent idiopathic scoliosis, and normal controls. Spine (Phila Pa 1976). 2013;38:1049–55.

[5] Ibid.

[6] Cited in Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[7] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[8] Ibid

[9] Ibid

Scoliosis bracing is becoming more effective

For some time now, scoliosis clinicians have broadly accepted the view that scoliosis bracing is an effective way to halt the progression of scoliosis, and (with the use of the correct brace) is also an effective way to reduce the curve.

The outlook for bracing was not always a positive as it is today – historically, studies suggested that bracing was only as effective as observation. Over time however, research has tended to show bracing to be more effective than was once thought, so that today the rates of success with bracing are very high.

In 2005, the Scoliosis Research Society (SRS) attempted to standardize the inclusion criteria and outcome measurements for bracing studies, to enable comparison among studies. In the guidelines, it was suggested that a curve progression of less than 5 degrees should be regarded as success. At the time, SRS did not even consider that bracing might actually serve to improve a curve – although it was quickly realised that this was possible. For this reason, the criteria for “improvement” (being a reduction of curve of at least 6 degrees) was established in 2009.

Despite some scepticism in the mid 2000’s however, some bracing studies today have demonstrated rates of surgery prevention as high as 100%[1][2] and the field is one of the major areas of study and advancement – so what caused such an improvement in the prognosis?


Braces are getting better

scoliosis braces

Scoliosis braces have come a long way!

One of the major reasons for the improvement in bracing effectiveness has been the improvement in braces themselves.  A recent review study conducted in 2016, attempted to explore this issue by examining 53 studies published between 1990 and 2016[3]. It showed that when comparing the percentage of patients eventually requiring surgery and the improvement rate in the past 26 years, we find that there is a trend towards reduction in surgical rate and an increase in improvement rate. Yet, close inspection showed that the change is strongly related to the type of brace used.

Key factors in bracing outcome are the amount of in-brace correction and comfort for the wearer. In the study, it was shown that large in-brace correction in excess of 50% would be accompanied by improvement at skeletal maturity[4][5] and hours of brace wear are positively associated with the rate of treatment success[6]. Simply put, an active correction brace which is also comfortable to wear is a key factor in significantly reducing surgical requirement[7]. This is why so much effort has been expended in ensuring that our ScoliBrace is the most comfortable brace available!

The study also showed that the effectiveness of a brace depended on the quality of its construction, not just its design[8]. In 2007 Danielsson et al pointed out the importance of the skill and dedication of the orthotist in creating a brace as a critical factor in the eventual success of treatment and similar views have been forwarded by other authors[9]. Today, advancements in technology mean that a higher quality of brace design and manufacture than ever before is available to us. Indeed, at the UK scoliosis clinic we use the latest laser scan and computer aided manufacture processes to create a brace for each client, which fits their needs perfectly.


Combination treatment is most effective

Today we also appreciate that in most instances an individualised treatment plan based on a number of complementary methods provides the best chance for a significant reduction of the curve. In fact, today it is generally accepted that bracing should not be employed alone in the management of Adolescent Idiopathic Scoliosis in particular – instead individualised scoliosis specific exercises should also be incorporated. This is because Scoliosis specific exercises improve the muscle strength of the trunk and the postural awareness of the patients. More importantly perhaps, when combined with bracing, evidence suggests the results are an improvement in curve reduction[10]. Properly tailored exercise programs may also help to reduce the loss of correction which frequently accompanies the end of brace treatment if not properly managed.[11]


Scoliosis clinicians are working hard to improve bracing technology.


Modern scoliosis braces are highly effective

At the UK scoliosis clinic, we respect and value the work that surgeons can do in correcting very serious cases of scoliosis which are unsuitable for conservative treatment. However, the 2016 review study has suggested that a conflict of interest in bracing development might be a negative factor for patients[12].

One of the lest effective forms of brace is the Boston brace – yet these are often favoured by orthopaedic surgeons (especially in the US)[13]. The Boston brace is at least outdated, and in some situations may complicate scoliosis treatment unnecessarily. Boston braces also encourage thoracic flat back, which has been shown to be detrimental to the correction of curves[14].

