How To Treat Scoliosis In 2023

How To Treat Scoliosis Successfully

Scoliosis is a very common problem where the spine bends in a sideward direction. The condition mostly develops in childhood and through puberty (in the adolescent/teenage years). In this article, I’ll provide a thorough background understanding and show you how to treat scoliosis with a variety of approaches.

Help for Sufferers of Scoliosis in Childhood and as Adults

On this page, you’ll find comprehensive information on:

• the causes of scoliosis
• the symptoms
• the problems you might encounter, and
• the treatment for mild, moderate, and severe cases.
• I’ve taken extra effort to fill this with useful information, some of which you will not find anywhere else.

This website mainly explores the use of braces for all sorts of bodily conditions and injuries. So, naturally, we’ll have some recommendations for the use of good back braces for scoliosis so you can manage, improve and in some cases, even reverse the condition. 

Go and check out this page if you’re looking for specific recommendations for useful back braces you can use for scoliosis (and other back-related conditions). A lot of the products we recommend are designed for adults, because to treat children there are certain considerations you can take into account. As a result, in this article you’ll also find some very helpful information about how to treat scoliosis in children. We also discuss other ways to manage this complicated and often serious problem.

What Good Back Braces do for Scoliosis

A back brace designed especially for Scoliosis will aim to:

1. Provide the pressure to ensure a corrective force on your spine
2. Guide your spine for further growth and development during the growing years.
3. Provide symptomatic relief from pain and discomfort in your back.

On this page, here you will find a step-by-step guide to finding the best back brace for scoliosis.

In a hurry? Click here to skip to the reviews!

The nature of treatment including the type of brace you use is dependent on each patient’s individual situation. When it comes to back braces for scoliosis, there are hard braces (with varying degrees of customization to suit the patient), hybrid braces (a combination of hard and flexible panels, straps and devices), and soft braces. While a certain type might be recommended to you, the other types still may have good effect.

Read on so you can inform yourself about:

• many important aspects of scoliosis
• ranges of professional treatment, and…
• self-managed activities such as specific exercises, stretches and other ancillary therapies.

What is Scoliosis?

Scoliosis is a very common condition in which the vertebrae develop a lateral curve instead of staying straight (or vertical). A normal functional spine has an array of convex or concave front-to-back curves in the cervical, thoracic, and lumbar regions. 

Scoliosis usually starts in childhood

The non-functional lateral curves and rotation typical of scoliosis, are usually set into the spine during childhood and adolescent years. More specifically, there is a curve that bulges out to the side, and that curve will likely also involve a degree of rotation around the spine itself.

Scoliosis involves lateral curvature plus lateral rotation

Scoliosis, a 3-dimensional condition, causes abnormal curves and changes in the spine, which depart from the normal curves. The lateral curves are superimposed (in one or both directions) and put great stress on the spinal column. 

In normal function, the curves are there to maintain proper functional balance (and help distribute weight) needed for regular activities that most humans undertake.

Caused by some kind of structural or functional imbalance

It stands to reason that regardless of reason, if there is an upset to the curves, then the body becomes imbalanced. Scoliosis is when that imbalance institutes a longstanding change and the body can no longer create optimal conditions of balance, weight distribution, and most importantly, optimal function.

With scoliosis, there are changes in posture and function, which range from not obvious to highly disfiguring and dysfunctional.

The obvious physical changes manifest in unevenness in the shoulders, waist, and/or hips. This is a trademark of scoliosis.

Changes have a cascading effect that tends to magnify as they move up the body. Perhaps you’ll see the body leaning heavily to one side, and associated with that, the head may be out of alignment. The head is heavy in comparison to the rest of the body, so if that weight is continually being carried off to one side, this can worsen the effect of the scoliosis. This is because gravity will serve to amplify the ill-effects.

Is scoliosis painful?

Mild conditions may be completely asymptomatic. The more advanced cases may have associated pain that results from spinal imbalances. Longstanding problems in severe cases may mean that the altered thoracic space for lungs and heart could result in breathing difficulties; ribs are likely to misalign due to the introduced lateral curve and spinal rotation.

