Scoliosis is progressive, but it can be highly treatable. The best way to manage scoliosis and its symptoms is to treat it proactively. As uneven shoulders and hips are often the earliest signs of scoliosis, these types of postural changes should be watched for and assessed, particularly in children; progression is triggered by growth.
When it comes to the most common symptoms of scoliosis, these include postural changes and pain, but each case is unique, and symptoms are shaped by a number of factors. Being aware of the early signs of scoliosis can lead to early detection.
Before exploring the different types of scoliosis symptoms, let’s talk about how it’s diagnosed and the general benefits of early detection.
Diagnosing Scoliosis
Scoliosis ranges in severity, and because it’s usually progressive, its nature is to become more severe over time.
Diagnosing scoliosis early means while it’s still mild as mild scoliosis is simpler to treat than moderate or severe, and because the nature of scoliosis is to progress, the timing of when treatment is started can be important for results.
As scoliosis causes a lateral bend with rotation in the spine, and if it progresses, the size and rotation can increase, and it’s growth that triggers progression (1).
So patient age is an important factor when it comes to the amount of potential progression a patient can experience, and young patients can face rapid advancement due to growth spurts, so children in particular have a lot to gain from early detection (1, 2, 3).
Part of diagnosing scoliosis involves a comprehensive initial assessment, during which time, conditions are classified based on key variables, and these variables have to be as accurate and precise as possible so treatment plans can be fully customized for specific results.
Scoliosis is diagnosed through a physical examination and X-ray results, and an early diagnosis of mild scoliosis doesn’t mean there is a lack of urgency; it doesn’t mean parents have more time to consider different treatment options, or simply to observe.
The only way to keep scoliosis mild and/or prevent it from progressing is to counteract the progressive nature of scoliosis through the application of proven and effective treatment..
Early Diagnosis Benefits
The benefits of early detection are only available to patients who are undergoing proactive and customized treatment; being proactive means starting treatment as early as possible, while scoliosis is still mild (1, 2, 3).
Mild curves are smaller, more flexible, and often respond better to treatment. As progression occurs and severity increases, the spine becomes more rigid, making it less responsive to treatment.
As progression occurs, the symptoms of scoliosis can become more overt, and this is why it’s not always easy to diagnose scoliosis while mild: the subtlety of its symptoms.
The main symptoms of scoliosis affecting children are postural changes, and the main symptom of adult scoliosis is pain (4).
Mild curves are small, don’t commonly cause functional deficits, and the symptoms of mild scoliosis can be subtle.
The often subtle early signs of scoliosis, and the benefit of early detection, warrant awareness; if there’s awareness of the signs, particularly in children, early diagnosis can be followed by proactive corrective nonsurgical treatment, and progression may be preventable (1, 2, 5).
Preventing progression means preventing scoliosis symptoms from becoming more severe, and when it comes to a patient’s daily life with scoliosis, this is what shapes their experience, so let’s talk about the main factors that shape scoliosis symptoms: patient age, type, severity, and curve location.
Patient Age
As scoliosis progression is triggered by a patient’s rate of growth, patient age is a key predictor of how much potential progression a patient may face, along with how fast that progression can occur (6).
Compression is uneven pressure, and compression of the spine and its surroundings is the main cause of scoliosis pain.
Scoliosis doesn’t become compressive until growth has stopped and skeletal maturity has been reached, so childhood scoliosis treatment doesn’t focus as much on pain management as adult treatment (7).
So when growth stops, this is when scoliosis is most likely to become painful, and the more severe scoliosis is, or becomes, the more noticeable its symptoms can be (7).
Scoliosis is most often diagnosed between the ages of 10 and 18 as adolescent idiopathic scoliosis, and this age group is also prone to rapid advancement due to the stage of rapid growth they are in (2, 3, 6).
Awareness of the age scoliosis is most often diagnosed can mean knowing when to pay close attention to changes in a child’s posture; in addition, a family history is also considered a risk factor, so in families where one sibling, or another family member, has been diagnosed, regular screening from an early age is recommended (1).
Another important factor for shaping symptoms is condition severity.
Condition Severity
Scoliosis ranges in severity from mild scoliosis to moderate scoliosis and severe scoliosis, and the more severe scoliosis is at the time of diagnosis, the more likely it is to continue progressing and increasing symptoms.
The earliest signs of scoliosis are often one shoulder sitting higher than the other, one shoulder blade protruding more on one side than the other, and uneven hips where one hip sits higher than the other (4).
If progression is occurring additional postural changes to watch for include a noticeable lean to one side, an arch in the rib cage developing, and a general asymmetrical body appearance (4).
Disruptions to balance, posture, and coordination are also common as the body becomes increasingly asymmetrical.
In adults, as pain is the main symptom of scoliosis, increasing pain is what leads most adults to an assessment and diagnosis, and scoliosis pain can affect the spine’s surrounding muscles, nerves, and the back itself (7).
So if subtle postural changes were noticed in a child but weren’t assessed, and then additional changes are noticed, this is a sign that progression is occurring and a further indication that a screening examination should be conducted.
Scoliosis doesn’t just range in severity but also in type.
Type of Scoliosis
The most common type of scoliosis overall is adolescent idiopathic scoliosis with no single-known cause, and this type accounts for approximately 80 percent of diagnosed cases (2).
The remaining types of scoliosis are neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis, and in addition to having different causes, certain types cause unique symptoms and treatment needs.
Idiopathic scoliosis is the most common type of scoliosis to affect adults, and this is the perfect example of why awareness and early detection is so important (8).
Adolescent scoliosis in adult (ASA) cases are pre-existing from adolescence; in many of these cases, patients don’t notice their scoliosis symptoms until they become more severe and painful once growth stops (2, 8).