Why are these braces sometimes favoured then?  –  This maybe because in the event that the brace fails to achieve the objective, the surgeon can go on to treat the patient using surgery, although this might not be the patient’s preference. Conversely, the kinds of modern braces we use at our clinic and which are widely implemented throughout Europe today are predominantly used by physicians who treat patients conservatively. In this instance, failure of the brace requires an external referral for surgical treatment[15] – hence it is in the interest of non-surgical clinics to constantly develop and improve their braces, which results in highly advanced modern braces, like ScoliBrace.





[1] De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G. Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J.2013;22(6):S815–22.

[2] Aulisa AG, Guzzanti V, Perisano C, Marzetti E, Falciglia F, Aulisa L.Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria. Spine (Phila Pa 1976). 2012;37(13):E786-E791.

[3] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[4] Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up.

[5] Appelgren G, Willner S. End Vertebra Angle – A roentgenographic method to describe a scoliosis. A follow-up study of idiopathic scoliosis treated with the Boston brace. Spine (Phila Pa 1976) 1990;15(2):71- 74.

[6] A large number of studies are cited in Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[7] Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV. Effectiveness of the Boston brace in treatment of large curves adolescent idiopathic scoliosis. Spine. 2000;25(18):2326–2332.

[8] Rigo MD, Villagrasa M, Gallo. A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis. 2010;5(1):1. doi:10.1186/1748-7161-5-1.

[9] For example see Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner- Bonneau D. Ameta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997;79(5):664-674.

[10] Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correctionand task-oriented exercises reduce spinal deformity and improve quality of life insubjects with mild adolescent idiopathic scoliosis. Results of a randomized controlled trial. Eur Spine J. 2014;23(6):1204-14. doi:10.1007/s00586-014-3241-y.

[11] Goldberg CJ, Dowling FE, Hall JE, Emans JB. A statistical comparison between natural history of idiopathic scoliosis and brace treatment in skeletally immature adolescent girls. Spine. 1993;18(7):902-9088.

[12] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[13] Wynne JH. The Boston brace and TriaC system. Disabil Rehabil Assist Technol2008; 3(3):130-135. doi:10.1080/17483100801903988.

[14] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[15] Ibid.

Scoliosis specific exercise can reduce curve progression in adult scoliosis patients

While many of the patients we see at our clinic are children with juvenile or adolescent scoliosis, adult scoliosis cases also represent a significant percentage of those we help. There are many approaches which can be used in tackling adult scoliosis, but one of the most commonly chosen is scoliosis specific exercise. It was once thought that surgery was the only effective treatment for adult scoliosis, but today research is confirming that high quality, individualised treatment programs can be effective in stopping the progression of scoliosis in adults.


Adult scoliosis – an important field of research

While scoliosis clinicians often tend to focus on scoliosis in adolescents, it has long been known that idiopathic scoliosis can (and often does) continue to progress during adulthood after skeletal maturity[1], when growth has stopped.

While the development of scoliosis in adults is slower, over time the curve does worsen which can lead to a reduction in functional capacity and the development or the worsening of spinal pain and associated radicular symptoms[2](pain which radiates from the root of a nerve at the spinal column into the arms or legs), as well as spinal degenerative changes. This means that research into the best ways to tackle adult scoliosis is equally important as in adolescent scoliosis.

In fact, more than 60 % of cases of adult scoliosis progress, particularly in the case of curves exceeding 30 ° Cobb at skeletal maturity, regardless of the curve pattern[3]. Unlike adolescent scoliosis however, Marty-Poumarat[4] has shown that the rate of progression in adult scoliosis is linear (regular and constant) and can therefore be used to establish an individual prognosis. This rate of progression, if left untreated is deemed to be around 0.5-1 °per year[5].

While the prevailing view for some time has been that adult idiopathic scoliosis was only suitable for treatment with surgery when the curve becomes significant enough – more recent research clearly suggests that non-surgical approaches can be effective in reducing curve magnitude and halting progression, potentially eliminating the need for surgery in many cases.

