Adult Scoliosis: Symptoms, Progression & Treatment Options

What Is Adult Scoliosis?

Scoliosis is a three-dimensional spinal condition involving an abnormal
side-to-side curvature of the spine along with spinal rotation. The severity
of the curve is commonly measured using what is known as the
Cobb angle.

However, adult scoliosis is not one single condition. Adults can develop or
experience scoliosis for different reasons, and treatment should reflect those
differences.

Adult Idiopathic Scoliosis

Adult idiopathic scoliosis generally refers to scoliosis that originally
developed earlier in life, often during adolescence, and continues into adulthood.
Some people know they have had scoliosis for decades, while others discover the
curve later after having an X-ray for another reason.

Discovering scoliosis as an adult does not necessarily mean the curve recently
developed. A long-standing curve may remain relatively stable for many years.

Degenerative Adult Scoliosis

Degenerative adult scoliosis, sometimes called de novo scoliosis, develops later
in life as age-related changes affect structures within the spine.

These changes may involve the:

• Spinal discs
• Facet joints
• Vertebrae
• Ligaments
• Surrounding muscles

Degenerative scoliosis can also occur alongside spinal stenosis, disc degeneration,
foraminal narrowing, osteoporosis, spondylolisthesis, and changes in overall spinal
alignment.

What Are the Symptoms of Adult Scoliosis?

Adult scoliosis does not always cause symptoms. Some adults remain active and
experience very little discomfort despite having a measurable spinal curve.

When symptoms do occur, they may include:

• Low back pain
• Mid-back discomfort
• Muscle fatigue
• Uneven shoulders
• An uneven waist or hips
• A visible shift of the torso
• Difficulty standing for extended periods
• Reduced walking tolerance
• Stiffness or decreased mobility
• Changes in posture
• Balance difficulties
• Radiating leg pain
• Numbness or tingling in the legs
• Leg weakness when nerve compression is present

Symptoms can vary significantly from one person to another. A larger curve does
not automatically mean someone will experience more pain or disability.

Does Adult Scoliosis Always Cause Back Pain?

No. Finding scoliosis on an X-ray does not automatically prove that scoliosis is
causing someone’s back pain.

Adults with scoliosis can have little or no pain, while people without scoliosis
can experience significant back pain. The relationship between scoliosis and
symptoms needs to be evaluated alongside the patient’s history, neurological
function, spinal degeneration, activity level, strength, mobility, and other
findings.

This is one reason the Cobb angle should not be viewed as a direct measurement
of pain or disability.

Can Adult Scoliosis Get Worse With Age?

Some adult scoliosis curves can progress over time, but progression is not
inevitable and does not occur at the same rate for every person.

Factors that may influence progression include:

• Curve size and pattern
• Spinal degeneration
• Overall spinal balance
• Age
• Bone density and osteoporosis
• Disc degeneration
• Structural flexibility

When previous standing X-rays are available, comparing appropriately obtained
images may help determine whether meaningful progression has occurred.

Small changes in Cobb-angle measurements should be interpreted carefully because
some variation can occur between measurements.

Why Overall Spinal Balance Matters

Adult scoliosis is a three-dimensional condition. Looking only at the
side-to-side curvature does not provide a complete picture.

A scoliosis evaluation may also examine:

• Whether the torso is shifted to one side
• Forward or backward spinal balance
• Pelvic positioning
• Shoulder alignment
• Postural compensation
• Muscular endurance
• Walking mechanics

For some adults, overall balance and their ability to comfortably remain upright
may have a greater impact on daily life than the Cobb-angle measurement alone.

Adult Scoliosis and Nerve Symptoms

Neurological symptoms are particularly important when degenerative scoliosis
occurs together with spinal stenosis or foraminal narrowing.

Symptoms that should receive appropriate evaluation include:

• Radiating leg pain
• Persistent numbness or tingling
• Progressive leg weakness
• Foot drop
• Increasing difficulty walking
• Worsening balance

In these situations, determining whether nerves are being affected may be more
important than focusing exclusively on the visible spinal curve.

