Physical Therapy and Symptom Management of Scoliosis

By Victoria Luddy

Scoliosis is the change in the natural curvature of the spine typically in the mid or lower back. The curves of the spine are detected from a physical scoliosis screening and x-ray imaging.

The increased curvature may create a rib hump that is most noticeable as a person bends forward. The rib hump is created as the spine curves left or right with slight rotation. This deviation of the spine may create an asymmetry to other areas of the body, such as shoulders, hips, and waistline. For example, one shoulder may appear more elevated.

According to the Scoliosis Research Society, 80 percent of the cases are idiopathic, or unknown etiology. Other causes of scoliosis may be congenital, neuromuscular, or degenerative.

Idiopathic scoliosis presents during childhood and may continue to progress into adolescence. A physician will monitor the curvature of the spine using an x-ray image. This image provides the angle of degrees in the spine called Cobb angle. The Cobb angle helps determine progression of the scoliosis curve.

Moreover, a plan of care for treatment can be decided based on the progression. Treatment may not be necessary in mild cases; however, as the angle increases conservative and surgical treatments are available. Conservative treatments include bracing to prevent the curvature from worsening.

Often times there is minimal pain involved with scoliosis, however, over time there may be some muscle imbalances and flexibility issues in which physical therapy may help. 

Physical therapy and the treatment of scoliosis is continuously being researched. Physical therapy, solely, will not stop or reverse the progression for idiopathic scoliosis (although there are several methodologies that are currently being researched). 

Physical therapy is often utilized in treatment to complement bracing or surgical options or to manage patient symptoms due to scoliosis. 

A physical therapist’s approach to managing the treatment of scoliosis in physical therapy is to observe the slight imbalances the spinal curve has created and focus on the symptoms associated with these imbalances, such as pain, limited range of motion or flexibility, decreased strength, poor posture, or difficulty breathing.

Patient education is important to discuss the condition and management of scoliosis. Also incorporated in treatment sessions is postural retraining and stabilization through therapeutic exercises. 

Examination of muscles that have lengthened or tightened due to the curve are assessed. Stretches and strengthening exercises may be appropriate to relieve pain from these imbalances.

Lastly, breathing exercises may be utilized as the spine deformities may change rib positioning due to spine curvature. A patient with scoliosis will learn techniques and exercises to use for an independent home exercise program.