In a short-term case series Weiss et al. showed 43.93 % of 107 patients improved 5 or more Cobb degrees immediately after 4 – 6 weeks of in-patient scoliosis specific exercise program[6], while Morningstar et al. showed that 19 patients treated with spinal manipulation and various physiotherapeutic procedures reported immediately after the therapy an average correction of 17 ° Cobb [7][8]. In an earlier case report, Negrini et al. showed a 18.5 Cobb degrees reduction after one year of Scoliosis Specific SEAS exercises[9].


Treating adult scoliosis with scoliosis specific exercise – new research

Now, a larger study by Negrini et al. has now gone further in establishing the effectiveness of SEAS exercises in reducing the progression of scoliotic curves. SEAS exercises (one of the types we utilise in our own clinic) are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through the process known as active self-correction. Typically, therapy includes at least two weekly exercise sessions each lasting 45 min – but exercise prescription varies significantly in both length and frequency, since to be effective an exercise program must be individually tailored.

The study considered adults (18 years or more) who exhibited curves larger than 30° and documented curve progression during adulthood (at least 6° Cobb) or adults with curves larger than 40° who had refused surgical treatment. Patients were prescribed Scoliosis Specific SEAS Exercises exclusively and were required to practice their exercises regularly for at least ten months per year. Patients were assessed a minimum of 1 year after their first assessment, via x-rays which were independently verified.



The results from the study were highly encouraging – it confirmed that that Scoliosis Specific Exercises can be effective to obtain stability and, in some cases, to reduce the Cobb angles by degrees. In highly progressive curves, exercises appear to slow down the progression of the curvature (worsening).  Of the 34 patients included in the study, an average reduction of 4.1 degrees cobb was achieved after one year. [10]

More broadly, the study also went to confirm the fact that scoliosis specific exercise programs need to be maintained and monitored, and that the patient must continue to adhere to the exercise program in the long term in order to see sustained improvement.[11]

While the authors of the study were pleased with the outcome, it’s fair to say that more research on scoliosis specific exercise is required and will continue to be published over the coming months and years. Future larger, long term, observational studies will provide us with more insight on defining the best Scoliosis Specific Exercises management approach and explore other very important issues associated with adult progressive spinal deformities, such as, sagittal global balance, back pain, disability and quality of life.


Treatment for adult scoliosis at the UK Scoliosis Clinic

At the UK Scoliosis clinic, we utilise a variety of approaches as part of our scoliosis specific exercise program. This allows us to tailor our approach to our patient’s specific needs – this might include exercise programs based on the SEAS or Schroth methodologies as well as bracing if required. It’s because our scoliosis specialists have such a wide variety of tools at their disposal that we’re able to achieve targeted, measured and provable results for our patients.



[1] Collis DK, Ponseti IV. Long-term follow-up of patients with idiopathic scoliosis not treated surgically. J Bone Joint Surg Am. 1969;51(3):425 – 45

[2] Guigui P, Rillardon L. Adult spinal deformities. Rev Prat. 2006;56(7):701– 8

[3] Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA, J Am Med Assoc. 2003;289(5):559 – 67, Weinstein SL. Natural history. Spine. 1999;24(24):2592–600

[4] Marty-Poumarat C, Scattin L, Marpeau M, Garreau De Loubresse C, Aegerter P. Natural history of progressive adult scoliosis. Spine. 2007;32(11):1227 – 34, discussion 1235.

[5] Ibid.

[6]Weiss HR. Influence of an in-patient exercise program on scoliotic curve. Ital J Orthop Traumatol. 1992;18(3):395 – 406

[7] Morningstar MW, Woggon D, Lawrence G. Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskelet Disord. 2004;5:32.

[8] We wish to note that in this instance, the term ‘immediately’ should be taken literally – more research is needed to establish the long term prognosis offered by CLEAR  and associated approaches.

[9] Negrini A, Parzini S, Negrini MG, Romano M, Atanasio S, Zaina F, et al. Adult scoliosis can be reduced through specific SEAS exercises: a case report. Scoliosis. 2008;3:20

[10] Negarini et al. Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study. Scoliosis (2015) 10:20

[11] Ibid.

