Adolescent Idiopathic Scoliosis (AIS) often comes to a healthcare professional’s attention when a patient or parent notices postural changes, such as uneven shoulders or a more prominent rib on one side. AIS is defined as a lateral spinal curvature exceeding 10° on X-ray, typically identified during routine checks or through parental concern.
For general practitioners, nurses, and allied health workers unfamiliar with scoliosis, it may seem like a condition primarily managed by surgeons. However, most AIS patients rely on non-surgical approaches such as bracing and physiotherapeutic scoliosis-specific exercises (PSSE). Early diagnosis is critical for achieving the best possible outcomes and minimising structural progression.
Beyond the spinal curve itself, AIS can lead to escalating pain, psychological strain, and functional limitations—factors that, if overlooked, can significantly impact a patient’s quality of life. Recognising these red and yellow flags and responding promptly can make a substantial difference, even for healthcare providers without specialised scoliosis expertise. Below are key indicators and structured responses to enhance patient outcomes.
Red Flag 1: Escalating or Persistent Pain
Pain is less common in AIS than in adult degenerative scoliosis, but when present, it may indicate an underlying issue beyond idiopathic scoliosis. Adolescents may report persistent discomfort rated 4/10 or higher on the Visual Analog Scale, or stiffness after prolonged sitting or activity. Many AIS patients underreport pain, assuming it’s a “normal” part of scoliosis. Non-specialists may notice repeated visits for pain relief or parents mentioning disrupted sleep. Tackling all of these issues is part of a comprehensive management plan. At ScoliCare we ‘treat the human not just the spine’, making sure that each patient’s needs and goals are part of the management plan as much as possible.
Game Plan:
- Systematically assess pain at each encounter. Ask, “How often does it hurt, and what makes it worse?”
- If pain persists beyond two weeks, refer the patient to a healthcare professional trained in scoliosis assessment and management. Persistent pain may signal that the condition is not truly idiopathic.
- Consider how the treatment is helping, or could be better helping the situation. For example, at ScoliCare, we offer a comprehensive rehabilitation program called ScoliBalance. The Scoliosis Rehabilitation Therapists that deliver the program are well trained to ensure that activities of daily living are incorporated into the program. Likewise, if a patient is wearing the ScoliBrace at night, the Clinician treating the patient is well equipped to look at sleep positions and assist with making sure the patient is getting good quality sleep each night.
Red Flag 2: Psychological Distress
AIS affects more than just posture; it may significantly influence self-image and mental health in some patients, particularly during adolescence—a time already filled with identity challenges. Concerns about body appearance, bracing, or treatment options can cause distress, anxiety, and social withdrawal.
Game Plan:
- Assess emotional well-being as part of routine care. Ask, “How do you feel about your scoliosis?”
- If signs of distress, anxiety, or withdrawal are evident, refer the patient to a mental health professional experienced in supporting adolescents with scoliosis.
Red Flag 3: Functional Decline
Functional limitations may appear as reduced participation in activities—skipping sports, avoiding school events, or struggling with prolonged sitting. Non-specialists may hear parents say, “They’re not themselves”, or patients express frustration, “I can’t keep up like I used to.” These statements indicate a decline in physical capacity and overall well-being. We never want to catastrophise scoliosis. There is no reason that most patients can’t lead a normal, fulfilling life that is not hindered by their scoliosis. However for the patients that are struggling it’s important to acknowledge where they are at with their acceptance and management of the condition..
Game Plan:
- Evaluate function with direct questions: “What’s harder now than six months ago?”
- If activity levels are dropping, refer to a health professional trained in bracing and PSSE management to optimise physical function and prevent further deterioration.
‘We never want to catastrophise scoliosis. There is no reason that most patients can’t lead a normal, fulfilling life that is not hindered by their scoliosis.’
Why This Matters
For healthcare professionals unfamiliar with AIS, these red flags—pain, psychological distress, and functional decline—mirror warning signs of other chronic conditions. However, scoliosis requires specific vigilance. Early detection and intervention can significantly reduce the risk of scoliosis impacting their quality of life, helping adolescents navigate this pivotal developmental stage more effectively.
Your Next Step
At your next AIS patient encounter, assess your level of training and expertise. Know when to refer or co-manage with a scoliosis-trained healthcare professional. ‘Wait and see’ is not a treatment approach. Delayed intervention risks unnecessary scoliosis progression, potentially leading to surgical intervention.
Proactive assessment and timely referrals ensure that adolescents with AIS receive the best possible care—minimising pain, preserving function, and supporting psychological well-being.
For more information about ScoliBalance or ScoliBrace visit ScoliCare’s Health Professional’s page.
