Behind the Curve: What Causes Scoliosis?
Understanding What's Behind the Curve
When families first hear the diagnosis, one question immediately surfaces: what causes scoliosis? It's a natural concern when facing a condition that affects the very structure that holds us upright. While the answer isn't always straightforward, we've helped hundreds of patients steer these waters.
Scoliosis creates either a C-shaped or S-shaped curve when viewed from behind, rather than the straight alignment you'd expect to see. This sideways curve affects approximately 2-3% of Americans—that's 6 to 9 million people living with this condition.
Most people develop scoliosis during growth spurts between ages 10-15, with girls being eight times more likely than boys to need treatment. What surprises many parents is that despite common beliefs, poor posture, heavy backpacks, and sports activities don't actually cause scoliosis.
Here's what we currently understand about the main causes:
Type of ScoliosisPrimary CausesIdiopathic (80% of cases)Unknown cause; likely combination of genetic factors, hormones, and growth patternsCongenitalBirth defects in spine formation during fetal developmentNeuromuscularConditions like cerebral palsy, muscular dystrophy, or spina bifidaDegenerativeAge-related wear and tear of spinal disks and jointsFunctionalTemporary curves due to leg length differences or muscle spasms
The uncertainty can feel overwhelming. Is it genetic? Will it get worse? Can we prevent it? These questions are completely valid when facing a condition that might affect quality of life and physical function.
I'm Lou Ezrick, founder of Evolve Physical Therapy + Sports Rehabilitation, and I've witnessed how understanding what causes scoliosis empowers patients. Our specialized treatment approaches address both the structural and functional aspects of spinal curvature, helping patients regain confidence and control.
Scoliosis 101: Understanding the Spine's Natural & Abnormal Curves
When you look at a healthy spine from the side, you'll notice it naturally forms a gentle S-shape. These natural curves—the inward curve at your neck (cervical lordosis), the outward curve in your mid-back (thoracic kyphosis), and another inward curve in your lower back (lumbar lordosis)—aren't just there by accident. They work together like shock absorbers, helping you balance and move with ease.
But here's the key difference with scoliosis: When viewed from behind, a healthy spine should run straight down your back. With scoliosis, the spine develops an unexpected sideways curve in this plane (called the coronal plane), often twisting as it curves, which can make ribs or muscles stick out more on one side.
"Scoliosis is a very manageable condition when diagnosed early," explains Dr. Paul Sponseller, a pediatric orthopedic surgeon. "If scoliosis can be diagnosed before the child has a growth spurt, the provider can determine a treatment plan that prevents a bigger curve from forming during times of growth."
Doctors measure these curves using something called the Cobb angle on X-rays, which helps determine if your scoliosis is:
Mild scoliosis: 10-24 degrees
Moderate scoliosis: 25-39 degrees
Severe scoliosis: 40+ degrees
About 2-3% of Americans have some form of scoliosis—that's millions of people walking around with curves in their spines. And if you're female, your risk is about eight times higher than males for developing curves that need treatment.
Signs & Symptoms You Shouldn't Ignore
What makes scoliosis tricky is that it often sneaks up without pain, especially in kids and teens. This is why knowing what to look for is so important.
You might notice uneven shoulders where one sits higher than the other, or perhaps a shoulder blade that sticks out more prominently. Many people with scoliosis have one hip that sits higher than the other, creating an asymmetrical waistline that makes clothes hang unevenly.
When someone with scoliosis bends forward, you might see a more obvious curve in the spine or a rib hump—where the ribs on one side stick out more than the other, creating a raised area on the back.
For adults, scoliosis often brings different challenges. Chronic back pain might develop, especially after standing or sitting for long periods. Some experience leg pain, numbness, or weakness from nerves getting pinched. In severe cases, the curve can even affect breathing as it limits chest expansion. Many adults also notice they're getting shorter as their curve progresses over time.
Nicholas's story shows why regular check-ups matter. Diagnosed with scoliosis at just 3 years old, he showed almost no visible symptoms. His mother shares, "We wouldn't have noticed anything wrong just by looking at him—it was only through regular pediatric screenings that we caught it early."
Early detection makes all the difference in managing what causes scoliosis and preventing progression—another reason why those routine doctor visits are more important than they might seem.
The Different Types of Scoliosis You Might Encounter
Scoliosis isn't a one-size-fits-all condition. Each person's curve tells its own story, and understanding the specific type helps determine both the underlying cause and the best treatment approach.