June is Scoliosis awareness month

Scoliosis is a serious condition which can cause discomfort, disability and eventually require major surgery if left untreated. Catching scoliosis early makes it much easier to treat, so this week please take a moment to read this quick primer on scoliosis and pass it on to those you care about.


What is scoliosis?

Scoliosis is a disorder in which there is a sideways curve of the spine. Curves are often S-shaped or C-shaped. In most people, there is no known cause for this curve, although those who have a family history of scoliosis do seem to be at greater risk.


What are the signs and symptoms of scoliosis?

In the absence of formal screening programs scoliosis is often first discovered by parents when they see an obvious curve or hump on their child’s back, especially when bending forwards.

Occasionally scoliosis might be detected through a complaint of back pain, but scoliosis is frequently present without pain.

Typical symptoms include:

  • Uneven shoulders
  • Head appears to be off centre
  • Uneven waist
  • One side of the rib cage is higher than the other when bending forward



How common is scoliosis

Scoliosis is much more common than most people think. The latest research suggests that between 2 and 3% of children aged 10-15 years will develop scoliosis. This might seem like a small number, but 3% would be 3 in every 100 – which would be one in every 30. Therefore, about one child in each school class will develop scoliosis.

Girls are more likely to develop scoliosis than boys (about 75% of scoliosis patients are girls) but boys can and do develop scoliosis too. Research suggests that some sports and activities are associated with a higher risk of scoliosis – the most notable example are ballet dancers and gymnasts, where the condition is us up to 12 times more prevalent[1][2].


How is scoliosis treated

If scoliosis is not diagnosed early, or if the scoliotic curve is left to develop unchecked then surgery to fuse the spine may eventually be required. It was once thought that this was the only effective means of treating scoliosis – which is one of the reasons why a screening program was not put into place. [3]

Today there are a wide variety of approaches which can be used to treat scoliosis non-surgically. These methods are far less physically invasive and much less emotionally disturbing, especially for young people. Evidence strongly indicates that non-surgical treatment can be highly successful in reducing the chance that surgery will eventually be required.[4]

Often, more than one approach can be used to develop a treatment program – the two main approaches used at our clinic are scoliosis specific exercise and scoliosis bracing, however we may also complement these approaches with evidence-based Chiropractic treatment or postural correction programs. While these additional tools do not directly reduce scoliosis, they can often assist the sufferer in terms of pain relief, or with regards to improving body symmetry.


What can I do?

The biggest single factor in ensuring a good outcome for scoliosis patients is early diagnosis – a very small curve is much easier to stabilise and correct than a larger one. June is Scoliosis Awareness Month. Throughout the month, our aim is to raise awareness about scoliosis screening and the importance of early detection -you can help by raising the issue of scoliosis with your child’s school, local clubs or youth groups.

This month, we are offering free scoliosis screening sessions and informational talks to schools. So if you know anyone who might be interested, please ask them to get in touch!

You can screen for scoliosis yourself, at home, using our scoliscreen tool – available at  (https://scoliosisclinic.co.uk/scoliscreen/) if you’re a parent please feel free to use this tool to screen your own children.  It’s an excellent idea to screen all children, but those between 10 and 15 are at the highest risk. If you do have a child who participates in a high-risk activity, please take a moment to screen them if you possibly can.

If you have concerns about a young person, please don’t worry – simply get in touch to book a free professional screening here at our clinic.


[1] Tanchev, Panayot I. MD; Dzherov, Assen D. MD; Parushev, Anton D. MD; Dikov, Dobrin M. MD; Todorov, Miroslav B. MD, Scoliosis in Rhythmic Gymnasts, Spine: June 1st, 2000 – Volume 25 – Issue 11 – p 1367-1372

[2] Longworth, Brooke et al. Prevalence and Predictors of Adolescent Idiopathic Scoliosis in Adolescent Ballet Dancers Archives of Physical Medicine and Rehabilitation , Volume 95 , Issue 9 , 1725 – 1730

[3] R Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[4] M Rigo, C Reiter, HR, Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 6(3-4)  (2003) 209-14.

Scoliosis and sport- what’s the best approach?

