Scoliosis: Diagnosis, Treatment, Exercises

Scoliosis is a pathological curvature of the spine towards the left or right side of the body.

What Is Scoliosis and How Do I Recognize It?

Scoliosis is a pathological curvature of the spine towards the left or right side of the body. The term is derived from Ancient Greek skolios – “crooked”, and was probably coined by the great physician Galen (131 – 201 AD).

Scoliosis may or may not be structural. Structural scoliosis is caused by structural changes to the vertebrae or their abnormal rotations or asymmetries. Non-structural scoliosis has no basis in the anatomy of the spine itself, and the vertebrae are normal. Instead, the scoliosis is due to secondary causes, such as lumbar muscle contracture, substantially mismatched leg lengths, skewed pelvis, etc.

Causes of Scoliosis

Scoliosis is most commonly idiopathic, meaning it arises without an obvious external causative factor. Like many conditions placed in the “idiopathic” category, the exact causative mechanism is unknown. Leading theories include developmental disorders of vertebral growth, mismatch between the rate of growth of the osseous (bone) structure of the spinal canal and the spinal cord, central nervous system dysfunction, and others. Clinical classification is by age of appearance – infantile (appears before 3 years of age), juvenile (from 3 years to beginning of puberty), and adolescent (beginning of puberty to end of growth, after which idiopathic scoliosis does not appear).

  • If not idiopathic, scoliosis can also be neuromuscular, which is caused by a CNS developmental disorder.
  • Scoliosis can also appear as a result of neurofibromatosis.
  • It can also be a secondary condition arising from inflammation in the spinal area, as well as certain injuries, surgeries, and diseases. 
  • Postural scoliosis is caused by substantially unequal length of the legs.

Diagnosing Scoliosis

Kolář et al. (2009) classify common examinations for scoliosis as either “informative” or “special”. Informative examinations are simple and used for early detection; they are most commonly performed by pediatricians, physical therapists, and even some PE teachers with the proper training. Detecting scoliosis in its early stages is essential for selecting a therapeutic strategy and achieving maximum effect.

The basis of informative examinations is visual assessment of the torso while standing. The examiner notes the overall curvature and extent of musculoskeletal compensation and compares height to arm span. Healthy children under 10 years of age should have an arm span equal to their height, while with scoliosis the torso is shortened by the spinal deformity.

Special examinations involve determining the cause of scoliosis by reference to various characteristic signs, such as the coffee-stain skin patterns caused by fibromatosis, hair clumps in the lumbar area in diastematomyelia, milky corneas seen with mucopolysaccharidosis, etc.

Basic differential diagnosis involves the patient leaning forward. Structural scoliosis remains unchanged, while postural scoliosis is not apparent in this position. If the scoliosis is suspected to be structural, the next step is X-ray images to determine the extent of the skeletal changes.

Lékař diagnostikuje stupeň skoliózy páteře
Examination for scoliosis

Degrees of Scoliosis

The degree of pathological curvature in scoliosis is expressed by reference to the so-called Cobb angle, determined from an X-ray image.

  • A Cobb angle under 10° is not considered scoliosis
  • In the 10 – 20° range, regular monitoring is recommended 
  • In the 20 – 40° range, the patient should wear a therapeutic corset 
  • A Cobb angle in excess of 40° generally requires surgery

Childhood Scoliosis

The age of appearance of scoliosis is correlated with the likely prognosis: The sooner the condition appears, the more severe it is likely to eventually become (Kolář, 2009).

Prof. Repko (2017) writes that school-age children present with various spinal defects frequently, with varying severity and defect type. Non-structural posture problems are very common in the present day and most often due to a lack of physical activity. More severe, structural defects, such as severe hyperkyphosis and scoliosis, require complex interdisciplinary treatment and, quite often, surgery.

The spine is the axis of the musculoskeletal system and undergoes substantial development in childhood. Lack of physical activity, obesity, and asymmetrical overloading in competitive sports are among the most frequent causes of poor childhood posture (Repko, 2017).

Lékařka zkoumající držení těla dítěte
A doctor examines a child for proper posture

Adult Scoliosis

The scoliotic curve progresses most rapidly at the time of the most rapid bodily growth, i.e., during about the 1 to 2 years after the beginning of puberty. If by age 14 to 15 growth has slowed and sexual development is mostly complete, not much more further progression is likely (Janíček et al., 2012).

