Adult Scoliosis: Causes, Symptoms and Treatments

Adult scoliosis: Adult scoliosis is a much more widespread condition than commonly thought. If you were diagnosed with scoliosis as a child, or if you’ve started to notice changes in your posture over the years, know that you are not alone. In this comprehensive guide we explain everything you need to know: from causes to symptoms, from the most effective exercises to treatment options based on scientific evidence. For more details, consult the guide on biomechanics of posture. For more details, consult the guide on Exercises for Scoliosis: SEAS, Schroth and Effective Protocols.

What is Adult Scoliosis?

Scoliosis is a lateral deviation of the spine greater than 10 degrees (Cobb angle), accompanied by a rotational component of the vertebrae. When we talk about adult scoliosis, we refer to two main situations:

1. Adult idiopathic scoliosis: is the continuation of scoliosis that appeared during adolescence that persists and can progress in adulthood.
2. Degenerative scoliosis (de novo): appears de novo after 40-50 years of age, as a consequence of degenerative processes affecting the intervertebral discs, articular facets and spinal ligaments.

In both cases, the spine loses its natural alignment, with consequences that can range from simple aesthetic discomfort to significant pain and functional limitation.

Differences from adolescent scoliosis

In adults, scoliosis presents some peculiar characteristics:

• Pain is the predominant symptom (rarely present in adolescents)
• Stiffness joint is greater compared to young people
• Degenerative problems such as disc protrusions, spinal canal stenosis and disc herniations may coexist
• Curve progression, although slow, can continue over time (approximately 0.5-1 degree per year in curves greater than 30 degrees)

How Widespread is Adult Scoliosis? Data and Statistics

The prevalence of adult scoliosis is surprisingly high. According to international scientific literature:

• Degenerative scoliosis affects between 30% and 68% of the population over 60 (Schwab et al., 2005; Kebaish et al., 2011)
• In Italy, it’s estimated that approximately 2-3 million adults live with some form of scoliosis
• Women are affected more frequently than men, with a ratio of approximately 2:1 in the degenerative form
• Adolescent idiopathic scoliosis, which persists in adulthood, has a prevalence of 2-4% in the general population
• After menopause, osteoporosis accelerates the progression of the scoliotic curve

These numbers highlight how adult scoliosis is an often underestimated public health problem.

Causes and Risk Factors

Causes of persistent idiopathic scoliosis

Idiopathic scoliosis, by definition, has no known cause. When scoliosis diagnosed in adolescence persists in adulthood, factors that influence its progression include:

• Magnitude of the curve at the end of growth: curves greater than 30 degrees have a higher probability of progressing
• Location of the curve: thoracic curves tend to progress more than lumbar ones
• Sagittal imbalance: loss of lumbar lordosis is a negative prognostic factor

Causes of degenerative scoliosis

Degenerative or “de novo” scoliosis is caused by:

• Asymmetric disc degeneration: the intervertebral disc loses height unevenly, creating lateral inclination
• Arthritis of the facet joints: asymmetric wear of the posterior joints alters segmental stability
• Ligamentous failure: spinal ligaments lose elasticity and containment capacity
• Osteoporosis: bone resorption weakens the vertebral body, favoring microfractures and deformity

Risk factors

• Advanced age (over 50 years)
• Female gender
• Osteoporosis and osteopenia
• Previous spinal surgery
• Sedentary lifestyle and lack of physical activity
• Overweight and obesity
• Demanding jobs or those with repeated asymmetric loads
• Family history of scoliosis

Symptoms of Adult Scoliosis

The symptoms of adult scoliosis are very different from those of adolescents. While in young people scoliosis is often asymptomatic, in adults the clinical picture can be complex and disabling.

Pain

Pain is the main reason why adults with scoliosis turn to physiotherapists or doctors. It can manifest as:

• Low back pain: pain in the lumbar region, the most frequent symptom, often aggravated by prolonged standing and walking
• Thoracic pain: pain in the thoracic region, related to the thoracic component of the curve and compensatory muscle contractures
• Radicular pain: pain radiating to one or both lower limbs, caused by compression of nerve roots at the curve level or in the lower lumbar tract (similar to sciatica)
• Neurogenic claudication: difficulty walking long distances due to associated spinal canal stenosis

Postural alterations

• Asymmetry of shoulders and pelvis
• Costal hump (prominence of ribs on one side)
• Lateral shift of the trunk (decompensation)
• Loss of lumbar lordosis with forward projection of the trunk (sagittal imbalance)
• Alterations in foot support and gait

For an in-depth look at the importance of pelvic alignment and posture, we recommend reading the dedicated article.

