Body Area
ScoliosisConservative Management and What to Expect
For people living with scoliosis, honest about what chiropractic can and cannot do. Focused on pain, mobility, and movement confidence.
Book Your First VisitChiropractic cannot correct a scoliotic curve. Current evidence does not support curve correction through manual therapy. What conservative care can do: reduce pain from asymmetric loading, improve mobility, and support a better quality of life. Exercise is the most important long-term tool.
Who comes to see me for scoliosis
Scoliosis is a lateral curvature of the spine measuring more than 10 degrees on X-ray, usually accompanied by vertebral rotation. The majority of cases are idiopathic (no identifiable cause). Most patients I see with scoliosis fall into one of three groups, and the clinical focus is different for each.
- Adults with mild childhood scoliosis who are managing MSK symptoms: The largest group in my practice. A curve was found in adolescence, often under 30 degrees, never required surgery or bracing, and has been largely stable since. The presenting complaint now is back pain, stiffness, fatigue from asymmetric muscle loading, or reduced movement confidence. Most adults in this group don't require urgent re-imaging, though a baseline assessment is worthwhile if they haven't had one recently. What they need is someone who can assess the mechanical consequences of the curve and help manage them.
- Adults who had corrective surgery (Harrington rods or modern instrumentation): Surgery significantly reduces spinal mobility at the fused segments. The adjacent segments above and below the fusion compensate, and that compensation produces its own load patterns and symptoms. Post-surgical patients often have a combination of reduced range in the fused region and hypermobility at adjacent levels. Manual therapy is modified to work around the instrumented spine, focusing on the adjacent mobile segments and associated soft tissue tension. For post-surgical patients, I communicate with the treating surgeon as part of the intake process before beginning manual therapy.
- Adolescents (and their parents) in active monitoring: Growing spines require orthopaedic monitoring for progression. Chiropractic has a supporting role here, managing pain and maintaining mobility alongside the orthopaedic pathway. I will always ensure monitoring is happening through the appropriate channels and refer promptly if I have any concern about progression.
If you haven't had recent imaging and don't know your current curve measurement, we can assess you first and determine what's needed from there. If your curve was documented as stable at the end of adolescence and you have no new or worsening symptoms, you don't need imaging before your first visit. We can assess together whether updated imaging adds anything. Those over 50 or with a history of adult-onset progression should seek updated imaging regardless6,7.
What conservative care can and cannot do
I want to be direct about this, because there is misinformation in this area.
- Chiropractic cannot correct a scoliotic curve. Spinal manipulation does not straighten scoliosis. The current evidence does not support the claim that spinal manipulation alone can significantly reduce a Cobb angle. If you have been told otherwise, it is worth asking what evidence that claim is based on.
- What chiropractic can do: reduce pain and stiffness related to the asymmetric loading scoliosis creates, improve mobility in restricted spinal segments, address compensatory muscle tension in paraspinal and accessory muscles, and support better movement and function over time. These are meaningful goals.
- Exercise is the most important tool. Scoliosis-specific physiotherapeutic exercise approaches like the Schroth method and SEAS (Scientific Exercise Approach to Scoliosis, a curve-specific physiotherapeutic exercise approach) are designed to improve spinal awareness, breathing patterns, and postural control for specific curve types. I can guide general movement and exercise, and identify when a referral to a scoliosis-specific physiotherapist would be more appropriate.
How I approach scoliosis
The first session involves reviewing any available imaging, assessing spinal mobility, identifying restricted segments, and understanding how the curve is affecting how you feel day to day. A common complaint is pain from asymmetric loading: one side working harder than the other creates muscle fatigue and joint irritation that can respond to conservative management.
I'll be honest about what I think is realistic for your curve type and degree. Adolescent scoliosis with a growing spine needs orthopaedic monitoring for progression; I'll make sure that's happening alongside any conservative care. Adult scoliosis that is stable and not causing neurological symptoms is appropriate for conservative management.
On monitoring
Adolescent idiopathic scoliosis that is not being monitored orthopaedically should be. Curves can progress significantly during growth spurts, and the window for bracing intervention, where it's indicated, is time-sensitive. Monitoring intervals during the growth phase are risk-stratified: curves above 20 degrees during active growth are typically reviewed every 4-6 months; lower-risk or post-peak curves may extend to 12 months. Your orthopaedic specialist will determine the appropriate schedule. Ask your GP for an orthopaedic referral if this isn't happening.
Scoliosis can't be corrected with manual therapy, but the pain scoliosis creates often comes from the muscle tension, joint stiffness, and movement restrictions that build up around the curve, rather than from the curve itself. These are what chiropractic care can address directly. It's worth separating what the curve is actually causing from what's happening alongside it. If you'd like to talk through your situation before booking, get in touch.