The key difference between child and adult scoliosis is that, by the time of adulthood, growth has ended and there is very little that can be done to affect the scoliotic curve anymore. Nonetheless, treatment efforts e.g. through exercise are far from pointless.

A small proportion of scoliotic deformities arise in adulthood as a result of advanced degenerative changes in spines not previously affected by childhood scoliosis. This is called primary degenerative scoliosis, or scoliosis de novo (Repko, 2012).

Treatment of Scoliosis

Kolář (2009) notes that a key factor in the future course of disease is early diagnosis. If the scoliotic curve is as yet mild and conservative therapy (physical therapy, corset) begins immediately, progression can be halted and future complications avoided. For idiopathic scoliosis – by far the most common type – no causal treatment (treatment of the ultimate cause) exists, as the causative mechanism is unknown. The only option here is treating symptoms – usually by physical therapy or orthoses, though some cases may require surgery.

Kolář (2009) lists these basic requirements for successful physical therapy of scoliosis:

  • targeted activation of autochthonic muscles (deep core muscles surrounding the spine)
  • working towards balance in abdominal and dorsal (back) muscle activity
  • learning diaphragmatic breathing and proper pelvic posture

The most common scoliosis treatments include:

1. Klapp exercises

This quadrupedal (done on all fours) technique was developed by the German orthopedist Rudolf Klapp (1873 – 1949). The aim is to correct the scoliotic curve by two kinds of crawling on all fours: using the arm and leg on the opposite sides, and the arm and leg on the same side (Kolář, 2009).

Klappovo lezení
Klapp exercises. From (in Czech) 

2. Schroth Technique

In the early 20th century, Katharina Schroth developed a then-visionary approach to scoliosis as a three-dimensional spinal deformity, notionally dividing the body into three rectangular blocks – pelvis, chest, and shoulders ­– stood on top of each other. Her system of exercise uses, among others, stretching in the spinal axis, targeted correction of pelvic posture, and breathing exercises (Kolář, 2009).

3. Vojta Technique

Vojta’s reflex locomotion, commonly called the Vojta technique, was developed by Czechoslovak neurologist Prof. Vojta in the mid-20th century. It relies on reflexive motions arising from early neurological development, eliminating the imprecision and poor execution that often mar the results of intellectually learned exercises (Kováčiková, 2017).

All of the technique’s locomotion models (exercise positions) involve straightening and rotation of the spine, motions ideal for treating scoliosis. When used to treat scoliosis, a powerful advantage is the technique’s ability to activate the autochthonous muscles between vertebrae, which activate first at the beginning of a motion, but are outside of voluntary control and therefore not directly accessible to conventional exercise. (Kutín, Apr 6, 2021, lecture at RL-Corpus).

A common misconception about the Vojta technique is that it is only useful with infants, while in fact, patients of all ages can successfully rehabilitate with it.

Gym Ball Exercises

Another treatment option for scoliosis is expert-led exercise with a gym ball. An essential part of these activities is maintaining a straight posture on the ball. This activates muscles along the spine and exercises spinal discs. 

Balancing on the unstable ball helps activate deep core stabilizing muscles, which are essential for back health.

The exercises below are from the online course at (in Czech)

(These exercises are presented for your inspiration and to illustrate the possibilities of the gym ball. When actually exercising, always consider your and others’ safety. There is a risk of falling off gym balls, and we cannot be held liable for any injuries sustained from improper exercise.) 

1. Squats with gym ball at the back 

Stand with your back to a wall, with the ball held against the wall by your middle back, then squat low. Maintain a straight spine throughout; the ball helps avoid hunching.

Žena cvičí dřepy s gumballem za zády
Exercise 1 – Squats with gym ball at back

2. Balancing 

Sit on the ball, lean on your palms, straighten your spine, activate torso muscles, and lean back slightly. (Make sure not to fall off.) Then, while keeping spine straight, alternate lifting one leg and the other.

Žena cvičí balanční cvičení na míči
Exercise 2 – Balancing on a gym ball

3. Deep core stabilizing system activation

Lie down on your back, lift your legs up, activate torso muscles, and while breathing out, toss the ball gently upward (helping activate the diaphragm, an important part of core musculature). Catch the ball while breathing in.