Functional limitations

• Difficulty standing for long periods
• Reduced walking ability
• Early muscle fatigue
• Difficulty in daily activities (dressing, picking up objects, housework)
• In severe cases, reduced respiratory capacity (significant thoracic curves)

Psychological impact

The impact on quality of life should not be underestimated: anxiety, depression, reduced self-esteem and social isolation can accompany adult scoliosis, especially when the deformity is visible and pain is chronic.

Diagnosis: How to Evaluate Adult Scoliosis

The diagnosis of adult scoliosis involves several steps.

Clinical evaluation

The expert physical therapist performs:

• Complete postural examination: analysis in standing position (anterior, posterior and lateral view)
• Adams test: forward trunk flexion to highlight costal hump and vertebral rotation
• Mobility assessment: flexion, extension, lateral inclination and rotation of the spine
• Neurological examination: reflexes, muscle strength, sensitivity of lower limbs
• Sagittal balance assessment: lateral profile analysis with plumb line
• Functional assessment: ability to walk, stand, balance

Imaging diagnostics

• Full spine X-ray (weight-bearing): is the fundamental examination, allows measurement of the Cobb angle, assessment of sagittal and coronal balance
• Magnetic resonance imaging (MRI): indicated when nerve compression, canal stenosis or associated disc pathology is suspected
• CT scan: useful for surgical planning and detailed study of bone structures
• DEXA scan: bone densitometry to assess the presence of osteoporosis, fundamental in postmenopausal women

Severity classification

The Cobb angle allows classification of scoliosis:

• Mild: 10-25 degrees
• Moderate: 25-40 degrees
• Severe: over 40 degrees

In adult scoliosis, however, severity doesn’t depend only on the Cobb angle: sagittal imbalance (forward projection of the trunk) is often the factor that most correlates with pain and disability.

Conservative Treatment: the Central Role of Physiotherapy

Conservative treatment represents the first line of intervention in adult scoliosis and, clinical experience shows that it brings significant results in most patients.

Objectives of physiotherapy treatment

• Reduce pain and improve quality of life
• Stabilize the curve and prevent its progression
• Improve functionality in daily activities
• Optimize postural balance (sagittal and coronal)
• Strengthen the musculature supporting the spine
• Maintain or improve mobility joint range of motion
• Improve respiratory capacity

Evidence-based physiotherapy approaches

SOSORT (Society on Scoliosis Orthopaedic and Rehabilitation Treatment) guidelines recommend several specific approaches for scoliosis:

SEAS Method (Scientific Exercises Approach to Scoliosis)

Developed in Italy by ISICO (Italian Scientific Institute Spinal Column), the SEAS method is an approach based on active three-dimensional self-correction of the scoliotic curve. The patient learns to:

• Recognize their incorrect posture
• Perform active self-correction of the curve
• Maintain correction during daily activities
• Integrate breathing exercises stabilization and strengthening

Schroth Method

Developed in Germany, the Schroth method is one of the most studied and scientifically validated approaches. It’s based on:

• Exercises for three-dimensional elongation of the spine
• Rotatory breathing to derotate the trunk
• Specific postural correction for the type of curve
• Muscle strengthening in the correct position

Manual therapy

Manual therapy is an important complement to the exercise program:

• Mobilization of rigid areas (curve convexity)
• Myofascial release techniques for contractures
• Treatment of trigger points in paravertebral musculature
• Mobilization of the pelvis and sacroiliac joints

Clinical Pilates and integrated approaches

Pilates adapted to scoliosis can be a valuable tool for:

• Improving body awareness
• Strengthening deep musculature (core stability)
• Improving flexibility in a controlled manner
• Working on balance and coordination

Exercises for Adult Scoliosis: Practical Guide

Exercises represent the pillar of conservative treatment. Here’s a series of exercises frequently recommended to patients, divided by objective. Important: these exercises are general indications; the program must always be personalized by the physical therapist based on the type and severity of the curve.

Mobilization exercises

Exercise 1: Cat-Cow

Difficulty: Easy | Equipment: Mat | Duration: 5 minutes

Starting position:
Quadruped position with hands directly under shoulders and knees under hips. The back is in neutral position, gaze directed toward the floor.