When many people discover they have scoliosis (or when parents discover their child has scoliosis) one of the first things they ask is often “do I need to give up X sport”.

There is a great deal of misinformation around scoliosis and sport, perhaps this is mainly because there is a perception that scoliosis and sport don’t mix. It’s certainly true that on average scoliosis sufferers do tend to be less physically active – in some cases this might be related to the condition (severe scoliosis can make exercise more difficult)[1] but the cause can also often be social in nature.

It’s also true that some activities (Especially those which involve contorting the spine) do tend to correlate with a higher incidence of scoliosis sufferers amongst its participants. Ballet and rhythmic gymnastics are good examples.

Today, we’ll attempt to tease out some easy to follow guidelines for scoliosis sufferers – here’s what we do know:


Should I exercise with scoliosis?

Cardiovascular exercise is always good for you.

Whether you suffer from scoliosis or not, exercise in any form is going to be beneficial to your body. Exercise results in health benefits such as an increase in cardiovascular health, increased aerobic capacity, increased bone density, improved mental outlook, reduced body fat and increased life expectancy.

This means that in general, it certainly is advisable for scoliosis patients to exercise regularly. What might need some consideration is the type of exercise undertaken – especially when dealing with adolescents who are still growing and are therefore more skeletally immature.[2] This being said, much of the advice that goes for adolescent scoliosis patients could also be applied to non-scoliosis patients!


Which exercises should scoliosis sufferers be careful with?

At the UK scoliosis clinic, we focus heavily on individualised care. Rather then taking the group treatment or “bootcamp” route, we tailor scoliosis treatment to an individual’s exact requirements. For that reason, we’re not so quick to say that certain exercises should be avoided altogether. That being said, there are some forms of exercise which need to be performed carefully and with a mind to avoiding stressing the spine, especially in adolescents. These include:


Impact sports carry a risk to the spine for everyone

Impact sports

Impact sports such as rugby are a cause for concern not only with scoliosis patients, but with adolescents in general. The risk here is obvious, an impact injury always carries a risk of concussion, spinal injury or damage to the joints. In a scoliosis sufferer, this kind of injury might serve to worsen the progression of the scoliotic curve. [3]

When considering impact sports, we should also include athletic events such as long jump or high jump which can place significant load on the spine if performed with poor technique.

Adolescents are at the highest risk here, but much of this can be mitigated by playing non-impact versions of the sport in question, such as touch rugby – which is probably to be recommended anyway!


Resistance training

Some forms of resistance training, such as free weight lifting can post a risk to the scoliosis sufferer. The curvature of the spine disturbs the body’s natural balance and makes it more likely that an injury arising from spinal loading will occur. This is not to say that resistance training should be avoided altogether – instead, targeted programs using appropriate equipment (lean towards fixed weights and bands) should be used.  Also of concern is the mount of weight used during resistant training , due to increased lading or compressional forces, which can compress the growth plates and potentially inhibit vertebral body growth and may progress or worsen scoliosis.

At the UK scoliosis clinic, we are especially well equipped to work with patients to improve their balance and posture, which will greatly reduce this risk – through methodologies such as chiropractic biophysics, postural analysis and scoliosis specific exercise.


“One-sided” activities

Asymmetric loading simply means that the spine is being subjected to different degrees of force on either side. If you carry a rucksack on your back by a single strap, you’re asymmetrically loading your spine.

Some practitioners suggest that activities which tend to asymmetrically load the body (most things with a bat or racket) should be avoided – however this approach is too broad in most cases and tends to cut off many of the most enjoyable sports! (this also serves to demonstrate the importance of individual patent cantered care!)

The risk with asymmetric sports is that over time, one side of the body (and of the muscle supporting the spine) becomes stronger and larger than the other side – this factor can then serve to worsen scoliosis. Assuming a proper warm up there is very little risk in actually participating in these kinds of sports.

The solution is to carefully monitor growth and symmetry and perform targeted exercise on the non-playing side of the body (usually the non-dominant side) in order to balance out development. Again, this is important to scoliosis patients, but good advice for anyone!


Are there exercises which cause scoliosis?

