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Written by Rhys. J | Exercise Physiology, PsychPhys™ 

Scoliosis is a term used to describe a “lateral curvature of the spine with rotation of the vertebrate within the curve” (1) that requires at least 10° of spinal curvature in the coronal plane (1, 2). This can also be referred to as the ‘Cobb Angle’.

Scoliosis itself can be broadly categorised into several different categories depending on the cause:  Congenital, neuromuscular, syndrome-related, idiopathic, and spinal curvature due to secondary reasons (1)

While scoliosis does affect people of all ages, we will be focusing primarily on Adolescent Idiopathic Scoliosis (AIS). 

What Is It?

Idiopathic scoliosis is used to describe scoliosis that has no known cause. It is classified based on age, with AIS being used for individuals aged 10+ years old (2)

The prevalence rate of AIS has been suggested to range between 1% and 5% (1, 3,4, 5), while also accounting for 90% of all idiopathic scoliosis cases in children (6). Further, AIS has been frequently shown to affect more women than their male counterparts. In particular, the male-female ratio can be as high as 1:8 with a spinal curve of 10° (1) and 1:10 (5) when the spinal curve exceeds 30°. 

The Impact of AIS

With a growing body of literature, there is current evidence to suggest that, in many cases, AIS does not lead to severe long-term health consequences (4,7); however, in some instances, it can require more intensive treatment options which is often associated with more severe curves.
AIS can lead to a greater prevalence of pain, particularly back pain (4), and more severe bouts of pain (4,7), but despite the presence of pain, the majority of individuals will be able to function at or near normal levels (4). In more severe cases, AIS can lead to cardiopulmonary compromise due to altered anatomy, but this is quite rare.

As humans are not just a body but also a mind, a large piece of the puzzle would be missing if we just focused on the potential physical problems of AIS. Currently, more research is required into how AIS impacts a person psychosocially, however, there is evidence suggesting AIS has the biggest impact on a person’s self-image (4, 8).

Treatment options

In most cases, the treatment plan for AIS will often be determined based on the degree of the spinal curve, with physical therapy being used as a conservative treatment option to assist in reducing the Cobb Angle. 

Physical exercises have been shown to slow the progression and/or reduce curve severity; improve neuromotor control, respiratory function, back muscle strength, and cosmetic appearance (10)

To go into detail on some of the programs that have been created to provide insight into AIS rehabilitation:

Schroth Method

Currently, the Schroth method developed by Katharina Schroth, has also been a widely accepted and utilised approach towards preventing further progression and/or achieving correction through the provision of patient-specific exercises aiming to:

  1. Restore muscular symmetry and postural alignment;
  2. Promoting proper breathing patterns
  3. Promoting postural awareness

Further, The Schroth method has been shown to have positive impacts on back muscle strength, breathing function, slowing curve progression, improving cobb angles, and reducing the prevalence of surgery intervention (10).

Scoliosis Specific Exercise 

Exercises for individuals with AIS should be individualised and specific to the type and degree of scoliosis. An additional treatment option involves the use of Scoliosis Specific Exercises (SSE’s). SSE’s are part of an exercise protocol that has been created according to the Study group on Scoliosis and Orthopaedic and Rehabilitative Treatment (SOSORT) and personalised according to the medical and physiotherapeutic evaluations. The exercise protocol will look to serve several potential benefits, including (11).

  • Reducing the progression of the scoliotic deformity;
  • Postponement and possible avoidance of brace prescription;
  • Stabilising and reducing curve magnitude; 
  • Reducing the incidence of surgery;
  • Improving respiratory function that has been altered by the chest deformity. 

Maintaining Fitness

For many individuals with AIS, maintaining activities of daily living, sports participation, and health and well-being will be crucial towards maintaining a good quality of life.
It should be noted that the research regarding pursuing various exercise modes such as generalised Physiotherapy; stretching and strengthening exercises, such as Yoga and Pilates, have remained controversial in whether they are truly effective in treating individuals with AIS (12, 13).

Surgical Intervention

Whilst conservative treatment such as physical therapy will usually be the first option considered, surgical intervention can be required in more severe cases of AIS where the spinal curve cobb angle exceeds surgery may not be the first option considered , for severe cases of AIS where the spinal curve cobb angle exceeds 45° – 50° (9).


  1. Janicki, J. A., & Alman, B. (2007). Scoliosis: Review of diagnosis and treatment. Paediatrics & Child Health, 12(9), 771-776
  2. 2. Parr, A., & Askin, G. (2020). Paediatric scoliosis: Update on assessment and treatment. Australian Journal of General Practice, 49 (12)
  3. Choudhry, M. N., Ahmad, Z., & Verma, R. (2016). Adolescent Idiopathic Scoliosis. The Open Orthopaedics Journal, 10, 143-154
  4. Asher. M. A., & Burton, D. C. (2006). Adolescent idiopathic scoliosis: natural history and long-term treatment effects. Scoliosis, 1(1), 2
  5. Reamy, B. V., & Slakey, J. B. (2001). Adolescent idiopathic scoliosis: review and current concepts. American Family Physician, 64(1), 111-116
  6. Konieczny, M. R., Senyurt, H., & Krauspe, R. (2013). Epidemiology of adolescent idiopathic scoliosis. Journal of Child Orthopaedics, 7(1), 3-9
  7. Weiss, H-R., Karavidas, N., Moramarco, M., ^ Moramarco, K. (2016). Long-Term effects of untreated Adolescent Idiopathic Scoliosis: A Review of the Literature. Asian Spine Journal, 10(6), 1163-1169
  8. Gallant, J-N., Morgan, C.D., Stoklosa, J.B., Gannon, S.R., Shannon, C.N., & Bonfield, C.M. (2018). Psychosocial difficulties in Adolescent Idiopathic Scoliosis: Body Image, Eating Behaviours, and Mood Disorders. World Neurosurgery, 116, 421-432
  9. Maruyama, T., & Takeshita, K. (2009). Surgery for Idiopathic Scoliosis. Clinical Medicine. Paediatrics, 3, 39-44
  10. Schreiber, S., Parent, C. E., Moez, E. K., Hedden, D. M., Hill, D., Moreau, M. J., Lou, E., Watkins, E. M., & Southon, S. C. (2015). The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis, 10, 24
  11. Romano, M., Minozzi, S., Bettany-Saltikov, J., Zaina, F., Chockalingam, N., Kotwicki, T., Maier-Hennes, A., & Negrini, S. (2012). Exercises for adolescent idiopathic scoliosis. The Cochrane Database of Systematic Reviews, 2012(8): CD007837
  12. Negrini S, Aulisa AG, Aulisa L, Circo AB, Mauroy JC, Durmala J, et al. 2011 SOSORT Guidelines: Orthopaedic and Rehabilitation Treatment of Idiopathic Scoliosis During Growth. Scoliosis2012 Jan 20;7(1):3

13. Negrini S, Negrini A, Romano M, Verzini N, Negrini Al, Parzini S. A controlled prospective study on the efficacy of SEAS.02 exercises in preventing progression and braces in mild idiopathic scoliosis. Studies in Health Technology and Informatics 2006;123:523‐6