How Adult Scoliosis Can Affect Daily Life

One of the most useful ways to understand adult scoliosis is to evaluate how it
affects normal activities.

For example:

• Can you comfortably walk through a grocery store?
• Can you stand long enough to prepare a meal?
• Can you complete a normal workday?
• Can you exercise?
• Can you travel comfortably?
• Can you garden or work around your home?
• Can you lift and carry normal objects?
• Can you participate in activities with your family?

These functional measures can help determine whether treatment is necessary and
whether a treatment program is actually producing meaningful results.

Does Adult Scoliosis Always Need Treatment?

Not every adult with scoliosis requires intensive treatment.

An adult who has minimal symptoms, remains physically active, has good neurological
function, and shows no evidence of concerning progression may primarily need
monitoring, exercise, strength training, and attention to general health.

Monitoring may involve:

• Remaining physically active
• Maintaining strength and mobility
• Watching for meaningful functional changes
• Addressing bone health
• Periodic clinical reassessment when appropriate
• Obtaining new imaging when medically indicated

What Does Successful Adult Scoliosis Treatment Look Like?

Treatment success should not automatically be defined as making an adult spine
perfectly straight.

Depending on the patient’s condition, meaningful treatment goals may include:

• Reducing pain
• Improving strength
• Improving muscular endurance
• Improving balance
• Increasing walking distance
• Increasing standing tolerance
• Improving mobility
• Returning to exercise
• Maintaining work and recreational activities
• Supporting independence
• Monitoring structural progression

In selected cases, improving aspects of spinal alignment may also be a reasonable
goal. However, structural goals should take into account the person’s age,
spinal flexibility, degeneration, anatomy, and overall condition.

Can Adult Scoliosis Be Corrected?

Certain components of adult spinal alignment may be modifiable, particularly when
there is a flexible or postural component to the curve.

Long-standing structural curves involving substantial vertebral rotation,
disc degeneration, bone remodeling, arthritis, or other fixed changes generally
require different expectations than flexible curves.

Even when major structural correction is unrealistic, adults can often work toward
meaningful improvements in strength, mobility, endurance, balance, walking ability,
confidence, and overall function.

Treatment expectations should therefore be individualized rather than based on a
promise to completely straighten every adult scoliosis curve.

Conservative Treatment Options for Adult Scoliosis

Conservative adult scoliosis treatment is usually most effective when it is
individualized and focuses on the patient’s symptoms, function, physical capacity,
and specific spinal characteristics.

Exercise and Strength Training

Exercise is often an important component of adult scoliosis management.

Rehabilitation may focus on improving:

• Strength
• Muscular endurance
• Cardiovascular conditioning
• Balance
• Mobility
• Confidence with movement

Depending on the patient, exercises may include walking, squatting, hinging,
carrying, pushing, pulling, stair climbing, trunk endurance exercises, and
strengthening the hips and legs.

Scoliosis-Specific Exercises

Physiotherapeutic scoliosis-specific exercises may be used to provide a more
individualized approach to rehabilitation.

These programs may incorporate:

• Three-dimensional postural correction
• Breathing strategies
• Postural awareness
• Stabilization exercises
• Balance training
• Movement retraining

The goals for adults may differ from those used for growing adolescents.
Improvements in function, mobility, balance, strength, symptoms, and quality
of life may be particularly important adult treatment goals.

Learn more about

advanced scoliosis rehabilitation in Spokane
.

Chiropractic Care and Manual Therapy

Chiropractic care and other forms of manual therapy may be incorporated into an
adult scoliosis treatment program when appropriate.

For some patients, reducing musculoskeletal pain or stiffness can make it easier
to participate in exercise, rehabilitation, walking, and normal daily activities.

Manual treatment should generally support active rehabilitation rather than
replacing strength, conditioning, and movement.

Learn more about

chiropractic care in Spokane
.

Adult Scoliosis Bracing

Bracing in adults typically has different goals than bracing during childhood
or adolescence.

