Wait and see, back brace or physical therapy?

Photo of a girl being treated by a physiotherapist

Sometimes, teenagers with scoliosis can wait and see what happens and don’t need treatment. But it's important to have regular check-ups to keep an eye on how the curve develops over time. If it gets worse, a back brace might be needed – like in people with severe scoliosis.

Roughly 2% of teenagers have a curved spine (scoliosis). The cause is usually not known. The likelihood that the scoliosis will get worse depends on how severe it is and how far the person’s bones have already developed overall (their skeletal maturity). Severe scoliosis tends to get worse. If the person’s bones are still growing, the curve in their spine is more likely to get worse.

When are regular check-ups enough?

Scoliosis isn't very likely 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 and 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, there’s still time to start treatment.

Illustration: How the Cobb angle is measured

When is a back brace recommended?

A brace is recommended if

  • the Cobb angle is between 20 and 30 degrees and increases by more than 5 degrees between two check-ups or
  • the Cobb angle is between 30 and 45 degrees.

The recommendations vary for teenagers

  • with a Cobb angle between 20 and 30 degrees,
  • whose scoliosis hasn't got worse and
  • whose bones are still not fully mature (Risser stages 0 to 2).

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

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

Illustration: A back brace for treating scoliosis

Can physical therapy help?

Doctors sometimes recommend physical therapy (physiotherapy) for 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 breathing exercises.

The 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 hardly any high-quality research on the effects of physical therapy on scoliosis. A few studies suggest that the exercises can have a slight effect on the curve. 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 still a good idea to stay active and do exercise.

Dunn J, Henrikson NB, Morrison CC, Nguyen M, Blasi PR, Lin JS. Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task Force. (AHRQ Evidence Syntheses; Volume 156).

Negrini S, Minozzi S, Bettany-Saltikov J, Chockalingam N, Grivas TB, Kotwicki T et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2015; (6): CD006850.

Thompson JY, Williamson EM, Williams MA, Heine PJ, Lamb SE. Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis. Physiotherapy 2019; 105(2): 214-234.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on May 10, 2022

Next planned update: 2025

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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