When to seek specialist care
Seek orthopaedic review if you have:
- A known curve that has not been assessed for progression in the past year (adolescents)
- Neurological symptoms: leg weakness, numbness, or bladder/bowel changes. These warrant prompt specialist contact, not routine review
- New onset spinal curvature or asymmetry developing in an adult over 50, particularly with leg symptoms
- Scoliosis with significant pain that is worsening rather than stable
- A curve measuring over 40-45 degrees in a growing spine (adolescent), or over 50 degrees in an adult, particularly with symptoms
- Scoliosis diagnosed in childhood that has not had specialist review as an adult. A GP referral for orthopaedic review is a sensible first step. A chiropractic assessment can be a useful adjunct while you await that referral, particularly if you have pain or mobility concerns.
Conservative chiropractic care is appropriate for pain management and function in stable adult scoliosis. It does not replace orthopaedic monitoring.
Common questions
No, and I won't tell you it can. Structural scoliosis (a true lateral curvature of the spine with vertebral rotation) cannot be corrected by manual therapy. What chiropractic can do is address the pain and functional consequences of scoliosis: reduced spinal mobility, muscle imbalances, joint stiffness, and associated neck or back pain. The goal is to help you function better with your scoliosis, not to correct the curve itself.
For most adults with stable scoliosis, general exercise is not contraindicated and staying active is encouraged. Current evidence does not support the concern that general exercise worsens established scoliosis. Most sports are appropriate; for adolescents with a progressing curve, careful monitoring of high-load training is worthwhile, and I can advise based on your specific situation.
An 18-degree curve in an adult with closed growth plates is unlikely to progress significantly6,7. Curves below 25 degrees in adults are typically monitored rather than actively treated with bracing or surgery. What matters clinically is whether the curve is stable (not progressing), whether it's associated with symptoms, and what your functional capacity is. If you're an adolescent still growing, the monitoring threshold is different and I'll factor that in. I'll review your imaging and give you a clear picture of what your curve means in practical terms. If you don't have recent imaging, we can discuss whether updated imaging is appropriate as part of your initial assessment.
Schroth is a scoliosis-specific exercise approach that uses postural correction, rotational breathing, and three-dimensional movement to address the particular pattern of each curve. The evidence is strongest for adolescents with progressing curves; evidence from clinical trials suggests it may slow Cobb angle progression in adolescents2,3, though trial quality varies. For adults, randomised trial evidence is currently limited; what exists is largely extrapolated from adolescent data and clinical experience, though patients often find the body-awareness component useful for managing day-to-day discomfort. I apply scoliosis-informed movement principles in my approach and will explain how they relate to your curve pattern. For patients who would benefit from a full Schroth exercise programme, I can refer you to a certified Schroth physiotherapist.
Scoliosis doesn't reliably cause pain in proportion to curve size. Many people with scoliosis have back pain from the same sources as people without it (disc irritation, joint dysfunction, muscle imbalance), with the curve as a background factor rather than the direct cause. Distinguishing these is important because the treatment differs. I'll assess what's actually driving your pain rather than attributing everything to the curve by default.
Related reading
References
- Piqueras-Toharias M, et al. Effects of High-Velocity Spinal Manipulation on Quality of Life, Pain and Spinal Curvature in Children with Idiopathic Scoliosis: A Systematic Review. Children. 2024;11(10):1167. PMC11506289
- Schreiber S, et al. Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis. PLOS One. 2016;11(12):e0168746. PubMed 28033399
- Burger M, et al. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. South African Journal of Physiotherapy. 2019. PMC6556933
- Negrini S, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and Spinal Disorders. 2018;13:3. PMC5795289
- Rigo M, et al. Differential diagnosis of back pain in adult scoliosis. Scoliosis. 2010;5(Suppl 1):O44. PMC2938676
- Dragsted C, et al. Curve progression in non-surgically treated patients with idiopathic scoliosis: 40-year follow-up. Acta Orthopaedica. 2025. PMC11747841
- Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am. 1983;65(4):447-455. PubMed 6833318
- Schreiber S, Di Felice F, et al. Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials: Systematic Review of Methods. Children. 2023;10(6):954. PMC10297476
Disclaimer
This page is for general information only and does not constitute medical advice. Every person's situation is different. Nothing here should be used as a substitute for assessment and advice from a qualified health professional who can evaluate your specific circumstances.
If you are experiencing severe or rapidly worsening symptoms, loss of bladder or bowel control, progressive weakness, or any symptom that concerns you, seek medical care promptly rather than reading websites.
This page was written with AI assistance and reviewed by Erik Anderson for accuracy. If you find an error, please contact us and we will endeavour to correct it.
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