Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 19 peer-reviewed journal articles Updated
Orthopedics · Adolescent Idiopathic Scoliosis

Active Surveillance and Physical Therapy

At a Glance

For growing adolescents with mild idiopathic scoliosis, active surveillance means regular examinations and selected X-rays rather than ignoring the curve. Schroth exercises may modestly improve trunk rotation and quality of life, but they do not replace bracing when it is recommended.

When you are told that your scoliosis requires “observation,” it does not mean your doctors are ignoring the problem or “waiting for it to get worse.” In the medical community, observation is better described as active surveillance [1].

This approach is the standard of care for most adolescents with mild curves—those between 10 and 25 degrees—who are still growing [2]. The goal of active surveillance is to monitor the spine closely enough to step in with treatment if, and only if, it becomes necessary [3].

The Routine of Active Surveillance

Active surveillance is a proactive process that involves regular “check-ins” with your orthopedic team.

  • Follow-up Intervals: Follow-up intervals are individualized. Some doctors recommend a clinical exam and a standing X-ray every 6 months while you are growing quickly, though not every visit requires radiography [4]. If your growth has slowed down, these visits might be moved to every 12 months [5].
  • Minimizing Radiation: Because you may need several X-rays over a few years, many specialized centers use EOS imaging. This technology uses lower radiation protocols compared to traditional X-rays and provides clinically useful biplanar images and 3D measurements [6][7].
  • Standardized Positioning: It is important that every X-ray is taken the same way—usually standing with your arms in a specific position—to ensure that any change in the curve is a real change and not just a result of how you were standing that day [8][9].

Physiotherapeutic Scoliosis-Specific Exercises (PSSE)

While “general” physical therapy (like core strengthening or stretching) is good for your health, it has not been proven to stop scoliosis from progressing [10]. However, an optional adjunct therapy called PSSE—most famously the Schroth method—is designed specifically for the 3D shape of a scoliotic spine [2][3].

What is the Schroth Method?

The Schroth method involves specialized exercises prescribed by a certified therapist that focus on three-dimensional self-correction [2]. You learn to use your breath and muscle engagement to “de-rotate” the spine and improve your posture in daily life [3].

  • The Time Commitment: To see results, PSSE requires a significant commitment. A typical program might involve a one-hour supervised session with a certified therapist once a week, plus 30 to 45 minutes of home exercises every day for several months [11][12].
  • What the Evidence Says: Research suggests that for mild curves, PSSE can provide modest improvements in the curve (averaging about 3 to 5 degrees in some studies, which may fall within Cobb measurement error limits) and, more importantly, can improve trunk rotation (the “rib hump”) and overall quality of life [13][14].
  • It is Not a Substitute: PSSE is an optional adjunct. It must not replace recommended bracing or surveillance if the curve reaches a moderate level (usually 25 degrees or more) during a growth spurt [2][15].

Living Your Life: Sports and Activity

One of the biggest concerns for adolescents is whether they have to stop playing sports. The short answer is: No. Untreated AIS usually does not require sports restrictions.

  • Encouraging Movement: Staying active is one of the best things you can do for your spine. General physical activity, gym classes, and competitive sports are all highly encouraged [3][16].
  • No “Bad” Sports: There is no scientific evidence that specific sports—like gymnastics, swimming, or soccer—cause scoliosis or make a curve worse [17][18]. Note that if you have pain, wear a brace, or had recent surgery, restrictions will be individualized by your clinician.
  • Backpacks and Posture: You can continue to wear a backpack, though general school health advice recommends wearing both straps and keeping the weight under 10-15% of your body weight for comfort [19]. Remember: “bad posture” did not cause your scoliosis, and while sitting up straight is good for your muscles, it will not “fix” the curve of the bone [2].

Active surveillance is about finding a balance: keeping a close eye on the spine’s development while ensuring that the diagnosis doesn’t stop you from being an active, healthy teenager.

