Can Scoliosis Improve Without Surgery?

Written By Dr. Rosemary Carvajal, PT, DPT

When families first hear a scoliosis diagnosis, one of the most common questions that follows is a simple one: Does this have to lead to surgery? For many people with scoliosis, the answer is no, and non-surgical care can make a real difference.

What "Improvement" Actually Means

Improvement in scoliosis is not always captured by a single number. The Cobb angle is one important measure, but meaningful progress also includes better postural alignment, reduced pain, improved function, and a slowed or halted rate of progression. For growing adolescents, the primary goal is often preventing the curve from reaching surgical range. For adults, the focus tends to be maintaining function, managing symptoms, and preserving quality of life.

The Role of PSSE and Evidence-Based Care

Physiotherapeutic scoliosis-specific exercise (PSSE) is distinct from general strengthening or standard physical therapy. It is an individualized, three-dimensional approach to the scoliotic curve. Methods such as Rigo Concept BSPTS and SEAS, both rooted in the original Schroth method, are the approaches used at ScoliSource and are supported by international guidelines from SOSORT, the Society on Scoliosis Orthopaedic and Rehabilitation Treatment.

Research supports PSSE in slowing curve progression and, in some cases, achieving modest improvements in curve magnitude during growth. For bracing patients, PSSE works alongside the brace, training the neuromuscular system to actively support what the brace is doing externally.

What Influences Outcomes

Curve size, age, and consistency all affect how well conservative care works. Smaller curves and patients who are still growing tend to respond most readily, but adults benefit too, particularly in terms of pain management, strength, and preventing further decline. Results are most meaningful for patients who commit to their home exercise program and attend sessions regularly.

When Surgery Is Considered

Surgery is typically considered when a curve approaches or exceeds approximately 50 degrees in a growing adolescent, though this threshold varies between surgeons and depends on individual factors. Progression that continues despite conservative treatment, or pain and dysfunction that significantly affect daily life, are also considerations. It is worth noting that surgery does not eliminate the need for ongoing care, and many post-fusion patients continue to benefit from scoliosis-specific physical therapy to maintain function in the unfused spine.

Non-surgical and surgical care are not opposites. The goal of early, consistent PSSE is to keep as many options open as possible and to give patients the best chance of managing their scoliosis well.

At ScoliSource Physical Therapy, every patient receives a one-on-one evaluation and a personalized program based on their specific curve, age, and goals. If you have questions about whether PSSE is right for you or your child, we are happy to help.

Dr. Rosemary Carvajal, PT, DPT

Dr. Rosemary Carvajal, PT, DPT is a board-certified Doctor of Physical Therapy and scoliosis-specific rehabilitation specialist. She has dedicated her career to helping children, adolescents, and adults with scoliosis and other spinal conditions move with greater ease, manage pain, and achieve lasting improvements in posture and function.

Rosemary is certified in the Rigo Concept BSPTS (Barcelona Scoliosis Physical Therapy School) method (L1, L2, L3 Advanced Certification) and SEAS (Scientific Exercise Approach to Scoliosis) method, both internationally recognized systems of Physiotherapeutic Scoliosis-Specific Exercises (PSSE) that evolved from the original Schroth Method. These advanced certifications allow her to design individualized treatment plans rooted in the most current research and best practices in scoliosis care.

Her passion for scoliosis rehabilitation is deeply personal. As a teenager, Rosemary wore a scoliosis brace and later underwent spinal fusion surgery. She has experienced firsthand the physical, emotional, and social challenges that scoliosis can bring. Today, she continues to practice scoliosis-specific exercise herself, which fuels both her empathy and her belief in the effectiveness of the methods she teaches. This lived experience allows her to provide not only clinical expertise but also compassionate, understanding care that truly connects with patients and families.

Rosemary provides scoliosis-specific physical therapy across the lifespan, including pre- and post-surgical care, brace management support, and long-term exercise programs. Her clinical practice is complemented by active involvement in research.

Beyond clinical care, Rosemary serves on the Communication Committee of SOSORT (International Society on Scoliosis Orthopaedic and Rehabilitation Treatment), where she helps advance global education and collaboration in scoliosis treatment.

Her approach blends advanced clinical expertise with personal experience and compassion. By combining evidence-based scoliosis-specific exercise methods with a hybrid practice model- offering both in-home and private clinic sessions, Rosemary ensures that every patient receives personalized care designed to support both spinal health and quality of life.

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