Step-by-step execution:

1. Step 1: Inhaling, slowly let the abdomen drop toward the floor, lifting head and tailbone toward the ceiling (cow position)
2. Step 2: Exhaling, round the back upward bringing chin toward chest and tailbone downward (cat position)
3. Step 3: Alternate the two positions fluidly and slowly, synchronizing movement with breathing

Sets and repetitions: 10-15 slow repetitions — 30-second pause before possible second set

Common mistakes to avoid:

• Performing the movement too quickly without control
• Moving only the neck without involving the entire spine
• Forcing the lumbar arch in the “cow” phase if it causes pain

How to know you’re doing it correctly:
You feel a wave of movement involving the entire spine, from pelvis to head. The movement is fluid, without jerks. You feel a sensation of progressive mobilization and loosening of vertebral stiffness.

Exercise 2: Seated Trunk Rotation

Difficulty: Easy | Equipment: Stable chair | Duration: 5 minutes

Starting position:
Seated on a stable chair with feet firmly on the ground at hip width. Arms are crossed over chest or hands placed on opposite shoulders. Back is erect.

Step-by-step execution:

1. Step 1: Elongate the spine upward, imagining growing a few centimeters
2. Step 2: Exhaling, slowly rotate the torso to the right keeping the pelvis still on the chair, bringing gaze beyond the right shoulder
3. Step 3: Hold the position for 15-20 seconds breathing normally, then return to center and repeat to the left

Sets and repetitions: 10 repetitions per side with 15-20 second holds — 5-second pause between repetitions

Common mistakes to avoid:

• Rotating pelvis along with trunk (pelvis must remain still)
• Tilting trunk laterally during rotation
• Forcing rotation beyond the comfort point

How to know you’re doing it correctly:
You feel stretching in the lateral trunk musculature and a sensation of “unwinding.” The hips remain parallel and still on the chair. Range of rotation increases progressively with practice.

Exercise 3: Lateral Inclination with Stretching

Difficulty: Easy | Equipment: None | Duration: 4 minutes

Starting position:
Standing with feet hip-width apart, arms extended along sides. Weight is distributed evenly on both feet. Back is erect and gaze forward.

Step-by-step execution:

1. Step 1: Elongate the spine upward and slightly contract abdominals to stabilize the trunk
2. Step 2: Incline laterally sliding the hand down the thigh, bending toward the side of the scoliotic curve concavity
3. Step 3: Hold the position for 15-20 seconds feeling the stretch of the contracted musculature in the concavity, then return to upright position

Sets and repetitions: 5 repetitions of 15-20 seconds on the side indicated by the physical therapist — 10-second pause between repetitions

Common mistakes to avoid:

• Rotating trunk during lateral inclination (movement should be purely in frontal plane)
• Bending forward instead of laterally
• Performing the exercise equally on both sides without considering the direction of the scoliotic curve

How to know you’re doing it correctly:
You feel stretching along the flank on the side opposite to inclination, from hip area to ribs. Movement is controlled and doesn’t cause pain. Hips remain aligned without shifting laterally.

Strengthening and stabilization exercises

Exercise 4: Plank

Difficulty: Intermediate | Equipment: Mat | Duration: 5 minutes

Starting position:
Prone position, supported on forearms (elbows directly under shoulders) and on toes. The body should form a straight line from head to heels.

Step-by-step execution:

1. Step 1: Place forearms on the ground with elbows under shoulders, fingers pointing forward
2. Step 2: Lift body off ground supported on toes, activating abdominals and glutes to keep body aligned
3. Step 3: Hold position for 20-30 seconds (gradually increase up to 60 seconds), breathing normally

Sets and repetitions: 3-5 repetitions with 20-60 second holds — 30-second pause between repetitions

Common mistakes to avoid:

• Letting pelvis drop down, creating an arch in lumbar area
• Lifting pelvis too high forming a “tent”
• Holding breath during the hold

How to know you’re doing it correctly:
You feel uniform work of all trunk musculature (abdominals, glutes, shoulders). A lateral observer sees a straight line from head to heels. You don’t feel pain in the lumbar area.

Exercise 5: Side Plank

Difficulty: Intermediate | Equipment: Mat | Duration: 5 minutes

Starting position:
Lying on side with forearm on ground, elbow directly under shoulder. Legs are extended and overlapped (or upper foot in front of lower for greater stability).

Step-by-step execution:

1. Step 1: Activate lateral abdominal musculature and glutes
2. Step 2: Lift pelvis off ground until creating a straight line from head to feet
3. Step 3: Hold position for 15-20 seconds, then descend in controlled manner. Repeat on other side

Sets and repetitions: 3-4 repetitions of 15-20 seconds per side — 20-second pause between repetitions

Common mistakes to avoid:

• Letting pelvis drop down during hold
• Rotating trunk forward or backward losing lateral plane alignment
• Holding breath during exercise

How to know you’re doing it correctly:
You feel intense work in lateral trunk musculature (obliques). Body remains aligned on single plane, without rotations. Note: in scoliosis, the physical therapist will indicate which side to emphasize more based on curve direction.