Idiopathic Scoliosis makes up about 80% of all cases, and the term "idiopathic" simply means doctors don't know exactly what causes it. We categorize it by when it appears:
Infantile: From birth to 3 years
Juvenile: From 4 to 10 years
Adolescent: From 11 to 18 years (this is the most common time for curves to develop)
Adult: After the skeleton has finished growing
When Sarah first came to our Brooklyn clinic, she had adolescent idiopathic scoliosis that wasn't finded until a routine school screening. "I had no idea my spine was curved," she told us. "I never felt any pain or noticed anything different about my body."
Congenital Scoliosis is present right from birth because the vertebrae didn't form correctly during those crucial early weeks of pregnancy. Between weeks 4 and 7 of development, these spinal abnormalities begin to take shape, creating the foundation for a curved spine that will become more apparent as the child grows.
Neuromuscular Scoliosis develops when conditions affect the brain, spinal cord, or muscles. Children with cerebral palsy, muscular dystrophy, spina bifida, or (rarely nowadays) polio often develop this type of scoliosis because their muscles can't properly support the spine. Without that crucial support, gravity gradually pulls the spine into a curved position.
For adults over 50, Degenerative Scoliosis is the most common type. Years of wear and tear on spinal discs and joints, especially when combined with osteoporosis or arthritis, can cause the spine to gradually curve sideways. Many of our older patients at Evolve Physical Therapy didn't have scoliosis in their youth but developed it as they aged.
Some people develop Rotoscoliosis, where the vertebrae not only curve sideways but also twist along the spine's axis. This rotation often creates that telltale rib hump that becomes visible when bending forward. More info about rotoscoliosis
We also classify scoliosis as either:
Structural: These curves are permanent and include vertebral rotation. They won't straighten even when you bend or change positions.
Functional (Non-structural): These temporary curves often resolve when the underlying issue—like muscle spasms or leg length differences—is addressed.
Why Idiopathic Is So Common
The most puzzling aspect of scoliosis is that in around 8 out of 10 cases, we simply don't know what causes scoliosis. This mystery is particularly true for adolescent idiopathic scoliosis (AIS).
"Parents often ask what they could have done to prevent their child's scoliosis," notes Dr. Sponseller, "but the truth is that there's currently no known cause or prevention method."
Researchers believe idiopathic scoliosis likely results from several factors working together:
Genetic predisposition plays a significant role—about 30% of people with scoliosis have a family member with the condition. Hormonal factors might explain why girls are eight times more likely than boys to need treatment, suggesting estrogen may influence curve progression.
Growth and development patterns matter too. It's no coincidence that curves often worsen during growth spurts. Some theories suggest neuromuscular development issues, particularly with the brain's postural control mechanisms, while others point to connective tissue abnormalities in collagen or elastic fibers.
As the National Institute of Health explains: "Researchers suspect that many genes are involved in adolescent idiopathic scoliosis. Some of these genes likely contribute to causing the disorder. Others play a role in determining the severity of spinal curvature and whether the curve is stable or progressive."
When Scoliosis Starts at Birth or With a Condition
Unlike idiopathic scoliosis, some forms have clear causes that can be identified from birth or develop from specific conditions.
Congenital Scoliosis occurs when vertebrae don't form properly during fetal development. This might include wedge-shaped vertebrae (hemivertebrae), fused vertebrae or ribs, or missing portions of vertebrae. These malformations create an imbalance that causes uneven spinal growth and curvature. Children with congenital scoliosis often have other birth defects, particularly in their hearts and kidneys.
Neuromuscular Scoliosis develops when conditions affect the muscles supporting the spine. In our Brooklyn practice, we work with many patients managing this type of scoliosis, including those with cerebral palsy that affects muscle control, muscular dystrophy that causes progressive weakness, and spina bifida where the spinal column didn't close completely during development.
We also see patients with scoliosis from spinal cord injuries that damaged critical nerve pathways. In these cases, muscle imbalances prevent proper spinal support, allowing gravity to gradually pull the spine sideways. These curves often progress more rapidly than idiopathic scoliosis and may continue worsening into adulthood.
At Evolve Physical Therapy in Brooklyn, we create specialized exercise programs to help patients with all types of scoliosis maintain function and prevent progression. Understanding what causes scoliosis in each individual case helps us develop the most effective treatment plan for each unique curve.
What Causes Scoliosis? The Core Factors Explained
When patients ask what causes scoliosis, the answer isn't always straightforward. Think of scoliosis causes as falling into two main categories: structural (permanent changes to spine anatomy) and non-structural (temporary curves that may resolve when underlying conditions are treated).