The wear and tear, and cumulative effects of scoliosis

A slight or small curve (or imperfection) is not that significant. However, large curves are prone to cause damage to the bones and joints. Even though the damage is cumulative over time, and starts out to be relatively minor, small asymmetrical degradations and wear of the vertebrae and facet joints mean that the longer the condition is left untreated, the worse the cumulative effects and the more difficult it will be to return to normal spinal curvature in all directions.

A large curve is the main cause of arthritis of the spine and can make the ribs rub against the pelvic bone (usually on one side). This back problem can also initiate a severe lung problem due to changing the shape of the space in which the lungs need to operate effectively.

Effects of scoliosis over time

The effect over time is to decrease spinal mobility, flexibility and agility and can create systemic problems if severe.

These conditions might include arthritis, muscular and mobility issues due to asymmetry of function, decreased lung function, circulation difficulties, and more.

Good back braces can help

Fortunately, regardless of the cause, cases of scoliosis can benefit from the use of good back braces. They can be an effective way to manage, improve, and in some cases even reverse the condition. Remember, for a reversal to be possible, it does depend on the cause and the timing of treatment.

Four Types of Scoliosis

There are 4 broad types of scoliosis.

1.  Congenital scoliosis:

• Caused by deformed vertebrae or ribs.
• Present at birth.

2. Idiopathic scoliosis:

• Comprises the greatest proportion of cases, about 80%.
• Of unknown cause (hence the label, idiopathic)

Idiopathic scoliosis usually appears in childhood and is diagnosed around 10 years old.

Here is a list of possible causes:

• Diet (possible malnourishment)
• Prolonged or repeated dysfunctional or asymmetrical activity
• Posture and postural and movement habits
• Genetic issues

3. Scoliosis from neuromuscular causes

When the condition is a result of surrounding supportive muscles via certain activities or conditions. Cerebral Palsy and Muscular Dystrophy are the two main problems referred to here. This is because they affect spinal development, spinal strength, and tone. A third is Spina bifida, which is a disease of spinal deformity.

4. Degenerative scoliosis

Rather than form in childhood and adolescence, this form of scoliosis is usually diagnosed after 60 years old. Changes in postural alignment are the result of wear and tear and are often combined with the effects of dysfunctional movement. Oftentimes it happens because the patient is decreasingly active and does not exercise the way they used to.

Symptoms of Scoliosis:

• Uneven shoulders and asymmetry of waistline (one exaggerated curve, the other might be a straight line)
• One hip higher than the other one
• One of the shoulder blades appears more prominent than the other one

Complications caused due to Scoliosis:

• Back Problems: Adults who most likely developed scoliosis during childhood, can experience chronic back pain.
• Lung and Heart Damage: Severe scoliosis can cause lung and heart problems. The rib cage unevenly presses the lungs and heart backward which can cause breathing problems. This backward push may create circulation issues and make it more difficult for the heart to pump blood.
• Physical Appearance: Severe scoliosis affects the physical appearance of the body. The changes are noticeable; such as uneven shoulders, prominent ribs (on one side), uneven hips, a sideways shift of the waist, and of the trunk to the side. People may suffer from confidence and self-esteem issues due to their appearance.

Diagnosing Scoliosis

A diagnosis of scoliosis occurs after certain tests have been carried out. The most common of which is the observation of misalignment of shoulders, hips, and or ribs with the use of Adam’s Forward Bend Test. The patient bends over from standing. When the clinician stands behind, they note any misalignment which becomes more obvious in this position.

Confirmation of the diagnosis then comes with further testing. MRI, CT scans, and X-rays can provide more information on the location and severity of the curves. An angle of over 10 degrees calculated from radiograph indicates the presence of scoliosis. The curve is significant if above 25 degrees and severe if over 45 degrees.

Effects on muscles around the curve

Associated with one side of overdeveloped, and the other side, underdeveloped muscles may be a weakness of muscles. One side may be in chronic or permanent spasm as the band of muscles contracts around the extra curve. Less common but still possible are numbness and abnormal reflexes. A thorough investigation will test for all these things.