Exercise 6: Bird-Dog

Difficulty: Intermediate | Equipment: Mat | Duration: 7 minutes

Starting position:
Quadruped position with hands under shoulders and knees under hips. Back is in neutral position, gaze toward floor.

Step-by-step execution:

1. Step 1: Activate transverse abdominis to stabilize lumbar spine
2. Step 2: Slowly extend right arm forward and simultaneously left leg backward, until bringing them parallel to floor
3. Step 3: Hold position for 5 seconds keeping pelvis stable and horizontal, then return to starting position and repeat with left arm and right leg

Sets and repetitions: 10 repetitions per side — 30-second pause after completing both sides

Common mistakes to avoid:

• Rotating pelvis when extending leg (pelvis must remain horizontal)
• Arching lumbar area during leg extension
• Lifting arm and leg too high, beyond body line

How to know you’re doing it correctly:
Pelvis remains stable and horizontal during entire movement (a glass of water placed on lumbar area shouldn’t fall). You feel deep trunk stabilization work. Movement is slow and controlled.

Exercise 7: Bridge

Difficulty: Easy | Equipment: Mat | Duration: 6 minutes

Starting position:
Lie supine with knees bent and feet on ground at hip width. Arms are extended along sides with palms facing down.

Step-by-step execution:

1. Step 1: Contract glutes and abdominals, pressing feet into ground
2. Step 2: Slowly lift pelvis off ground, vertebra by vertebra, until aligning knees-pelvis-shoulders in straight line
3. Step 3: Hold position at top for 5-10 seconds, then descend slowly one vertebra at a time

Sets and repetitions: 10-15 repetitions with 5-10 second holds — 30-second pause every 5 repetitions

Common mistakes to avoid:

• Hyperextending lumbar area in high phase (pelvis shouldn’t exceed knee-shoulder line)
• Pushing pelvis upward using lumbar muscles instead of glutes
• Placing weight on shoulders and neck instead of feet

How to know you’re doing it correctly:
You feel intense work in glutes and posterior thighs. Lumbar area is relaxed. Body forms straight line from knees to shoulders without “peaks” in lumbar area.

Postural self-correction exercises

Exercise 8: Self-Correction in Front of Mirror

Difficulty: Intermediate | Equipment: Full-length mirror | Duration: 5 minutes

Starting position:
Standing in front of full-length mirror, feet at hip width, arms at sides. Observe your natural posture in mirror, noting asymmetries.

Step-by-step execution:

1. Step 1: Observe your posture in mirror, identifying trunk inclination and shoulder asymmetry
2. Step 2: Actively elongate spine upward (as if a string were pulling from top of head) and correct lateral deviation, recentering trunk on midline
3. Step 3: Hold correct position for 30-60 seconds, memorizing the body sensation of correct posture, then release and repeat

Sets and repetitions: 5-10 repetitions of 30-60 seconds throughout the day — Insert practice into habitual moments (morning, during breaks)

Common mistakes to avoid:

• Correcting only with shoulders without involving entire spine
• Being too rigid in correct position (it should remain natural and maintainable)
• Performing self-correction without mirror before acquiring sufficient body awareness

How to know you’re doing it correctly:
In mirror you observe improved alignment of shoulders and trunk. You feel a sensation of “growth” and spine elongation. With practice, correct posture becomes more natural and easier to maintain.

Exercise 9: Diaphragmatic and Costal Breathing

Difficulty: Easy | Equipment: Mat or chair | Duration: 5 minutes

Starting position:
Seated on chair with erect back or supine on mat. One hand placed on chest and other on abdomen to perceive respiratory movements.

Step-by-step execution:

1. Step 1: Inhale slowly through nose, trying to expand chest consciously, directing air particularly toward concave side of scoliotic curve
2. Step 2: Feel with hand on chest the costal expansion, trying to obtain symmetric expansion between both sides
3. Step 3: Exhale slowly through mouth, completely emptying lungs. Repeat for 10-15 complete respiratory cycles

Sets and repetitions: 10-15 respiratory cycles — Perform 2-3 times per day

Common mistakes to avoid:

• Breathing only with upper chest (superficial breathing)
• Lifting shoulders during inspiration
• Forcing inspiration excessively creating tension

How to know you’re doing it correctly:
You feel chest expansion under hand, with progressive sensation of “opening” of concave side. Breathing is slow and deep without effort. With practice, concave side expansion becomes wider and more symmetric compared to convex side.