The spine is an amazingly complex structure, and several factors can influence its alignment. For many families navigating a new diagnosis, understanding these causes helps make sense of the condition.
Genetic factors play a significant role in many cases. If you have a first-degree relative with scoliosis, your risk increases by about 11%. Specific gene variations affecting bone growth and certain hereditary conditions like Marfan syndrome can predispose someone to developing a curve. I've worked with multiple families where several members across generations have scoliosis, highlighting this genetic connection.
Your environment might also influence scoliosis development. Research suggests nutritional deficiencies, hormonal imbalances during growth periods, and even vitamin D levels may contribute to curve development or progression. These factors don't cause scoliosis directly but may influence how the spine develops in susceptible individuals.
Growth-related factors are particularly important in adolescent scoliosis. Those rapid teenage growth spurts can trigger curve progression, especially when growth happens asymmetrically. This explains why we often see curves worsen during puberty, when the body is changing rapidly.
For patients with conditions like cerebral palsy or muscular dystrophy, neuromuscular disorders create imbalanced muscle tension on the spine. Without proper muscle support on all sides, the spine can gradually curve. These patients often need specialized approaches to manage their scoliosis.
In older adults, degenerative processes commonly cause scoliosis. Years of disc and joint degeneration, vertebral compression fractures, and asymmetric arthritic changes can slowly alter spinal alignment. As one patient in her 70s told me, "I never had scoliosis as a child, but now my spine has a definite curve."
Trauma and structural changes can also lead to scoliosis. Spinal fractures that heal unevenly, previous spinal surgeries, and tumors affecting vertebral structure can all disrupt normal alignment. These cases often have a clear starting point—the injury or medical event that initiated the curve.
Less commonly, infections and inflammatory conditions like vertebral osteomyelitis, spinal tuberculosis, or inflammatory arthritis can damage spinal joints asymmetrically, leading to curvature.
Dr. Dean Chou, a neurosurgeon specializing in spinal disorders, explains it well: "Adult scoliosis can be different from the scoliosis that occurs in children and teenagers, especially if it develops later on in life." This highlights how causes vary significantly across age groups.
For evidence-based information on scoliosis epidemiology and causes, the National Library of Medicine provides comprehensive resources: Scientific research on scoliosis epidemiology
What Causes Scoliosis in Children & Teens?
When parents bring their children to our Brooklyn clinic asking what causes scoliosis, I often see the worry in their eyes. They wonder if they could have prevented it somehow. The truth is, for about 80% of pediatric cases, we simply don't know the exact cause—these are called idiopathic cases, meaning the cause remains unknown.
However, research has uncovered several contributing factors that help us understand why some children develop curves while others don't.
Genetic predisposition plays a significant role. About 30% of patients with adolescent idiopathic scoliosis have a family member with the condition. I remember one family where both mom and daughter had nearly identical curve patterns—a clear example of genetic influence. As the National Institute of Health notes, "Adolescent idiopathic scoliosis probably results from a combination of genetic and environmental factors."
Hormonal influences likely contribute too, especially considering girls are eight times more likely than boys to develop curves requiring treatment. The connection between estrogen levels and scoliosis progression is particularly notable during puberty when growth accelerates. Many of our young female patients see their curves progress most rapidly during growth spurts.
Some researchers believe neuromuscular development issues may be involved. The brain's control of posture and spinal alignment—sometimes called "postural memory"—might develop incorrectly in some children. This could explain why the body doesn't automatically correct the curve as it forms.
Growth patterns themselves can trigger curve progression. Many children with mild curves experience significant worsening during adolescent growth spurts. One 12-year-old patient gained four inches in height over six months, and during that same period, her curve increased from 15 to 27 degrees.
For children with early-onset scoliosis (before age 10), the causes may differ slightly:
Infantile idiopathic scoliosis (0-3 years) might relate to positioning in the womb or sleeping position after birth
Juvenile idiopathic scoliosis (4-10 years) often has a stronger genetic component
For more information on the hereditary aspects of scoliosis, visit our detailed guide: Is Scoliosis Hereditary?
What Causes Scoliosis in Adults?
Adult scoliosis falls into two main categories, each with distinct causes that we regularly address at Evolve Physical Therapy.
