Treating Adult Scoliosis Without Surgery

Is non-surgical care the right first step?

Yes, for most people. Non-operative management is considered first-line treatment for adult spinal deformity, even though strong supporting evidence is lacking. The exceptions are rapidly worsening nerve symptoms or severe, progressive deformity.

Can exercise or physical therapy help?

Exercise is the best-supported non-surgical option. In a randomized trial of 130 adults with scoliosis, a 20-week program combined posture self-correction exercises with cognitive-behavioral strategies. Disability scores in that group fell from 38 to about 18, and pain dropped from 6.5 to 2.2 out of 10. Those results were better than with general physiotherapy. Core strengthening, supervised strength training, cycling, and pool therapy are commonly recommended.

Do braces work for adults?

Bracing works much better in growing children than in adults. The evidence for adults is very limited. One study found that wearing a brace more than six hours a day slowed curve progression in degenerative scoliosis. However, long-term brace use can weaken trunk muscles, so braces are generally used for short periods to relieve pain.

Do injections help?

For leg pain caused by pinched nerves, epidural steroid injections can help. In patients with degenerative scoliosis and nerve pain, more than half had significant relief lasting at least one month. About 37% still had benefit at one year, and 27% at two years.

What about pain medicines?

My nonoperative colleagues offer a range of nonsurgical treatment plans. I personally offer ReActiv8, an advanced technology that provides an active form of muscle rehabilitation. Read about ReActiv8 →

What about chiropractic care, yoga, and other options?

Systematic reviews rate the evidence for chiropractic care, yoga, and bracing as low or very low quality. That does not mean they never help, only that good studies are lacking. A 2007 review concluded that no single non-surgical treatment has proven to be the preferred option.

How well does non-surgical care work overall?

Non-surgical care often makes symptoms manageable, but it rarely leads to large, lasting improvement. In the NIH-funded ASLS study, patients treated without surgery did not improve much on average, and about 31% eventually chose surgery. In another study, two years of non-surgical care cost about $10,800 on average without measurable improvement in quality of life.

When should I consider surgery?

Consider seeing a deformity surgeon if any of these apply:

• Leg pain, numbness, or weakness is getting worse
• You lean forward or tire quickly when standing or walking
• Your curve is measurably progressing on X-rays
• Months of good non-surgical care have not improved your quality of life

See Is adult scoliosis surgery worth it?

My article · Brown University HealthSarcopenia: aging muscles are a hidden cause of back pain at every stage of lifeOften the problem isn’t the spine but the muscles that hold it up. Why muscle loss can start at any age, why muscle health predicts how long and how well we live, and why active therapy comes before injections or surgery.Read on brownhealth.org →

Restorative muscle therapy for one kind of back pain

Some chronic low back pain comes from a muscle that has stopped doing its job. The multifidus is the deepest muscle along the spine, and it steadies each level automatically as you move. After an injury, the nervous system can switch it off. Over time the muscle stiffens with scar tissue and loses its sense of position, and exercise alone can no longer wake it up. This is a recognised diagnosis, with its own code, separate from non-specific back pain.

ReActiv8, made by Mainstay Medical, is an FDA-approved implanted stimulator for this problem. Through a small outpatient procedure, thin leads are placed beside the nerve that controls the multifidus. At home, you start two 30-minute sessions a day with a remote. The stimulation contracts the muscle directly, retraining it rather than masking pain, so improvement tends to build over the first year.

In a randomised trial of 203 patients, those treated improved far more on disability, pain and quality of life at one year than those who continued standard medical care. A second trial followed patients for five years, and most who completed it still reported substantial improvement.

It is meant for a specific group: people whose pain is mechanical and traced to multifidus dysfunction on history, examination and MRI, who have not improved with therapy and other conservative care, and who are not candidates for spine surgery. It is not a treatment for scoliosis itself or for pinched nerves.

Disclosure. Dr. Diebo serves on an advisory board for Mainstay Medical, which makes ReActiv8.

Sources for this section

1. Schwab F, et al. RESTORE randomised controlled trial. Pain Ther, 2025;14:401–423.
2. Gilligan C, et al. ReActiv8-B trial, 5-year outcomes. 2024.
3. Bess S, et al. Meta-analysis of restorative neurostimulation. 2025.
4. Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain. JOSPT, 2019.

When to see a specialist. Request an appointment for a full evaluation, including full-length standing X-rays.

Sources

1. Diebo, Bassel G., et al. "Adult Spinal Deformity." The Lancet, vol. 394, no. 10193, 2019, pp. 160–172. PMID 31305254.
2. Everett, C. R., and R. K. Patel. "A Systematic Literature Review of Nonsurgical Treatment in Adult Scoliosis." Spine, 2007. †
3. Monticone, M., et al. "Adults With Idiopathic Scoliosis Improve Disability After Motor and Cognitive Rehabilitation: Results of a Randomised Controlled Trial." European Spine Journal, 2016. †
4. Schoutens, C., et al. "Outcomes of Nonsurgical Treatments for Symptomatic Adult Degenerative Scoliosis: A Systematic Review." Pain Medicine, 2020. †

Restorative muscle therapy

Is ReActiv8 right for you?

Answer a few questions to see whether ReActiv8 is worth asking about at a visit. Your answers stay on this page; nothing is sent or stored. This is a first look, not a diagnosis; the decision is made together at a visit, after an examination and an MRI.

It may be worth asking about if: your pain is mostly in your lower back, it flares with small tasks such as brushing your teeth over a sink, or it builds when you sit, stand or drive for a while.

Have you had back pain for more than 3 months? *

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Is your low back pain worse than your leg pain? *

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Over the last 7 days, how bad has your low back pain been on average? *0 = very little pain, 10 = worst possible

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Have you tried prescription medication or physical therapy for it? *

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Would you consider a procedure for your low back pain? *

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Have you had lumbar decompression or fusion surgery before? *

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See my answers

To ask about ReActiv8, call (401) 443-4270. Please do not email health information.

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