Cases of degenerative scoliosis affect older adults, and as they involve spinal degeneration and instability, lower back pain is a common symptom, as are changes to balance and coordination, putting adults at risk of injury from a fall (9).
Neuromuscular scoliosis is caused by a larger neurological or muscular condition like spina bifida, muscular dystrophy, and cerebral palsy, so it can progress rapidly and cause severe symptoms capable of severely disrupting movement; patients becoming can become wheelchair bound, but these symptoms aren’t considered typical scoliosis symptoms because they are being shaped by the larger condition (10).
Different curve types and locations within the spine are also associated with different symptoms.
Curvature Location
The spine consists of three main sections, and the area of the body located closest to the affected spinal section can experience the most symptoms.
The cervical spine refers to the neck, and the thoracic spine is the largest section. The lumbar spine refers to the lower back.
For example, a rib cage outwards arch and related chest pain is most closely associated with thoracic scoliosis because it’s the only spinal section attached to the rib cage.
A common complication of lumbar scoliosis involves the sciatic nerve; the sciatic nerve starts in the lower back and extends down the backside of the body, so if scoliosis develops in the lower back and compresses the sciatic nerve, sciatic nerve pain can be felt throughout the lower body.
The best way to manage scoliosis symptoms is to treat the scoliosis proactively.
Managing Scoliosis Symptoms
Scoliosis symptoms are shaped by a number of factors, so what one patient experiences isn’t always an indicator of what others will face.
When it comes to managing scoliosis, how a patient responds to their diagnosis is key.
Awareness of the different treatment options is key.
Scoliosis can cause the spine to become increasingly unbalanced and unstable as it progresses, and this can change the body’s appearance; particularly in adolescents, body image issues should be a concern.
Scoliosis can disrupt a person’s posture increasingly over time, and the best way to manage the effects of progression is working towards preventing it, and early diagnosis makes this more possible (4).
The longer an effect of scoliosis is left unaddressed, the more established it can become, making it more difficult to improve and/or reverse.
Solely addressing a condition’s symptoms may only provide short-term relief; for sustainable long-term symptom relief, proactive treatment has to impact the cause of the symptoms: the condition itself.
When it comes to evidence-based and customized nonsurgical scoliosis treatment, the power of 3D corrective bracing and scoliosis-specific exercise-based treatment programs have a lot to offer (11).
Conclusion
While no two scoliosis cases are the same, there are certain symptoms associated with particular age groups, condition types, severity levels, and spinal section affected.
It’s important to be aware of the early signs of scoliosis as it can lead to an early diagnosis and the option to start treatment early.
While there is also surgical treatment involving spinal fusion, the procedure comes with risks and long-term effects. Another benefit of early detection and early intervention is helping patients avoid the need for surgical treatment.
A less invasive option that works towards preserving the spine’s natural strength and function is nonsurgical treatment; the ScoliCare approach integrates the advanced ScoliBrace® and comprehensive exercise-based ScoliBalance® program; together, these treatment modalities work together to improve the spine’s position for 3D postural correction and symptom relief.
References:
- Dunn J, Henrikson NB, Morrison CC, et al. Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jan. (Evidence Synthesis, No. 156.) Chapter 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493369/
- Weinstein SL. The Natural History of Adolescent Idiopathic Scoliosis. J Pediatr Orthop. 2019 Jul;39(Issue 6, Supplement 1 Suppl 1):S44-S46. doi: 10.1097/BPO.0000000000001350. PMID: 31169647
- Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. PMID: 29435499; PMCID: PMC5795289
- Hong KS, Van Minh P, Nguyen HT, Phan MH, Nguyen HN, Pham TP. Re-evaluation of Incorrect Posture as a Diagnostic Criterion for Scoliosis in School Screenings: A Cross-Sectional Study in Vietnam. Cureus. 2025 Mar 31;17(3):e81535. doi: 10.7759/cureus.81535. PMID: 40314041; PMCID: PMC12043434
- Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J. 2014 Jun;23(6):1204-14. doi: 10.1007/s00586-014-3241-y. Epub 2014 Feb 28. PMID: 24682356
- Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. PMID: 29435499; PMCID: PMC5795289
- Ilharreborde B, Simon AL, Shadi M, Kotwicki T. Is scoliosis a source of pain? J Child Orthop. 2023 Nov 28;17(6):527-534. doi: 10.1177/18632521231215861. PMID: 38050593; PMCID: PMC10693849
- Negrini, A., Negrini, M.G., Donzelli, S. et al. Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study. Scoliosis 10, 20 (2015). https://doi.org/10.1186/s13013-015-0044-9
- Marty-Poumarat, Catherine MD*; Scattin, Luciana MD†; Marpeau, Michèle MD*; Garreau de Loubresse, Christian MD‡; Aegerter, Philippe MD, PhD§. Natural History of Progressive Adult Scoliosis. Spine 32(11):p 1227-1234, May 15, 2007. | DOI: 10.1097/01.brs.0000263328.89135.a6
- Wishart BD, Kivlehan E. Neuromuscular Scoliosis: When, Who, Why and Outcomes. Phys Med Rehabil Clin N Am. 2021 Aug;32(3):547-556. doi: 10.1016/j.pmr.2021.02.007. Epub 2021 May 12. PMID: 34175013
- Marchese R, Du Plessis J, Pooke T, McAviney J. The Improvement of Trunk Muscle Endurance in Adolescents with Idiopathic Scoliosis Treated with ScoliBrace® and the ScoliBalance® Exercise Approach. J Clin Med. 2024 Jan 23;13(3):653. doi: 10.3390/jcm13030653. PMID: 38337346; PMCID: PMC10856658
