Scoliosis is defined as an abnormal side-to-side curvature of the spine, measured by a Cobb angle of ten degrees or more. Adult scoliosis generally falls into two categories: the progression of a curve that began in adolescence (adult idiopathic scoliosis) or a curve that develops later in life due to disc degeneration and joint arthritis (degenerative or de novo scoliosis). The degenerative form often develops in the lumbar spine, or lower back, typically affecting people over the age of 40. Many adults with scoliosis experience chronic back pain, stiffness, or symptoms of nerve compression as the spinal structures wear down unevenly. Non-surgical approaches are the primary recommendation for most adult patients, focusing on managing these symptoms and maintaining spinal health.
Understanding Non-Surgical Goals for Adult Scoliosis
For adults, the non-surgical management of scoliosis is generally aimed at stabilizing the curve and reducing associated pain, rather than achieving a significant curve reversal or “correction”. Unlike in growing adolescents, where bracing and specialized therapy can sometimes reduce the curve magnitude, the primary goal for the skeletally mature spine is to prevent further progression and improve function. Non-surgical treatment prioritizes enhancing the patient’s quality of life by controlling pain and preventing the curve from worsening.
The focus shifts to addressing the secondary effects of the curve, such as muscle imbalance, postural collapse, and chronic discomfort. Treatment aims to provide the muscular support necessary to manage the asymmetrical loading placed on the spine by the curvature. Successfully stabilizing the spine involves a comprehensive approach that empowers the patient to actively manage their condition through daily habits and targeted movement. Setting realistic expectations is important, as the adult spine has limited potential for structural change without surgical intervention.
Targeted Physical Therapy and Specialized Exercise Programs
Physical therapy is a cornerstone of non-surgical care, focusing on active, movement-based interventions. Therapies are highly individualized and aim to address the specific muscle imbalances and postural deviations unique to each curve. A key component is core strengthening, which improves spinal stability and provides better support for the vertebral column against gravitational forces.
Specialized approaches, such as the Schroth Method, use three-dimensional exercises to de-rotate, elongate, and stabilize the spine. This method teaches patients to actively correct their posture, often utilizing props to maintain alignment during exercise. A technique called rotational angular breathing is incorporated to help expand the rib cage on the concave side of the curve, which aims to improve lung capacity and spinal alignment.
Exercises also target flexibility and mobility, which are often compromised by stiffness and asymmetrical muscle tension. Therapists might employ asymmetrical stretching to lengthen tight muscles on one side of the curve while simultaneously strengthening the weakened muscles on the opposite side. Consistent practice of these tailored exercises can improve posture, reduce muscle fatigue, and enhance awareness of spinal alignment.
Non-Invasive Pain and Symptom Management
Medical approaches to managing adult scoliosis symptoms focus on controlling pain and inflammation. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are often recommended for temporary relief of muscle and joint inflammation. Heat and ice therapy can also be used to manage localized muscle soreness and discomfort.
For more severe or radiating pain caused by nerve compression (radiculopathy), a physician may recommend interventional procedures. Epidural steroid injections (ESIs) deliver corticosteroids directly into the epidural space near the affected nerve root to reduce inflammation and temporarily alleviate nerve pain. These injections are not a treatment for the curve itself but manage debilitating symptoms, allowing the patient to participate more effectively in physical therapy.
While bracing is a common treatment for adolescents, its role in adults is generally limited to temporary pain relief and postural support, not curve correction. A custom-fitted brace can help reduce discomfort by providing external stabilization and lessening muscle strain. However, prolonged use may cause muscles to weaken, so bracing is typically used selectively in conjunction with active exercise programs.
Determining When Non-Surgical Care is No Longer Effective
Non-surgical care is deemed insufficient when the patient experiences rapid curve progression, severe functional decline, or neurological compromise despite conservative management. Surgery is typically considered when the Cobb angle progresses to 45 to 50 degrees or more, especially if it continues to worsen. Even curves below this threshold may warrant surgical consultation if they cause severe, unmanageable pain that significantly impairs daily function.
Functional decline is often measured by a patient’s inability to walk long distances, stand for extended periods, or perform routine self-care tasks. Neurological symptoms are a serious indicator that conservative care has failed, including the onset of leg weakness, numbness, or signs of nerve root compression like foot drop. In rare cases, very severe curves can compromise cardiopulmonary function, necessitating surgical intervention to prevent a decline in breathing or heart health.