Adult Idiopathic Scoliosis is essentially a continuation of adolescent scoliosis that persists into adulthood. While the initial cause remains unknown, several factors can contribute to curve progression in adults. Loss of bone density (osteoporosis) weakens the vertebrae, making them less able to maintain proper alignment. Disc degeneration reduces the cushioning between vertebrae, allowing for more movement and potential curve progression. Asymmetric arthritic changes and muscle imbalances that develop over time can pull the spine further out of alignment.
Jane, a 45-year-old patient who'd had scoliosis since her teens, found her previously stable 25-degree curve had increased to 32 degrees after menopause, likely due to hormonal changes affecting her bone density.
De Novo (Degenerative) Scoliosis develops after skeletal maturity, typically between ages 50 and 70. This type results from age-related changes in the spine. As intervertebral discs lose height and hydration, the spine can become unstable and shift laterally. Facet joint arthritis creates uneven forces on the spine as these small joints wear down asymmetrically. Vertebral compression fractures, often due to osteoporosis, can create wedge-shaped vertebrae that initiate curves. And as spinal ligaments lose elasticity and strength with age, they provide less structural support.
Dr. Dean Chou explains it clearly: "Adult scoliosis can develop between ages 50 and 70 due to vertebral ligament degeneration, disc degeneration, and asymmetric spinal loading."
An estimated 1 in 3 adults aged 40-90 may be affected by some degree of scoliosis, though many cases remain asymptomatic and undiagnosed.
Leg length discrepancy can also contribute to functional scoliosis in adults. When one leg is shorter than the other, the pelvis tilts, causing the spine to curve as a compensation mechanism. We've had great success addressing this type of scoliosis with proper orthotics and targeted exercises.
For more information on adult-onset scoliosis, see this article: Adults can develop scoliosis too
Injuries, Infections & Other Medical Triggers
Beyond the common causes, several less frequent medical conditions can trigger scoliosis. These cases often have a clearer starting point than idiopathic scoliosis.
Traumatic injuries can significantly alter spinal alignment. Vertebral fractures from car accidents, falls, or sports injuries create asymmetry in the spine as they heal. Spinal cord injuries may cause muscle imbalances leading to gradual curvature. Even previous spinal surgeries, particularly laminectomies (removal of part of the vertebral arch), can destabilize the spine.
Robert, a construction worker who came to our Brooklyn clinic, developed a progressive curve after falling from scaffolding and fracturing two vertebrae. His case illustrates how trauma can initiate scoliosis even in previously healthy adults.
Though less common in developed countries, infections can damage the spine and lead to scoliosis. Osteomyelitis (infection of bone or bone marrow) can erode vertebrae, while tuberculosis of the spine (Pott's Disease) can severely damage vertebral bodies. Even discitis (inflammation of intervertebral discs, usually due to infection) can create enough damage to alter spinal alignment.
Tumors and space-occupying lesions represent another category of medical triggers. Spinal cord tumors can cause pressure and neurological changes affecting posture, while vertebral tumors may weaken or deform vertebrae directly. Syringomyelia, a fluid-filled cavity within the spinal cord, can disrupt normal function and lead to progressive curvature.
Several other medical conditions can predispose someone to scoliosis, including Ehlers-Danlos Syndrome (affecting collagen and connective tissue), Marfan Syndrome (affecting connective tissue including in the spine), Neurofibromatosis (causing abnormal bone growth), and Rheumatoid Arthritis (damaging spinal joints asymmetrically).
At Evolve Physical Therapy, we've worked with patients whose scoliosis developed after specific medical events. Through targeted physical therapy, we help stabilize curves and manage pain effectively, even when the underlying cause can't be reversed.
Myths Busted: Posture, Backpacks & Sports
Part of understanding what causes scoliosis is clearing up what doesn't cause it. I've heard so many misconceptions from worried parents and patients over the years, and it's important to separate fact from fiction.
Poor posture doesn't cause structural scoliosis. I can't tell you how many grandmothers have blamed themselves for not making their now-adult children "sit up straight." While slouching might make an existing curve more noticeable or cause temporary postural changes, it cannot create the structural changes in the spine that characterize true scoliosis. As the Cleveland Clinic notes, "The misconception that slouching or sitting up straight can fix scoliosis stems from confusing cause and effect."
Heavy backpacks don't cause scoliosis either. This is a common worry for parents watching their children trudge to school with seemingly oversized bags. Research has not established any link between carrying heavy backpacks and developing scoliosis. Dr. Paul Sponseller puts it clearly: "Parents tend to ask what they could have done to prevent scoliosis, but scoliosis is a very interesting disease because there is currently no known cause or prevention method." While heavy bags can certainly cause muscle strain and back pain, they don't cause the structural spinal changes seen in scoliosis.