Depending on the individual, a customized three-dimensional brace may be
considered to help support goals such as:

• Managing symptoms
• Supporting posture
• Improving standing tolerance
• Improving walking tolerance
• Supporting daily function
• Managing spinal imbalance

The purpose of a brace should be clearly established before treatment begins.
Not every adult with scoliosis requires a brace.

Learn more about

ScoliBrace® and KyphoBrace®
.

Corrective Spinal Traction

Corrective spinal traction may be considered in selected cases when the evaluation
identifies a specific and potentially modifiable alignment problem.

Before including corrective traction, important questions include:

• What specifically are we trying to improve?
• How flexible is the targeted area?
• Why would changing the alignment matter?
• How will improvement be measured?
• Will the change improve something meaningful for the patient?

Learn more about

corrective spinal traction in Spokane
.

Can Adults With Scoliosis Exercise?

In many cases, yes. Having scoliosis does not automatically mean an adult needs
to avoid exercise or normal movement.

Depending on individual health status and medical recommendations, activities may
include:

• Walking
• Strength training
• Cardiovascular exercise
• Bending and lifting
• Gardening
• Recreational activities
• Appropriate sports

Exercise may need to be modified for someone who has significant pain,
osteoporosis, neurological problems, severe deconditioning, or another medical
condition.

A qualified healthcare professional can help determine whether specific
restrictions or modifications are appropriate.

When Should Adult Scoliosis Be Evaluated Further?

Certain changes deserve additional medical evaluation, particularly when
neurological symptoms or significant changes in function develop.

Seek appropriate evaluation for symptoms such as:

• Progressive leg weakness
• Persistent or worsening numbness
• Foot drop
• Significant deterioration in walking ability
• Worsening balance
• Major loss of standing tolerance
• Rapid changes in posture or spinal alignment
• Significant pain following trauma
• Possible compression fracture
• Unexplained functional decline
• Persistent disabling symptoms despite appropriate conservative care

New bowel or bladder dysfunction, numbness around the groin or saddle area,
or rapidly progressing neurological symptoms can require urgent medical
evaluation.

Adult Scoliosis and Osteoporosis

Bone health becomes increasingly important as adults age. Osteoporosis and
vertebral compression fractures can affect spinal alignment and may sometimes
produce relatively rapid changes in posture.

Sudden spinal pain or a significant postural change after even relatively minor
trauma may warrant evaluation for a compression fracture rather than being
automatically attributed to scoliosis.

When Is Imaging Helpful for Adult Scoliosis?

Imaging is most useful when it helps answer a specific clinical question.

Standing spinal X-rays may be considered when there is concern about structural
progression, substantial changes in posture or function, or when alignment needs
to be evaluated as part of treatment planning.

MRI provides different information and may be appropriate when healthcare
providers need to evaluate spinal stenosis, nerve compression, discs, or other
neurological structures.

The need for imaging should be determined individually based on symptoms,
examination findings, prior imaging, and clinical history.

When Is Surgery Considered for Adult Scoliosis?

An adult scoliosis diagnosis does not automatically mean surgery will be required.
Many adults manage their condition without surgery.

A surgical consultation may be appropriate when significant problems are present,
such as:

• Progressive neurological loss
• Severe spinal stenosis with disabling symptoms
• Major deterioration in walking or standing ability
• Significant progressive spinal imbalance
• Progressive deformity
• Persistent severe limitations despite appropriate conservative treatment

Receiving a surgical consultation does not mean a patient is required to have
surgery. A consultation can provide additional information regarding treatment
options, risks, benefits, and whether continued conservative management remains
appropriate.

Living an Active Life With Adult Scoliosis

A scoliosis diagnosis does not have to define what an adult can accomplish
physically.

Even when the spinal curve itself remains visible, patients may still be able to
improve strength, mobility, walking tolerance, exercise capacity, balance, and
independence.

The goal of conservative treatment should be to help patients become more capable
and confident in managing their condition whenever possible.