Wait and see, back brace or physical therapy?

Scoliosis is unlikely to get worse if

• the degree of the curve (measured using the “Cobb angle”) is between 10 and 20 degrees.
• the Cobb angle is between 20 and 30 degrees but the bones have almost stopped growing ("Risser stage" 3 or higher, where skeletal maturity is divided into Risser stages ranging from 0 to 5).

In these cases, regular check-ups might be enough. The important thing is to make sure you have a check-up every three to six months.

At the check-up, an orthopedist will do a test that involves you bending forward so they can look at the shape of your spine. They will also place a special type of spirit level (a scoliometer) on your back. If the results suggest that the scoliosis has got worse, you will usually need to have an x-ray to measure the Cobb angle again. If the angle has increased, it’s still possible to start treatment then.

Orthopedic back braces can prevent scoliosis from getting worse by putting pressure on certain parts of the spine. Most braces are plastic and made to measure. At the points where they apply pressure, they are padded on the inside.

A brace is recommended if

• the Cobb angle is between 20 and 40 degrees and increases by more than 5 degrees between two check-ups or
• the Cobb angle is between 25 and 50 degrees.

The recommendations vary for teenagers

• with a Cobb angle between 20 and 25 degrees,
• whose scoliosis hasn't got worse and
• whose bones are still not fully mature (Risser stages 0 to 2).

In these cases, some experts recommend a back brace. Others favor regular check-ups and only recommend a brace if the curve gets worse.

Doctors usually recommend physical therapy (physiotherapy) for people with scoliosis. Certain types of physical therapy, like the Schroth method, were developed especially for scoliosis. They include various exercises to straighten the spine – such as posture and stretching exercises, exercises for particular groups of muscles and special breathing exercises.

The exact exercises the physical therapist chooses for you will depend on the severity and form of your scoliosis. They show you how to do the exercises so that you can do them regularly at home – ideally in front of a mirror to make sure you’re doing them correctly.

Schroth therapy is offered as an outpatient treatment in physical therapy practices and at specialized rehabilitation centers – usually as part of longer-term treatment.

There is little high-quality research on whether physical therapy helps in scoliosis. This research suggests that the exercises can improve the curve of the spine and your quality of life somewhat. But it’s not clear whether this is enough to avoid the need for a brace or to prevent back pain, for instance.

If a brace is needed, physical therapy and exercise can help. But they shouldn’t be seen as an alternative to the brace. A brace is a passive form of treatment. It supports the muscles rather than strengthening them. So it’s important to stay active and do exercise. Physical therapy can also be a good idea after having surgery.