Scoliosis is an abnormal curvature of the spine due to rotation of the vertebral bodies. It occurs most often in adolescents, affecting females 7 times more frequently than males. 




  • Uneven shoulders
  • One shoulder blade that appears more prominent than the other
  • Uneven waist
  • One hip higher than the other
  • One side of the rib cage more pronounced
  • A prominence on one side of the back when bending forward

What causes scoliosis

Most scoliosis cases are idiopathic which means that there is no identifiable cause for the condition. In some cases, scoliosis has been found to be caused by:


  • Certain neuromuscular conditions, such as cerebral palsy or muscular dystrophy.
  • Birth defects affecting the development of the bones of the spine.
  • Previous surgery on the chest wall as a baby.
  • Injuries to or infections of the spine.
  • Congenital spinal cord abnormalities.


What if Scoliosis is left untreated

Scoliosis is normally a progressive condition and not something a child can outgrow. If left untreated, scoliosis can worsen and have serious long-term physical and emotional complications. Severe scoliosis, where the curvature exceeds 50 degrees, can cause the spinal rotation to reach a point where it impacts the patient’s chest structure, which can lead to decreased lung capacity and heart problems.

Individuals with untreated scoliosis may also develop a condition called spondylosis, which is an arthritic condition where the spinal cartilage becomes compressed and deteriorates causing joints to become inflamed with the possibility of the nerve compression and bone spurs.

Diagnosing Scoliosis: Adam’s forward bending test

The Adam’s forward bending test is a reliable, easy to do test that could indicate the possibility of a scoliotic curve. An X-ray will still need to be done to confirm the diagnosis and determine the severity of the curve but performing the forward bending test is a good place to start when diagnosing scoliosis.




  • The spine needs to be visible. 
  • The patient bends forward at the waist until the back comes in the horizontal plane.
  • Feet together
  • knees extended
  • Arms hanging
  • The palms are held together
  • The examiner looks from behind, along the horizontal plane of the vertebral column

High probability of scoliosis

Progression risk and when to intervene

When determining the risk of the curve getting worse(progressing) we take patient age and initial Cobb angle into consideration, the table below provides a guideline:

Cobb angle

Age 10-12

Age 13-15

Age 16+





20⁰ - 29⁰




30⁰ - 60⁰








Age plays a vital role in the treatment of scoliosis, while not everyone develops at the same pace, there is an anatomical marker that assists in determining how much time we have to possibly correct a scoliotic curve. We refer to it as the Risser sign which is determined by looking at the upper part of the pelvis (Iliac crest) on an X-ray. This marker in combination with the Cobb angle can assist us in estimating possible treatment outcomes.

How do we treat Scoliosis

Scoliosis treatment depends on the severity of the condition and the age of the patient. The curve is measured to determine the Cobb angle which will allow for certain treatment options using the following guidelines:


  • Curves less than 20⁰ in a child or adolescent can be monitored to ensure it isn’t getting worse
  • Curves between 20⁰ and 39⁰ are ideal candidates for bracing
  • Curves between 40⁰ and 49⁰ are still within the range for corrective bracing but could possibly need to consider surgical options if the curve does not improve
  • Curves greater than 50⁰ might not be ideal candidates for bracing and would most likely experience more long-term success with surgical interventions depending on age of initial diagnosis

Bracing: Chêneau Type 3D design


The main principles of the Chêneau brace are related to a derotational mechanism created by forces and counterforces to bring the trunk into the best possible correction. This design aims to correct scoliosis by affecting the alignment and forces in all three anatomical planes.

When designing the brace, we aim to:


  • Provide pressure, counter pressure, and expansion areas to reduce the Cobb angle.
  • Achieve regional derotation.
  • Ensure that there is alignment and balance in the sagittal plane (as seen from the side of the patient).

Understanding Scoliosis bracing


A scoliosis brace is a custom corrective orthotic device that makes use of the principles of the Chêneau Type 3D design to reduce the Cobb angle and rotation of the spine.


Depending on the severity of the curve and the age of the patient, it is generally recommended that the brace should be worn for 16-23 hours a day for optimal results.

Schroth physiotherapeutic scoliosis specific exercises (PSSE)

The Chêneau type brace and the Schroth PSSE address the 3D biomechanics of scoliosis in the similar way. The increased expansions in the brace correspond to the Schroth PSSE de-rotational breathing mechanics, which aim to expand the collapsed areas of the trunk affected by scoliosis, attempting to correct the horizontal (axial) plane of the body.


Specific pressure areas in the brace and Schroth PSSE principles work hand in hand to correct the frontal and sagittal planes of the body. That is why the Chêneau type brace and Schroth PSSE are considered to be a 3D conservative treatment of scoliosis.

Thus it is important to understand the treatment process of scoliosis does not stop with the brace and this is why we recommend consulting with a Schroth trained therapist to assist our patients to in getting best available treatment and ensuring the best possible outcome.