Important questions to ask yourself to help you diagnose the cause of your scoliosis

The following 2 points will inform your diagnosis. Regardless of the basic underlying cause, awareness of these can help you create better conditions for reversal.

1. Are you, for example, aware that you stand leaning preferentially on one leg? This is an extremely common characteristic of women. Mostly, men tend to stand with legs separated and firm and straight, distributing weight evenly. This is one reason why males are far less likely to have scoliosis.
2. Do you cross your legs frequently, and usually in the same way? (Maybe pay some attention to the way you habitually cross your arms as it too may affect spinal rotation.)

Why does scoliosis occur more often in girls?

For some reason, girls have a far higher incidence of scoliosis than boys. Why? Maybe there’s an elephant in the room!

Are You Experiencing a Structural or a Functional Scoliosis?

This factor is not discussed. Most websites will say that the cause of scoliosis (idiopathic) which accounts for 80% of all cases, is MYSTERIOUS. This is a ridiculous assertion.

You need to consider the single main underlying cause: Is your condition STRUCTURAL, or FUNCTIONAL? I say main underlying cause because a structural main cause will affect function. It will affect how you move and how your body operates. And, with time, scoliosis caused by purely functional causes will cause structural change (explained further).

The differences are important. Broadly speaking: If you are talking about a structural scoliosis, the spinal deformity could be due to defects in the building blocks (bones) or supportive structures. Clearly, changes to function are immediately inevitable. If you are talking about the possibility of the scoliosis occurring due to functional means, you are looking at how a potential normal (or close to normal) anatomy has been used asymmetrically, repeatedly, over time to create a change of function (causing dysfunction) in the body.

So, why even make the distinction?

It is true that factors that create or worsen a functional scoliosis (such as types of physical activity, gravity and so on) will also occur in the bodies of those with a structural scoliosis. Both types can respond to treatment.

However, it stands to reason that if a condition is caused by dysfunctional asymmetrical activity, then there is the possibility to reverse the effects of that longstanding habitual movement. If you can learn to move with proper function, with or without the support of back braces designed for scoliosis, you have a high(er) chance of improvement.

If you have a congenital (or structural) scoliosis, then you may be able to get a partial improvement of your condition because you can help reverse the effects of the ravages of gravity and time on your spine.

Permanent damage will hamper ability to reverse effects of scoliosis

It is essential to recognize this waiver: Habitual dysfunctional movement that has created scoliosis (regardless of cause) will cause some degree of permanent damage to the vertebrae and facet joints (from slight to advanced wear-and-tear on the tissues). The longer and more advanced the damage, the less able your body can re-take on completely normal function.

There is hope!

But, the excellent news is you can, with the right training towards proper functional symmetrical movement, regain a spine that is inherently more functional and less painful or uncomfortable. You could even approach something close to ideal or optimum position.

The switch to mindful activity and movement

It is also important to recognize this:

• The kinds of movements you have made have habituated your spinal muscles into their signature movements. You have trained them unconsciously, since you could walk, and when you started to load those muscles in the vertical plane.
• You may always have a tendency towards the spinal curvatures you developed. You may never be able to fully reprogram your neurology to move in complete function.
• But what you will have is a lessened severity, and you’re likely to have less pain and discomfort… and maybe no pain and discomfort at all.

Which brings us to why girls and women are greater sufferers of scoliosis than men.

It could be in the way women stand

It is estimated that 10 times as many females have scoliosis than males. There is much more to scoliosis than I will state here, but take the time to notice a very clear and obvious difference between the stance of men and boys versus women and girls. Men and boys tend to stand upright, both feet evenly weighted for the most part. They stand tall and often with feet that are spread out to about hip-width. They look solid and grounded when they stand still.

Women and girls on the other hand, very often lean on one leg. If you have ever leaned on one leg, you’ll notice you have a preference to lean on one side and not the other. If you do shift your weight to lean on the non-preferred leg, I can guarantee you will not spend an equal amount of time leaning on the other leg: It will be for a fraction of the time you spend leaning on the preferred one. Add to that the propensity in child-rearing years for women to carry children on one hip and you can get a real sense of the dysfunction that is occurring on a daily basis.

