Does scoliosis get worse in adulthood?

What is adult scoliosis?

Scoliosis is a sideways curve of the spine, usually combined with rotation of the vertebrae. In adults, it falls into two main groups. Some people have idiopathic scoliosis that began in childhood or adolescence and continues into adult life. Others develop degenerative, or de novo, scoliosis later in life because discs and small joints wear unevenly, allowing the spine to curve.

Adult spinal deformity also includes changes in the front-to-back alignment of the spine, such as a forward stoop, which often influence symptoms more than the sideways curve itself 1.

Which curves are more likely to progress?

Curves that were large at the end of growth are more likely to continue increasing slowly in adult life, while smaller curves often remain stable. Degenerative curves may progress as the discs and joints continue to change, and loss of bone density can contribute.

Progression is usually slow and is monitored with standing X-rays at intervals decided by the treating specialist. A single measurement does not predict the future on its own; the trend over time and the person's symptoms guide decisions.

What symptoms does adult scoliosis cause?

Many adults with scoliosis have no pain. When symptoms occur, they may include back pain, stiffness, muscle fatigue, a feeling of leaning to one side or forwards, and difficulty standing upright for long periods.

Degenerative scoliosis can narrow the spaces through which nerves pass, causing leg pain, numbness or heaviness when walking that eases with sitting or bending forwards, known as neurogenic claudication.

Does exercise or physiotherapy help?

A systematic review of non-surgical treatment for adult scoliosis found only low-level evidence for physiotherapy, chiropractic care and bracing, and slightly stronger but still limited evidence for injections. The authors concluded that conservative care may be helpful, but no single option has strong research support 2.

In practice, exercise programmes aim to improve trunk and hip strength, mobility, posture awareness, balance and walking tolerance. General activity, such as walking, swimming and cycling, supports overall health and bone strength. The goal is to reduce pain and maintain function rather than straighten the curve.

When is surgery considered?

Surgery may be considered when the curve is progressing, when there is significant imbalance of the trunk, disabling pain that has not responded to non-surgical care, or nerve compression causing leg symptoms or weakness 1.

Adult deformity surgery ranges from limited decompression of trapped nerves to extensive fusion with rods and screws. It carries significant risks, particularly in older adults with other health conditions, and requires a long recovery, so decisions are made carefully with a spinal surgeon.

What else helps protect the spine?

Keeping bones strong through weight-bearing exercise, adequate calcium and vitamin D, not smoking and assessment for osteoporosis when appropriate help protect the spine. Maintaining a healthy weight reduces load on the joints of the spine.

Pain management, such as simple analgesics, heat and pacing activities, helps people stay active. Psychological wellbeing matters too, as persistent pain and changes in appearance can affect mood.

How can pain from adult scoliosis be managed day to day?

Staying active, changing position regularly, using heat, and pacing activities through the day can reduce pain and stiffness. Many people find short walks, swimming or cycling more comfortable than long periods of standing still.

Simple pain relief, as advised by a doctor, can help people stay active. For nerve-related leg pain, sitting or leaning forward may ease symptoms. If pain limits walking or sleep, a specialist review can consider other options.

When should back symptoms be checked promptly?

Seek assessment for a visible change in body shape over a short period, new or worsening leg weakness, numbness, difficulty walking, unexplained weight loss or night pain.

New numbness around the buttocks or genitals, or loss of bladder or bowel control, requires emergency care.

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