Why Do I Need PSSE Instead of Just Strengthening or Core Exercises?

Dec 17

Written By Dr. Rosemary Carvajal, PT, DPT

If you or your child has been diagnosed with scoliosis, you may be wondering:

“Why can’t I just do strengthening exercises, core work, Pilates, yoga, or general physical therapy?”

This is a very common and valid question. While general exercise is important for overall health, scoliosis is a three-dimensional spinal condition that requires a three-dimensional approach. That’s where Physiotherapeutic Scoliosis-Specific Exercises (PSSE) come in.

Let’s break down why PSSE is different — and why it matters.

Scoliosis Is Not Just a Weak Core

Scoliosis is not caused by poor posture or weak muscles. It involves:

A lateral curvature of the spine
Torsion/ rotation of the vertebrae
Changes in rib cage shape and trunk alignment
Asymmetrical muscle length, strength, and activation

Because scoliosis is a structural and three-dimensional condition, simply strengthening muscles does not address the underlying problem.

Why General Strengthening Alone Is Not Enough

Traditional strengthening or core exercises are typically:

Focused on global strength, not curve-specific control
Not designed to address spinal rotation or asymmetry

In some cases, generic exercises can actually:

Reinforce existing asymmetries
Encourage movement into the curve
Miss opportunities for corrective alignment

This doesn’t mean strengthening is bad - it just means it needs to be applied correctly and specifically for scoliosis. A physical therapist certified in PSSE can assist you in learning how to work WITH your scoliosis to perform strengthening exercises, resistance training, core work, Pilates, yoga, and many other activities, while still being conscious of your curve.

What Makes PSSE Different?

Physiotherapeutic Scoliosis-Specific Exercise (PSSE) refers to a group of evidence-based rehabilitation approaches developed specifically for scoliosis and other spinal conditions. Unlike generalized exercise programs, PSSE protocols are tailored to each person’s unique spinal curve pattern and posture, addressing the spine in three dimensions. These programs are used worldwide to reduce curve progression risk, improve posture and alignment, support brace treatment, and enhance function at any stage of life. Different methods of PSSE include the Schroth method, Rigo Concept BSPTS, and SEAS, amongst others.

PSSE Is About Carryover Into Daily Life

One of the most important goals of PSSE is helping patients learn how to integrate their corrective posture and exercises into their daily life. It works on sitting, standing, walking, carrying a backpack, participating in sports, school, work, and daily activities with improved alignment and control.

This means the work doesn’t stop when the exercise session ends. PSSE helps retrain the nervous system so better posture and movement become part of everyday life.

Can Strengthening Still Be Part of Treatment?

Yes - strengthening absolutely has a role, but it should be curve-specific, and performed in a corrected posture. When strengthening is layered on top of PSSE principles, it becomes far more effective for someone with scoliosis.

Why a Scoliosis-Trained Physical Therapist Matters

Not all physical therapy is the same. PSSE requires advanced training in scoliosis-specific methods and an advanced understanding of:

Curve patterns
Growth and progression risk
Bracing and surgical considerations
Long-term spinal health

Working with a scoliosis-trained physical therapist ensures your exercises are intentional, individualized, and evidence-based.

The Bottom Line

General exercise is great for overall health - but scoliosis requires more than general exercise. If you have scoliosis and want an approach that goes beyond basic strengthening, PSSE offers a targeted, individualized path forward.

Ready to Learn More?

If you’re curious whether PSSE is right for you or your child, I’d be happy to help guide you through the next steps.

👉 Contact ScoliSource to schedule an initial evaluation, or free 15 minute chat to learn more about scoliosis-specific physical therapy.

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.