Ballter dancer

Ballet dancing can increase scoliosis risk substantially

There is some evidence that certain types of exercise – those which contort the spine – may promote scoliosis. These include ballet, dance and rhythmic gymnastics. Various studies have suggested that scoliosis incidence is anywhere between 12 and 30% more common amongst gymnasts[4]

Much more research on these correlations is required in order to make concrete determinations about the risk posed by these kinds of activities – it may, for example, simply be the case that scoliosis is more likely to be noticed among these disciplines, since there is more awareness of it.

It seems reasonable, however, to suggest that you book an appointment for an individual consultation before continuing with dance, ballet or gymnastics. In most cases, scoliosis does not need to prevent you from participating – but a personalised treatment plan should be put in place to ensure you are properly supported.


Which exercises are good for scoliosis sufferers?

It was once thought that swimming might be an effective treatment for scoliosis, and there’s no doubt that some scoliosis sufferers do use swimming as an enjoyable part of their scoliosis specific workout routine. Recent research has unfortunately suggested that swimming is not an effective treatment for scoliosis[5] – but more research is required in this area. Incidentally, the same study showed that swimming might increase the risk of hyper-kyphosis.

In general, low impact exercise is ideal for scoliosis sufferers, as is exercise which does not progress to the point of exhaustion. Since a many scoliosis patient also suffer with poor coordination exercises designed to improve coordination can also be beneficial as this helps to improve the body’s sense of position. Exercise taken to the point of exhaustion increases the risk of injury in anyone but carries more risk for the scoliosis sufferer.

Therefore, shorter runs or working out on an elliptical machine is a good alternative for basic cardio workouts. Biking is also a good alternative, as long as there is not too much forward flexion of the lumbar spine.



The most important factor to take away from this blog is the need for individualised care. Each scoliosis sufferer is an individual and requires a treatment plan which works for them and their choice of sport.

At the UK scoliosis clinic, we have in house sports therapists, postural specialists and chiropractors certified in chiropractic biophysics who can work with you to make modifications to your exercise routine to minimise risk whatever your sport!



[1] Pediatric Exercise Science. 30, 2, 243-250, May 2018

[2] Eur Spine J. 2011 August; 20(Suppl 3): 415–419. Beneficial effects of aerobic training in adolescent patients with moderate idiopathic scoliosis

[3] J Pediatr. 2015 Jan;166(1):163-7. doi: 10.1016/j.jpeds.2014.09.024. Epub 2014 Oct 25.

[4] https://scoliosisclinic.co.uk/blog/ballet-dancing-increase-risk-scoliosis/

[5] J Pediatr. 2015 Jan;166(1):163-7. doi: 10.1016/j.jpeds.2014.09.024. Epub 2014 Oct 25.

New research – Scoliosis impacts functional capacity

Tired out girl

Scoliosis can make exercise more difficult

Adolescent idiopathic scoliosis (AIS) is by far the most common cause of spinal deviation; it comprises about 80% of all idiopathic vertebral deformities and affects 2%–4% of adolescents.[1] The exact cause of AIS is still being investigated, but scientists generally agree that it is largely determined by genes that are activated by different factors.

When thinking about how we should direct the treatment of scoliosis, we often tend to focus on the well-known potential outcomes of the condition if left untreated- these include physical deformity, disability, pain and discomfort.  What we often forgotten is the impact that scoliosis can have in terms of overall health and fitness.

As it stands, research has already confirmed that that scoliosis influences factors like ease of breathing during exercise in a negative way[2] However, brand new research just published in the Journal of Paediatric exercise science now allows us to understand the degree to which cobb angle (the degree of the scoliotic curve) actually has an impact.

The research conducted at the Federal University of São Paulo in 2018, hypothesised that Individuals with scoliosis would have lower exercise tolerance in cardiopulmonary exercise testing (CPET) and in the incremental shuttle walk test (ISWT) – a suggestion which has already been confirmed in preceding studies.[3]  Researchers then sought to evaluate the functional capacity (that is to say, the ability of the participants bodies to cope with exercise) in patients with AIS with specific regard to the functional capacity and respiratory variables in patients with different degrees of scoliosis severity.