Repeated dysfunctional asymmetry: Is it a contributing factor? I strongly believe so.

Asymmetry

Asymmetry causes an immense imbalance in the function of the physical framework of the body. The body responds by creating neuromuscular pathways that may “fit” into this asymmetrical expression. The reason that this does not happen in every body that leans on one leg is that we all have unique physiological habits. You may lean, but perhaps you also are a fit and active person who partakes in a sport that demands symmetry of movement.

Gravity and types of activity affect the severity

The more severe the curve, the higher the degree of the curve, the more likely the curves will worsen with time.

Add bodily movement to the effect of gravity on a non-functional curve and the scoliosis will worsen, unless the patient is proactive with treatment and exercise.

Treatment: General rules of thumb

Generally, conditions may stabilize once bone growth has stopped, at least in the early decades when progression tends to slow down. Because of the plasticity of the body that occurs during growth, the time for the most effective treatment is during the bone growth years. Taking X-rays of hands can confirm status of bone growth.

ANGLES and SEVERITY and BRACES

You may have heard that severity of the condition is associated with a number expressed in degrees. This angle is calculated using X-rays. A number less than 10 indicates a condition that may not even need treatment, but rather evokes a ‘wait-and-see’ approach. Between 10 and c40 degrees is a moderate condition. Above 40 – 45 is severe. Younger patients with less than 40 degrees have excellent outcomes with brace use.

It’s worth stating again: Younger patients with less than 40 degrees have excellent outcomes with brace use.

Treatment for Idiopathic Scoliosis

A misaligned spine (scoliosis) significantly affects an imbalance of the back muscles. Your movements are a result of years of training and repetition that are so far behind the scenes and automatic (unconscious), their influence on your body is mostly not even noticed.

So, what does that mean? It means that your habitual movements are so strong that they can even return the spine to its misaligned state even after correction. This is why professional help from bodyworkers, Pilates studios, exercise physiologists, therapists and chiropractors is advised, during and after the use of braces.

The goal of treatment is to:

• Improve function
• Improve quality of life
• Allow for participation in normal activities
• Reduce the extra introduced lateral spinal curves (beyond the cervical, thoracic and lumbar curves common to all normal human spines); slow curve development (or stop and reverse)
• Strengthen the weak muscles and relax the tight muscles
• Achieve balance
• Reduce or eliminate pain
• Create increased comfort
• Create increased normal function
• Reduce dysfunction and one-sided movements and movement preferences that may have caused the imbalance
• Reduce the spasms that tighten the lateral convex curve of the spine
• Stimulate and increase the use of the underused muscles on the concave curve opposite

A wait-and-see approach is often taken in mild cases of idiopathic scoliosis.

However, it is best to try to restore (or part-restore) correct function to the spine. The aim is to restore the vertical stature of the spine. If there is no structural reason or condition (such as congenital and physical discrepancies) then targeted muscular and joint work will alleviate the condition.

This can be done through targeted symmetrical work (combined with targeted work to build up the weaker side). The most effective way to retrain the body is with Pilates. While yoga and other forms of exercise work, Pilates seems to have reliable benefits over the rest. While mat work is helpful, the use of a Pilates reformer which makes the patient work under traction and load (often without negative effects of gravity), will deliver the best results.

Surgery may be necessary

Braces can be used pre-surgery. They are used as an interim measure to stabilize before invasive intervention in severe cases.

If you have a severe case of scoliosis, age, plus the ravages of gravity on an imbalanced spine WILL mean the condition will worsen. Most doctors will suggest surgery to straighten the spine and stop the progression.