Common questions in this guide

What does observation mean for adolescent idiopathic scoliosis?
Observation means active surveillance, not ignoring the curve. Your orthopedic team follows the spine with physical examinations and imaging when needed, especially while you are growing. For many adolescents with mild curves, this helps the team identify whether treatment becomes necessary.
How often will my scoliosis be checked while I am growing?
Follow-up schedules depend on your curve and how quickly you are growing. Some patients are checked about every six months during rapid growth and less often when growth slows, but not every visit requires an X-ray. Your clinician may also use standardized positioning or lower-radiation imaging to compare measurements reliably.
Can the Schroth method improve idiopathic scoliosis?
The Schroth method is a form of scoliosis-specific exercise that teaches three-dimensional self-correction using breathing, posture, and muscle control. Research suggests it may modestly improve curve measurements, trunk rotation, and quality of life for some people. It requires regular supervised sessions and home practice.
Is physical therapy a substitute for a scoliosis brace?
General physical therapy, such as stretching or core strengthening, has not been proven to stop scoliosis from progressing. Schroth exercises may be a useful addition, but they should not replace recommended bracing or active surveillance when a curve reaches a level where those treatments are advised.
Can I play sports if I have adolescent idiopathic scoliosis?
Most adolescents with untreated idiopathic scoliosis can participate in school activities, exercise, and competitive sports. There is no evidence that a particular sport causes scoliosis or makes the curve worse. Restrictions may be individualized if you have pain, wear a brace, or recently had surgery.
When might observation change to bracing for scoliosis?
The decision depends on the curve measurement, how fast it is changing, and how much growth remains. Bracing is often considered when a curve reaches a moderate range, commonly around 25 degrees or more, during a growth spurt. Your orthopedic clinician should make the recommendation using your complete clinical picture.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is the exact interval you recommend for our follow-up visits, and will you be using EOS imaging to minimize radiation?
  2. 2.Does my current curve pattern and maturity level make me a good candidate for the Schroth method, or should we focus solely on observation?
  3. 3.Can you recommend a certified PSSE or Schroth therapist in our area who has experience working specifically with adolescents?
  4. 4.Are there any specific sports or physical movements I should avoid, or can I participate in all school activities and athletics?
  5. 5.At what Cobb angle measurement would you recommend moving from observation to bracing?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Analyzing the Effectiveness of the Push-Up Method for Idiopathic Scoliosis: A Preliminary Report.

    Kuroki H, Tajima N, Nagai T, et al.

    Cureus 2026; (18(4)):e106463 doi:10.7759/cureus.106463.

    PMID: 42093781
  2. 2

    Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools.

    Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al.

    Scoliosis and spinal disorders 2016; (11()):20 doi:10.1186/s13013-016-0076-9.

    PMID: 27525315
  3. 3

    2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.

    Negrini S, Donzelli S, Aulisa AG, et al.

    Scoliosis and spinal disorders 2018; (13()):3 doi:10.1186/s13013-017-0145-8.

    PMID: 29435499
  4. 4

    Physical Therapy Scoliosis-Specific Exercises May Reduce Curve Progression in Mild Adolescent Idiopathic Scoliosis Curves.

    Zapata KA, Sucato DJ, Jo CH

    Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 2019; (31(3)):280-285 doi:10.1097/PEP.0000000000000621.

    PMID: 31220013
  5. 5

    Curve progression in female adolescent idiopathic scoliosis with Risser grade ≥ 3: incidence, magnitude, and risk factors in a cohort of 915 unbraced female patients.

    Setojima Y, Kotani T, Asada T, et al.

    Spine deformity 2026; (14(5)):1789-1795 doi:10.1007/s43390-026-01375-1.

    PMID: 42082880
  6. 6

    Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis.

    Ng SY, Bettany-Saltikov J

    The open orthopaedics journal 2017; (11()):1500-1520 doi:10.2174/1874325001711011500.

    PMID: 29399226
  7. 7

    Radiation dose of digital radiography (DR) versus micro-dose x-ray (EOS) on patients with adolescent idiopathic scoliosis: 2016 SOSORT- IRSSD "John Sevastic Award" Winner in Imaging Research.

    Hui SC, Pialasse JP, Wong JY, et al.

    Scoliosis and spinal disorders 2016; (11()):46 doi:10.1186/s13013-016-0106-7.

    PMID: 28035336
  8. 8

    Systematic Review of Clinical Outcome Parameters of Conservative Treatment of Adolescent Idiopathic Scoliosis Patients.