Sports participation doesn't cause scoliosis, even in activities with asymmetrical movements like tennis or golf. In fact, physical activity is generally beneficial for spine health. Some sports may make an existing mild curve more noticeable due to muscle development on one side, but they don't create the curve. I always encourage my patients with scoliosis to stay active – strong core muscles provide better support for the spine.
Scoliosis isn't always painful, especially in children and adolescents. Many curves are finded during routine screenings or when parents notice clothing hanging unevenly, not because the child complained of pain. This painless presentation is why screening is so important – we can catch curves before they progress significantly.
Not all curves get worse over time. The likelihood of progression depends on the patient's age, curve pattern, degree of curvature, and skeletal maturity. Many mild curves remain stable throughout life, requiring only monitoring rather than intervention.
At Evolve Physical Therapy in Brooklyn, we encourage our patients with scoliosis to maintain healthy lifestyles. While good posture, proper backpack use, and regular exercise won't prevent or correct scoliosis, they contribute to overall spine health and may help manage symptoms in those who already have curves.
How Doctors Pinpoint the Cause
When you or your child receives a scoliosis diagnosis, understanding what causes scoliosis in your specific case becomes a top priority. Doctors use a thoughtful, systematic approach to identify the underlying factors behind each curve.
The diagnostic journey typically begins with a conversation about your symptoms and medical history. Dr. Lou Ezrick at Evolve Physical Therapy explains, "We start by listening to patients describe their experience—when they first noticed changes, any pain patterns, and family history can provide valuable clues about the cause."
Your doctor will then conduct a thorough physical examination. This includes observing your posture while standing naturally, checking shoulder and hip alignment, and measuring leg lengths. One of the most telling assessments is the Adam's Forward Bend Test, where you'll bend forward at the waist with arms hanging down—this position makes any spinal rotation or rib prominence much more visible to the trained eye.
During this exam, your doctor might use a scoliometer, a specialized tool placed along your spine that measures the angle of trunk rotation. This simple device helps quantify the three-dimensional nature of the curve.
"The physical exam is just the beginning," notes Dr. Clayton Stitzel, a scoliosis specialist. "A bent spine is the main sign, not the cause of scoliosis. Doctors search for reasons beyond the curve."
Imaging studies form the cornerstone of diagnosis. X-rays remain the primary tool, providing clear views of the spine from both front and side angles. From these images, doctors measure the Cobb angle—the gold standard for diagnosing and monitoring scoliosis severity. This measurement identifies the most tilted vertebrae at the top and bottom of the curve.
For patients with unusual presentations or neurological symptoms, an MRI might be ordered. These detailed images can reveal tumors, syringomyelia (fluid-filled cavities in the spinal cord), or other structural abnormalities that might be causing the curve. CT scans offer another option, particularly useful for congenital scoliosis or pre-surgical planning, as they provide detailed cross-sectional images of bone structure.
Beyond imaging, your doctor may recommend:
Genetic testing if there's a strong family history or signs of genetic syndromes like Marfan syndrome or Ehlers-Danlos syndrome
Bone density screening for adult patients to assess osteoporosis risk, which can influence treatment decisions
Pulmonary function tests for those with severe curves that might be affecting breathing capacity
At Evolve Physical Therapy in Brooklyn, we've seen how this comprehensive approach helps tailor treatment to each patient's specific needs. When Sarah, a 13-year-old patient, came to us with a newly diagnosed curve, her MRI revealed a small syrinx (spinal cord cavity) that had been causing her curve. This findy completely changed her treatment plan and prognosis.
For more detailed information about the diagnostic process, visit our guide: How to Know if You Have Scoliosis
Risk Factors & When to Get Screened
Understanding your risk factors helps determine when and how often to get screened for scoliosis. While we can't always pinpoint exactly what causes scoliosis, we can identify who's most likely to develop it.
Age plays a critical role in scoliosis development. Most idiopathic scoliosis emerges during growth spurts between ages 10-15, when the spine is growing rapidly. This is why school screenings typically target fifth through ninth graders.
Sex is another significant factor. While boys and girls develop small curves at roughly equal rates, girls are 7-8 times more likely to have curves that progress to needing treatment. This striking difference suggests hormonal influences during puberty might contribute to curve progression.
Family history significantly raises your risk. Having a parent or sibling with scoliosis increases your odds by about 30%. When Emma came to our Brooklyn clinic with early signs of scoliosis, her mother's history of wearing a brace as a teenager had already put the family on high alert, leading to early intervention.