Different surgical techniques for scoliosis include:

• Spinal fusion connects 2 or more vertebrae. Bone-building substrates are introduced to the space in-between (either as bone grafts or synthetic bone). Metal rods are installed to straighten and stabilize. Screws and wires may also be used. Some of the hardware may stay permanently in place.
• Decompression surgery may be performed.
• An expanding rod may be installed. These are adjustable as the child grows. Adjustments would occur every 3 – 6 months either under surgery or via a remote control. Wherever rods are installed, the patient will have a straight(er) spine but this comes with a permanent loss in flexibility and range of movement.
• Vertebral body tethering is a keyhole procedure. This kind of surgery uses small incisions to install screws along the outside (convex) edge of the spinal abnormality. A strong, flexible cord is then threaded through the screws. Once installed, pulling on the cord adjusts the curve to set the tension. The spine straightens as the cord is tightened.

Braces are effective, non-invasive treatment

Braces:

• Provide relief from pain
• Stabilize the spine
• Help correct curve abnormalities
• Help prevent a worsening of the deformity
• Best worn while the child is still growing
• Still, they are effective in adults
• For best results, particularly while body is still growing, brace should be worn for 20 hours per day
• Are effective in more than 3 out of 4 patients

Braces Help Improve Scoliosis Conditions

Bracing:

• Improves sitting balance and trunk support
• Which provides better head and neck control
• And as an extension of this, you get more efficient use of arms (and even legs)

When you use a brace for scoliosis:

When you brace the back, you no longer need your arms to provide extra supportive work to stabilize your body. Your arms are free to function normally and help carry out other activities. The whole body functions better.

Well-fitted, well-designed braces are very likely to slow the further progression of a scoliotic condition. The less severe the curve (and the sooner the brace is applied) the better the outcome. It is, however, never too late to slow down the degrading physiological effects of scoliosis. Use a brace at any age.

NON-INVASIVE treatment for scoliosis

Besides braces, you can help the condition in self-managed ways.

Stretches for Scoliosis

On one side of a misaligned lateral curve are muscles that are perpetually contracted. This is the tight side. The other side has underused, underdeveloped, under-stimulated muscles. The tight side needs stretching and lengthening and the weak side needs stimulation and strengthening. In most cases, work done to stretch the latissimus dorsi works very well for most sufferers. If you experience such tightness, you will naturally want to stretch the tighter side more.

A latissimus dorsi stretch:

1. Stand with feet shoulder-width apart and shoulders down and back, away from ears.
2. Inhale arms up overhead. Arms extended, grab the left wrist with the right hand.
3. Inhale, stretch up tall, and as you exhale, maintain your upright posture and allow the body to stretch over to the right by pulling the left hand up, out, and over to the right.
4. Feel the stretch from the outside of the legs in an arc right up through the hips to the hand and fingertips.
5. Stay in this position, breathing, 10 seconds at least, constantly correcting and recorrecting alignment to stay ‘flat’ (do not bend forward or back).
6. Repeat and grab right wrist with left hand and move to the left.
7. Repeat the cycle a second time.

Exercises for Scoliosis

A curve occurs when muscles tighten on one side. Correspondingly, on the other side, the muscles are weaker by comparison and underused.

A weak spine cannot hold the spine in its correct or natural alignment. Treatment aims to balance out the inequity.

Weightlifting? Maybe not.

A misaligned spine has a high chance that it will worsen if excessive or undue weight is applied such as heavy lifting or weightlifting. While exercise is required to improve the weaker side, weightlifting may further strengthen the stronger side and cause more curvature. It overloads the wrong (dysfunctional) curves to worsen the condition. People with scoliosis should not weightlift heavy weights that create extra forces on the curve. If the muscles of your weak side are not activated properly, you would just strengthen the muscles around the curve and potentially cause more damage.

Other helpful exercises

Core strength development is crucial: planks, abdominal presses are helpful. Try this exercise which will engage your abs, and flatten your back muscles onto the floor.

1. Lie on your back with legs in table-top (where thighs are vertical and legs are bent at 90 degrees).
2. Press your hands into your knees but do not allow the thighs to leave their vertical position. Strongly maintain the effort for a good solid 10 seconds. Arms and legs do not move. They both exert considerable pressure against each other.
3. Repeat the exercise 2 more times.

Pilates or exercise physiology?

