Preparing for Scoliosis Surgery: How PSSE Fits Into Pre- and Post-Op Care

Written By Dr. Rosemary Carvajal, PT, DPT

For some people with scoliosis, surgery becomes part of the conversation at some point, whether it is being actively planned, discussed as a future possibility, or simply something a family wants to understand ahead of time. Spinal fusion and other surgical approaches are significant decisions, generally considered when curves progress toward a range near 50 degrees in a child who is still growing, though that threshold varies between surgeons and depends on many individual factors. Regardless of where someone is in that process, scoliosis-specific physical therapy has a meaningful role to play, both before surgery and long after it.

Why PSSE Matters Before Surgery

Physiotherapeutic Scoliosis-Specific Exercise, using Rigo Concept BSPTS and SEAS principles, is not a substitute for surgery when surgery is medically indicated. It is, however, a valuable way to prepare the body for what is ahead. In the months leading up to a scheduled procedure, PSSE can help prepare the body by working to break down compensatory patterns that have developed over time around the torsional condition, while building strength and improving mobility in the affected joints.

Patients who enter surgery with better baseline strength and body awareness tend to have an easier time understanding and participating in their post-surgical rehabilitation. This is not about correcting the curve through exercise alone. It is about giving the body, and the patient, a stronger starting point.

What Pre-Op PSSE Sessions Focus On

A pre-surgical PSSE program is individualized, but it typically emphasizes a few consistent goals: improving muscle activation patterns, supporting core and postural control, and helping the patient develop a strong awareness of their curve pattern, working to adapt away from that pattern as much as possible so the body is better prepared for its post-surgical positioning. This last piece matters more than it might seem. Patients who already understand how their body moves and holds itself tend to adapt more easily to post-operative precautions and movement restrictions.

It is also an opportunity to address any secondary issues, such as tightness or asymmetry in the hips, shoulders, or trunk, that may otherwise complicate recovery.

The Role of Scoliosis-Specific PT After Surgery

Recovery from spinal fusion or other scoliosis surgery follows a timeline set by the surgical team, and physical therapy. Once a patient is cleared to begin rehabilitation, scoliosis-specific physical therapy can help address:

  • Loss of strength and mobility from the surgery itself and the recovery period leading up to clearance

  • New movement patterns needed above and below a fused segment of the spine

  • Postural habits that may need to adjust now that the spine's flexibility has changed

  • Confidence and comfort returning to daily activities, work, school, or sport

This phase is different from pre-op PSSE work. The goals shift from preparing the body to rebuilding it, and every plan is coordinated with the surgeon's guidance and any restrictions still in place.

A Collaborative Process, Not a Replacement for Surgical Care

What scoliosis-specific physical therapy offers is a complementary layer of care, one that treats the whole person and their movement patterns, not just the spine itself. Both imaging, such as X-ray or EOS imaging, and hands-on clinical assessment play a role in tracking how a patient is doing at each stage, and neither should be viewed as more essential than the other. They simply answer different questions.

For families and patients navigating this decision, having a physical therapist who understands scoliosis specifically, rather than general orthopedic rehabilitation alone, can make the process feel less overwhelming. It gives patients one more person on their team who understands the condition in depth, before, during, and after surgery.

If you or your child are preparing for scoliosis surgery, or recovering from a recent procedure, we would be happy to talk through how scoliosis-specific physical therapy could fit into your care plan. Reach out to ScoliSource Physical Therapy at (732) 245-9204 or office.scolisource@gmail.com.

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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How Scoliosis Affects Posture, and Why Posture Alone Can't Explain It