The study tested a cross section of participants with varying degrees of scoliosis severity. The group included eighteen patients with mild and moderate scoliosis, 8 patients with severe scoliosis, and 10 adolescents from a control group. Patients were selected from the Orthopaedic Clinic at a local hospital, and  they  were  submitted for radiography to evaluate the Cobb angles prior to the study.

In order to ensure the results were relevant and valid, patients were excluded if they had a previous or current history of heart, lung diseases or neuromuscular disorder, cognitive changes that influenced the understanding of tests, and all those who failed to perform the assessment proposed.



A 54 Degree Cobb angle (X-ray)

During the ISWT participants are asked to walk between two cones, placed 10 meters apart. Participants aim to match the pace provided by a simple beeping prompt. In this study, each of the partcipants performed the test twice, in order to try to ensure more even results.

Heart rate, blood pressure and fatigue were measured by modified Borg scale before and after the test[4]. The results of the study were conclusive. In the study, patients with AIS definitely performed worse than test subjects without scoliosis. Those with scoliosis found the test harder (more physically taxing) and also displayed a lower level of respiratory function. What’s more, the performance of the individuals with scoliosis was worse in individuals with a more severe cobb angle. Overall, patients with AIS walked shorter distance during the ISWT when compared with adolescents without scoliosis. Patients with  AIS > 45°  and  AIS < 45°  walked,  respectively, 156 m and 117 m less than the control group.

This study therefore identified that patients with severe scoliosis present worse functional capacity and, perhaps of greatest interest, it draws attention to the fact that even patients with mild and moderate scoliosis already show a significant reduction in functional capacity.


What we learn from this study.

At the UK scoliosis clinic, we are committed to ensuring that all our approach to treating scoliosis is always grounded in the most up to date scientific research available. From the results of the study there are two important take-aways.

In the first instance, the study goes to show the degree to which even a minor case of scoliosis (of the sort which may respond particularly well to bracing) may impact the quality of life and capability of an individual to participate in exercise – both for health-related purposes, and indeed as a social exercise. This is particularly interesting given that the authors of this study also noted a correlation between individuals with scoliosis and low exercise participation rates. Specifically the authors note “Adolescents with scoliosis for some reason are physically unconditioned; some authors believe that this fact is related only to the low adherence of individuals to physical activity, mainly due to the constraint of the disease deformity” .  This research therefore goes to underscore the importance of early intervention in dealing with cases of adolescent idiopathic scoliosis.

Secondly, this study (by its methodology) suggest that the ISWT can be a valuable tool for assessing functional capacity in patients with AIS. As a relatively low-cost but widely applicable test, the ISWT may therefore be worth further consideration within the scoliosis treatment community. Dr Irvine is keen to follow up on this insight and will be considering its possible applications within our clinic.


The main source article for this post was:

 SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018



[1] Weinstein SL, Dolan LA, Cheng JCY, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527–37. PubMed doi:10.1016/S0140-6736 (08)60658-3


[2] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041


[3] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041


Sperandio EF, Vidotto MC, Alexandre AS, Yi LC, Gotfryd AO, Dourado VZ. Exercise capacity, lung function and chest wall shape in patients with adolescent idiopathic scoliosis. Fisioter Mov. 2015;28(3):563–72. doi:10.1590/0103-5150.028.003.AO15


Barrios C, Pérez-Encinas C, Maruenda JI, Laguía M. Significant ventilatory functional restriction in adoles- cents with mild or moderate scoliosis during maximal exercise tolerance test. Spine. 2005;30(14):1610–5. doi:10.1097/01.brs.0000169447.55556.01


Bas P, Romagnoli M, Gomez-Cabrera MC, et al. Beneficial effects of aerobic training in adolescent patients with mod- erate idiopathic scoliosis. Eur Spine J. 2011;20 Suppl 3: 415–9. PubMed doi:10.1007/s00586-011-1902-7


[4] Hommerding PX, Donadio MV, Paim TF, Marostica PJ. The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis. Respir Care. 2010;55(6):729–33. PubMed