Find activities that alleviate pain and decrease deformity. Well-trained professionals can help you. Pilates is an excellent exercise that will not compress the spine. It provides training to teach functional and symmetrical action to the muscles, joints and body. It can move you towards balance.

Where you look matters

Get professional help to ensure you keep your head and neck in good alignment.

Maintain an outward and forward eye gaze (do not focus on the floor). Many scoliosis sufferers look down or favor a side to look towards. This affects function.

You can make positive changes to your body, that help future-proof it and slow down, stop and in some cases even partly or wholly reverse scoliosis. 

It takes more than just wishing your spine were better. You need to take positive action. Hopefully, this article has armed you with sufficient information to move forward with confidence… and a better posture! 

For Comprehensive Reviews of the Best Back Braces for Scoliosis… please look at our article… here

That’s right! Scoliosis can be treated by wearing a back brace that is specific for scoliosis. Depending on the type of brace fitted, a brace can reduce symptoms such as discomfort and pain, and the best ones are posture-correction devices that will actually help reverse the abnormal curve of the spine, and guide it towards better structure.  Braces are effective for adults and children and particularly effective if the subject is still growing.

Regardless of age, a brace should improve your comfort and relieve pain while creating some correction to your posture.

Read the article here to explore what makes a good back brace, and what you should look for. You will find a selection of the best back commercial braces for scoliosis (mostly for adults). If you have a child that requires a brace, these may also help, but do make sure you get professional help to assess all your treatment options (which could include a fully-customized soft-lined hardshell brace). 

Save yourself from buying the wrong back braces for scoliosis

There is still some debate between research scholars and doctors about the degree of effectiveness between full-time back braces and those designed purely for night-time wear. In theory, the longer you apply pressure to alter your spinal curve the less your condition will worsen and the more it will move towards healing and comfort… and an improvement in the quality of your life. In other words, the amount of time you put (constructive) pressure on your spinal curve is inversely proportional to the progression of scoliosis curve.

Balance time in the brace to give you best results

It’s all well and good to say you need to wear a back brace all the time. However, to wear one constantly introduces a far worse problem.

Yes, a child, or a person who is still developing their skeletal frame does benefit from longer duration use.

Once the bones have stopped growing and the body has now developed into its adult state, you must try to find the balance between wearing the brace to effect optimal effect and change. and not wearing it so that you encourage your spine and its supporting muscles, tendons and ligaments to actually actively support you.

To wear a brace for 24/7 is not recommended for most patients, especially adults. Your body needs the opportunity to stand on its own, tone and strengthen its own muscles.

This is why, when you look at our article that reviews specific braces, (here), that periodic wear of up to 2 or 3 hours at a time is advised. Rests should be taken. And the back should be encouraged to reinforce the muscle memory that it is being taught through use of the back brace.

Night-time compliance

Night-time wear is very beneficial because compliance is easy and activity is mostly unhampered. Wearing an appliance at night is just… easier and the protocol is simple (you wear it at night, at home, while you sleep).

Always get a professional diagnosis

It is important to get a proper diagnosis or at least to determine the severity of your condition (by measurement of the degree angle in your vertebrae).

Most doctors will recommend full-time wearing (14 – 20 hours per day) for angles above c35 degrees. Below 35 degrees, perhaps a brace at night-time only will suffice. Remember, the longer you wear it, the better and potentially shorter time to create change.

However, there are three other factors that are also crucial to determine before you advance towards your brace options.

• Bone maturity: Doctors mainly recommend a hard-pressure brace while your bones are young and are still growing. If your bones have matured and growth has stopped, heavy pressure applied through a hardshell brace is less advised. A hybrid or soft brace will do.
• The curvature of the spine: Determine the exact location of the curvature. It is more likely to be in the thoracic spine than lower down. Your doctor will make recommendations based on the degree and position of your curvature.
• Curve intensity: Doctors are likely to recommend back braces if you have a curvature between 25 and 40 degrees in your spine. The curve is determined with the use of specific Xrays. Off-the-shelf braces are not recommended for those with a huge curvature. Angles of more than 40 degrees are typically treated with back surgery. See the detailed notes above.

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