Patients with scoliosis have a high prevalence of back pain (BP). It is possible that scoliosis patients present with specific features when experiencing back or leg pain pathology. The aim of this systematic review is to report the signs, symptoms and associated features of BP in patients with scoliosis compared to adults without scoliosis during adulthood. From inception to 15 May 2023, we searched the following databases: PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. We found 10,452 titles, selected 25 papers for full-text evaluation and included 8 in the study. We found that scoliosis presents with asymmetrical pain, most often at the curve’s apex, eventually radiating to one leg. Radiating symptoms are usually localised on the front side of the thigh (cruralgia) in scoliosis, while sciatica is more frequent in non-scoliosis subjects. These radiating symptoms relate to rotational olisthesis. The type and localization of the curve have an impact, with lumbar and thoracolumbar curves being more painful than thoracic. Pain in adults with scoliosis presents specific features: asymmetrical localization and cruralgia. These were the most specific features. It remains unclear whether pain intensity and duration can differentiate scoliosis and non-scoliosis-related pain in adults.

Background: Non-surgical management of adolescent idiopathic scoliosis (AIS) includes physiotherapeutic scoliosis-specific exercise (PSSE). Determining the efficacy of PSSE in AIS has been challenging as the clinical effect is closely linked to exercise compliance (a dose–response relationship), with home exercise programs (HEPs) showing a general trend for decreased participation over time. The existing literature reports contradictory definitions and parameters of appropriate PSSE compliance in AIS. As such, this scoping review is necessary for therapists to identify PSSE prescription consistency, enabling clear guidelines for improved PSSE compliance. Methods: A scoping review of the literature was conducted to synthesize original research from inception to November 2024 and reference lists were examined for studies reporting compliance, adherence, or motivational strategies for PSSE in AIS. Results: Fifteen articles with a focus on PSSE in AIS were included in this review. The results demonstrate that compliance (C) and adherence (A) are terms commonly used interchangeably, only half of the studies clearly define compliance and/or adherence, and some utilize motivational strategies; however, outcomes of compliance/adherence were often not reported in the Results section or reflected in the discussion of results. Conclusions: Compliance and/or adherence are inconsistently reported within studies and numerous variations exist in (1) the section of the paper it is mentioned, (2) whether the inclusion criteria hinged on patient compliance/adherence, and (3) whether motivational strategies were employed and outcomes reported. Notably, there was a lack of compliance or adherence reporting in Results and Discussion sections of papers. The definition of appropriate compliance and any effective motivational strategies to improve compliance to achieve the desired results for treatment of AIS remain undetermined.

(1) Background: Schroth is a type of physiotherapeutic scoliosis specific exercise (PSSE) prescribed to adolescents with idiopathic scoliosis (AIS). Studies have investigated the effectiveness of Schroth but are yet to elucidate how Schroth is applied clinically and the factors that influence their prescription. (2) Methods: A mixed methods design was used comprising an anonymous survey and semi-structured interviews of Schroth therapists who treated AIS and who were publicly listed on the Barcelona Scoliosis Physical Therapy School or the International Schroth 3-dimensional Scoliosis Therapy School websites. The survey included 64 questions covering demographics, session and treatment characteristics, and whether therapists included other treatment modalities in their clinical practice. A convenience sample of survey participants were invited to participate in a semi-structured interview to further explore the factors that influenced their prescription of Schroth for AIS. Results from the survey were analyzed descriptively (n, %), whereas inductive thematic analysis was used for the interviews. (3) Results: of the 173 survey respondents (18% response rate), most were from Europe and North America (64.0%), female (78.6%), physiotherapists (96.0%), and worked in private settings (72.3%). Fifty-two per cent of participants used other types of PSSE as an adjunct to Schroth, the Scientific Exercise Approach to Scoliosis (SEAS) being the most frequently used (37.9%). Non-PSSE methods were used ‘at some point’ as an adjunct by 98.8% of participants, including massage and other soft tissue techniques (80.9%), Pilates (46.6%), and Yoga (31.5%). The Schroth techniques used by all survey respondents included breathing and pelvic corrections. Seven participants were interviewed, but data saturation was achieved after only four interviews. Thematic analysis revealed four, inter-related broad themes describing the factors that influenced Schroth prescription for AIS: (1) the adolescent as a whole, including physical, emotional and mental characteristics, and patient goals, (2) family, including parent relationship with the adolescent and the motivation of parents in regard to Schroth, (3) the systems within which the treatment was being offered, such as vicinity to the clinic and the presence of financial insurance support, and (4) therapist characteristics, such as their training and experience. (4) Conclusions: Schroth therapists worldwide use a variety of adjunctive methods to treat AIS. Therapists prescribing Schroth exercises to AIS consider the complex interplay of intra-, inter- and extra-personal factors in clinical practice. These considerations move beyond the three components of evidence-based practice of research, patient preferences, and clinical expertise, towards a systems-based reflection on exercise prescription.