Žena cvičí aktivaci středu těla (core)
Exercise 3 – Deep core stabilizing system activation 

Proper Seated Posture

Adaptic therapeutic chairs provide the same kind of active seated posture as a gym ball, as their tilting seats allow core muscles to remain active and keep the spine from stiffening. Unlike a gym ball however, Adaptic chairs have back- and armrests, allowing for a comfortable relaxed position that a gym ball cannot provide. (The relaxed position on a gym ball is hunching down, which is not healthy in the long term.)

Srovnání špatného a správného sezení
Healthy seated posture on an Adaptic chair compared to poor posture on a regular chair

Scoliosis Surgery

Surgery for adolescent and adult scoliosis involves correcting the scoliotic curve, supported by spinal fusion (spondylodesis) to fix the corrected posture in place (using bone splints). A spinal fusion requires 2 to 3 years to fully mature; recreational sports can typically be resumed 2 years after surgery. Curve correction is effected by rods, screws, hooks, and wires made of surgical steel or other advanced materials (Janíček a kol., 2012).

Depending on the severity and type of the scoliotic curve, surgical access may be from the back, from the abdominal cavity, or combined. In some cases, post-surgery patients may receive a cast or plastic corset. Surgery can correct upwards of 50% of the total pathological curvature (Janíček a kol., 2012).

Preventing Scoliosis

Most cases of scoliosis are idiopathic, with an unknown causative mechanism, making targeted prevention difficult. In general however, asymmetrical loading and long-term static loads of any kind affect the spine negatively in various ways. Children definitely shouldn’t wear a school bag on one shoulder or tote it in one hand, and should also sit symmetrically at the computer. Kolář (2009) recommends against major reductions of physical activity on account of scoliosis.

Frequently Asked Scoliosis Questions

How do I recognize scoliosis? 

The easiest lay approach is to look the person over. Looking at a bare back, the spine will show an unnatural-looking sideways deviation (C- or S-shaped) of some group of vertebrae. One shoulder will also be higher than the other. Another option is to have the person bend forward; scoliosis sufferers will show a gibbus (or paravertebral bulge – a prominent hump to one side of the spine).

Is scoliosis painful?

Not always. Children suffering from mild scoliosis may have no pain at all, also due to overall higher tissue regeneration. In adults, the long-term asymmetrical loading of various torso muscles usually does cause pain. This pain may not, however, always be localized at the site of the scoliotic curve, and may instead appear in various fairly remote parts such as the neck, head, or hips.

Is there any medication for scoliosis?

The only medication commonly used is for symptoms – usually analgesics to relieve pain. Primary treatment consists of rehabilitation, and in more severe cases wearing a corset or surgery. 

What is your opinion of the SM System for scoliosis treatment?

The Smíšek technique (SM System) is suitable for scoliosis. An advantage is the high number of trained practitioners [in the Czech Republic] and detailed patient-education materials. As with other specialized techniques, finding a skilled therapist certified on the particular technique is essential for successful treatment. Knowing “some exercises from school” and the like is not enough to be considered an expert in a technique.

Which physical therapists would you recommend for scoliosis in the Czech Republic?

Personally, I think the leading scoliosis expert in the country is PhDr. Marcela Šafářová, Ph.D. of the Motol University Hospital in Prague. She is advanced enough in two different techniques (the Vojta technique and Prof. Kolář’s DNS) to train other professionals in them, a rare combination of breadth and depth of knowledge. 

My son has been diagnosed with scoliotic posture. What is that?

Scoliotic posture, or functional scoliosis, is a type of poor posture. The spine leans to the side, but there are no structural changes to the vertebrae. If scoliotic posture is diagnosed early and the patient attends suitable rehabilitation courses, progress into actual scoliosis can be prevented. Common causes of scoliotic posture include unequal leg length and long-term asymmetrical loading.

My daughter’s doctor recommended PNF rehabilitation. What is that?

PNF is short for proprioceptive neuromuscular facilitation. It is an exercise-based rehabilitation technique, one of the most popular worldwide, and highly effective, including for scoliosis. In the Czech Republic, the primary professional tutor is Mgr. et Mgr. Petra Bastlová, Ph.D.


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Mgr. Vojtěch Šenkýř

I am a physical therapist and personal trainer. In the hospital and in the gym, I mainly rely on the Kolář DNS technique. I'm currently also learning the Vojta technique.

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