Recommendations for physical activity

• Swimming: useful but not “the cure” for scoliosis. Freestyle and backstroke are generally preferable; breaststroke may be contraindicated in some forms
• Walking: at least 30 minutes daily, preferably on level ground
• Yoga: with caution and supervision, can improve flexibility and body awareness
• Avoid: high-impact sports, repeated asymmetric loads, long periods of sedentary behavior

Bracing in Adult Scoliosis

Bracing (orthosis) in adults has different indications compared to adolescents:

• Doesn’t serve to correct the curve (as in growing adolescents)
• Can be useful as analgesic support during phases of pain exacerbation
• In some cases, specific braces (e.g., SPoRT, Sforzesco) can contribute to stabilizing progressive curves
• Use should be time-limited to avoid muscle weakening
• Must always be combined with active exercise program

When is Surgical Intervention Necessary?

Surgery in adult scoliosis is reserved for cases where conservative treatment is insufficient. Main indications are:

• Severe disabling pain non-responsive to prolonged conservative treatment (at least 6-12 months)
• Progressive neurological deficits (muscle weakness, sensory disturbances, sphincter problems)
• Documented curve progression despite treatment
• Severe sagittal imbalance with inability to stand upright
• Symptomatic spinal canal stenosis not treatable conservatively

Surgical intervention generally consists of spinal fusion (arthrodesis) with instrumentation (screws and rods) to partially correct deformity and stabilize the spine. It’s a demanding procedure, with long recovery times (3-6 months) and not without risks, especially in elderly populations. Therefore, the decision must be made with extreme caution and after thorough multidisciplinary evaluation.

Scoliosis and Associated Pathologies

Adult scoliosis rarely presents in isolation. It often coexists with other conditions that complicate the clinical picture:

• Disc protrusion and disc herniation: asymmetric load distribution favors disc degeneration
• Spinal canal stenosis
  Disclaimer medico: Le informazioni contenute in questo articolo hanno finalità esclusivamente educativa e informativa. Non sostituiscono il parere del medico o del fisioterapista. Per diagnosi e trattamento rivolgersi al proprio medico o fisioterapista di fiducia.

  For a broader overview of related conditions, see our complete guide to back pain.

  Sources and Scientific References

  1. Chen X et al. (2022). Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev. 9:CD006338. DOI | PubMed
  2. Carrasco-Vega E et al. (2024). Efficacy of physiotherapy treatment in medium and long term in adults with fibromyalgia: an umbrella of systematic reviews. Clin Exp Rheumatol. 42:1248-1261. DOI | PubMed
  3. Fan LJ et al. (2022). Ergonomic risk factors and work-related musculoskeletal disorders in clinical physiotherapy. Front Public Health. 10:1083609. DOI | PubMed
  4. de Santana Chagas AC et al. (2022). Physical therapeutic treatment for traumatic brachial plexus injury in adults: A scoping review. PM R. 14:120-150. DOI | PubMed
  5. Christofi I et al. (2024). The effectiveness and characteristics of physiotherapy interventions on adults with iliotibial band syndrome. A scoping review. J Bodyw Mov Ther. 40:1939-1948. DOI | PubMed

  Frequently Asked Questions

  What is adult scoliosis and how common is it?

  Adult scoliosis is a lateral curvature of the spine greater than 10 degrees, often accompanied by vertebral rotation. It can be a continuation of adolescent scoliosis or develop de novo due to age-related spinal degeneration. This condition is surprisingly common, affecting between 30% and 68% of the population over 60.

  What are the main symptoms of adult scoliosis?

  In adults, the predominant symptom is often pain, which is less common in adolescent scoliosis. Other common symptoms include spinal stiffness, noticeable postural alterations, and potential functional limitations in daily activities.

  Can adult scoliosis worsen over time?

  Yes, adult scoliosis can progress slowly over time, especially in curves greater than 30 degrees, typically at a rate of approximately 0.5-1 degree per year. Regular monitoring by a trusted doctor or physical therapist is important to track any changes.

  What is the role of physiotherapy in managing adult scoliosis?

  Physiotherapy plays a central role in the conservative management of adult scoliosis. A physical therapist can guide you through evidence-based exercises, including mobilization, strengthening, stabilization, and postural self-correction techniques, to effectively manage pain and improve function.

  How does adult scoliosis differ from scoliosis in adolescents?

  Adult scoliosis differs significantly from adolescent scoliosis primarily in its symptoms and associated conditions. Adults commonly experience pain and greater spinal stiffness, and often have coexisting degenerative issues like disc protrusions or spinal canal stenosis, which are rare in adolescents.