The impact of scoliosis bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE) on trunk muscle endurance in adolescents with idiopathic scoliosis is unknown. ScoliBrace^®, a rigid, three-dimensional, over-corrective thoraco-lumbar-sacral orthosis (TLSO), and ScoliBalance^®, a PSSE program, were used to treat adolescent idiopathic scoliosis (AIS) patients. A retrospective study of the trunk muscle endurance of 33 AIS patients who received ScoliBrace^® and ScoliBalance^® was conducted. The patients were treated with ScoliBrace^® and an individualized ScoliBalance^® program. Trunk extensor muscle endurance (TE) and abdominal muscle endurance (AE) tests were performed at initial assessment and then at averages of 6.6 and 24.4 weeks of treatment. The data were analyzed using the Wilcoxon signed-rank test, Stata version 15.1. The participants were aged 13.24 years (SD = 1.64) with a mean Cobb angle of 38.97° (SD = 9.49°). TE improved significantly (p < 0.001) at both short- and medium-term intervals using ScoliBalance^® and ScoliBrace^® in the AIS patients. AE also showed significant improvement between baseline and short-term follow-up, with non-significant improvement at medium-term follow-up. Overall, trunk muscle endurance showed improvement in the AIS patients using ScoliBrace^® and ScoliBalance^®. Future research is required to determine the individual and combined effects of each treatment. However, it seems likely that trunk muscle endurance will not deteriorate in AIS patients with this combined treatment.

Background/Objectives: Adolescent Idiopathic Scoliosis (AIS) is a lateral curvature of the spine combined with rotation and associated postural changes. Curves are classified according to direction and the spinal region, with right thoracic curves being a common presentation. Curve magnitude is measured using Cobb angles on radiographs and is used to monitor curve progression, with one of the main aims of treatment being prevention of progression to surgical levels. Treatment options may include observation, physiotherapeutic scoliosis-specific exercises (PSSE), thoracolumbosacral orthotic (TLSO) bracing, or surgery and are dependent on curve magnitude, risk of progression, and patient goals. Methods: This case series includes five patients (four female and one male, mean age of 14.8 y) who received previous non-surgical treatment without success and had severe right thoracic AIS with an average Cobb angle measurement of 53.4°, involving spinal curve magnitudes that warrant surgical recommendation. Results: These patients’ curves were successfully reduced to nonsurgical levels utilizing a non-surgical, multimodal treatment approach combining 3D corrective TLSO bracing using the ScoliBrace^®, PSSEs, and spinal rehabilitation over an average of 37.0 months. The average Cobb angle reduced from 53.4° to 29.6° (44.6% reduction) after being weaned off treatment. Conclusions: This series has shown successful, clinically significant improvement in Cobb angle and trunk symmetry in five patients with severe AIS using a non-surgical, multimodal approach combining 3D corrective TLSO bracing using the ScoliBrace^® and spinal rehabilitation procedures. Further investigation into this multimodal non-surgical approach for children, parents, and healthcare providers and policymakers seeking an alternative to surgical intervention for AIS is warranted.

Background/Objectives: There is a lack of both guidelines and evidence supporting the non-surgical treatment of juvenile idiopathic scoliosis (JIS). We present a case series of four juveniles presenting with primary right-thoracic curve types who were treated with the ScoliBrace^®. Methods: Four patients with JIS from a single scoliosis clinic database who met predefined inclusion and exclusion criteria were included in this case series. All patients were braced with the ScoliBrace^®, a three-dimensional rigid brace designed to target the deformity using Mirror Image^® postural over-correction. All patients were initially prescribed full-time (23 h/day) bracing; three patients later transitioned to part-time wear. Cobb angle and angle of trunk rotation (ATR) measures were monitored at 90-day intervals after a one-month in-brace check. Results: Patients had a mean (± standard deviation) initial age of 7.2 ± 1.5 years and were followed for a mean of 8.8 ± 1.7 years, including 22.5 ± 15.2 months of post-weaning monitoring. At final follow-up, the primary thoracic curve Cobb angle was improved by a mean of 21.5 ± 12.6°, and ATR by 7.5 ± 2.9°. Conclusions: The ScoliBrace^® brace and management protocol was associated with an average 21.5° Cobb angle reduction in primary right-thoracic scoliosis curves in four juvenile patients with idiopathic scoliosis. Given the small, uncontrolled sample, these findings should be interpreted as preliminary; they support further evaluation of the ScoliBrace^® in larger, prospective controlled studies.