    Kuru Çolak T, Durmuş BB, Saatçı EZ, et al.

    Journal of clinical medicine 2025; (14(4)) doi:10.3390/jcm14041063.

    PMID: 40004591
  9. 9

    Bi-planar spinal stereoradiography of adolescent idiopathic scoliosis: considerations in 3D alignment and functional balance.

    Pasha S, Capraro A, Cahill PJ, et al.

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2016; (25(10)):3234-3241 doi:10.1007/s00586-016-4661-7.

    PMID: 27334494
  10. 10

    Impact of Therapeutic Exercises Versus General Conservative Modalities and Brace on the Progression of Adolescent Idiopathic Scoliosis: Systematic Review and Meta-analysis.

    Andrade RM, Ribeiro AP, Ferreira MEC, et al.

    Archives of physical medicine and rehabilitation 2025; (106(12)):1874-1885 doi:10.1016/j.apmr.2025.06.021.

    PMID: 40712865
  11. 11

    Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: how many patients require treatment to prevent one deterioration? - results from a randomized controlled trial - "SOSORT 2017 Award Winner".

    Schreiber S, Parent EC, Hill DL, et al.

    Scoliosis and spinal disorders 2017; (12()):26 doi:10.1186/s13013-017-0137-8.

    PMID: 29164179
  12. 12

    Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial.

    Schreiber S, Parent EC, Khodayari Moez E, et al.

    PloS one 2016; (11(12)):e0168746 doi:10.1371/journal.pone.0168746.

    PMID: 28033399
  13. 13

    The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis.

    Ceballos-Laita L, Carrasco-Uribarren A, Cabanillas-Barea S, et al.

    European journal of physical and rehabilitation medicine 2023; (59(2)):228-236 doi:10.23736/S1973-9087.23.07654-2.

    PMID: 36692412
  14. 14

    Impact of scoliosis-specific exercises on adolescents with idiopathic scoliosis.

    Sun T, Dong X, Hong P, et al.

    BMC musculoskeletal disorders 2025; (26(1)):1113 doi:10.1186/s12891-025-09309-0.

    PMID: 41413806
  15. 15

    Physiotherapeutic Scoliosis-Specific Exercises (PSSE-Schroth) can reduce the risk for progression during early growth in curves below 25°: prospective control study.

    Karavidas N, Iakovidis P, Chatziprodromidou I, et al.

    European journal of physical and rehabilitation medicine 2024; (60(2)):331-339 doi:10.23736/S1973-9087.24.08177-2.

    PMID: 38502554
  16. 16

    Outcome of bracing vs. surgical treatment in adolescents with idiopathic scoliosis based on device measured daily physical activity: a prospective pilot study.

    Chopra S, Larson AN, Milbrandt TA, Kaufman KR

    Journal of pediatric orthopedics. Part B 2023; (32(6)):517-523 doi:10.1097/BPB.0000000000001016.

    PMID: 36445379
  17. 17

    Correlation between physical activity and adolescent idiopathic scoliosis: a systematic review.

    Qi X, Peng C, Fu P, et al.

    BMC musculoskeletal disorders 2023; (24(1)):978 doi:10.1186/s12891-023-07114-1.

    PMID: 38115016
  18. 18

    Factors Associated with Suspected Scoliosis Identified Through School Screening: The Role of Body Mass Index and Sports Participation.

    Glavaš J, Matković R, Rumboldt M, Aljinović J

    Healthcare (Basel, Switzerland) 2026; (14(12)) doi:10.3390/healthcare14121672.

    PMID: 42354530
  19. 19

    Adolescent idiopathic scoliosis for the primary care physician: frequently asked questions.

    Ghanem I, Rizkallah M

    Current opinion in pediatrics 2019; (31(1)):48-53 doi:10.1097/MOP.0000000000000705.

    PMID: 30461512

This page explains active surveillance and scoliosis-specific exercises for informational purposes only and does not constitute medical advice. Your orthopedic clinician should tailor imaging, therapy, sports guidance, and bracing decisions to your growth and curve.

Get notified when new evidence is published on idiopathic scoliosis.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.