Your growth rate matters too. Children experiencing rapid growth spurts need closer monitoring, as this is when curves tend to worsen most dramatically. The faster you grow, the higher the risk of progression.
The curve pattern itself offers clues about progression risk. Double curves (S-shaped) and thoracic curves (in the mid-back) typically have higher progression rates than single lumbar curves (lower back). Your doctor will consider this pattern when recommending follow-up intervals.
"Children around the age of 10 to 12 are usually becoming more private, and parents are no longer involved in activities like bathing or dressing them, when they might have otherwise noticed a change," notes Dr. Sponseller. This developmental shift makes formal screening especially valuable during these years.
For adults, degenerative scoliosis risk increases significantly after age 50, particularly for those with osteoporosis, previous spinal surgery, or a history of adolescent scoliosis. Height loss, increasing back pain, or noticeable postural changes in midlife warrant a spine assessment.
At Evolve Physical Therapy, we recommend these screening timeframes:
For children: Basic spine assessment during yearly pediatric check-ups
For pre-teens: School-based or pediatrician screenings around ages 10-12
During growth spurts: Extra vigilance when children are growing rapidly
With family history: Earlier and more frequent screenings if close relatives have scoliosis
For adults over 50: Consider spine assessment during regular physical exams, especially with height loss or new back pain
Early detection remains our most powerful tool for managing scoliosis effectively and preventing progression that might require more intensive intervention.
Prevention, Early Detection & Lifestyle Support
While we can't completely prevent idiopathic scoliosis, catching it early and making smart lifestyle choices can make a world of difference in managing the condition and stopping curves from getting worse.
Early detection is your best ally in the scoliosis journey. Regular check-ups with your pediatrician that include a quick spine assessment can catch subtle changes before they become obvious. Many schools offer screening programs around ages 10-12, which is perfect timing since this is when many curves first appear during growth spurts.
"I encourage parents to be curve detectives," says Lou Ezrick, founder of Evolve Physical Therapy. "Simple things like noticing uneven shoulders, clothes that hang unevenly, or one hip that seems higher than the other can lead to early intervention when treatment is most effective."
When it comes to supporting spine health, several approaches can help manage scoliosis:
Core strength truly matters. A strong core provides better support for your spine, almost like creating your own internal back brace. At Evolve, we design personalized strengthening programs that target the specific muscles needed to counterbalance your unique curve pattern.
Bone health shouldn't be overlooked either. Getting enough calcium and vitamin D supports overall bone strength, which becomes particularly important as we age. For our younger patients, building strong bones during growth years creates a more resilient foundation.
Healthy weight reduces stress on the spine. Each extra pound puts additional pressure on spinal structures, which can increase pain in those with scoliosis. We work with patients to find enjoyable activities that help maintain a healthy weight while being spine-friendly.
Our Brooklyn clinic specializes in the Schroth method – a three-dimensional approach to scoliosis treatment that uses customized exercises to elongate and de-rotate the spine. This method has shown remarkable results for many patients who commit to the program. Schroth Scoliosis Physical Therapy Brooklyn
Beyond Schroth, we offer comprehensive scoliosis care including postural re-education, hands-on manual therapy to address muscle imbalances, and functional training that translates into improved daily activities. Our approach is always individualized – what works for one curve pattern might not work for another.
The field of non-surgical scoliosis management continues to evolve with exciting new approaches. Dynamic bracing systems, scoliosis-specific yoga, and neuromuscular retraining show promise in helping patients manage their curves. We stay current with these developments to offer our patients the most effective options. What's New in Nonsurgical Scoliosis Treatment
Can Scoliosis Be Prevented?
This is perhaps the most common question I hear from concerned parents, and I wish I had a simpler answer. The truth is, for idiopathic scoliosis – which accounts for about 80% of cases – there is currently no known prevention method.
"It's like trying to prevent being tall or having blue eyes," I often explain to families. "There's a strong genetic component that we simply can't control."
However, for other types of scoliosis, we can sometimes address underlying factors:
For neuromuscular scoliosis, early and effective treatment of conditions like cerebral palsy or muscular dystrophy may help reduce the severity of spinal curves.
With degenerative scoliosis, which typically affects adults over 50, there are several modifiable factors that can help. Maintaining good bone density through weight-bearing exercise and proper nutrition makes a difference. Avoiding smoking is crucial since it accelerates bone loss. And preventing falls can help avoid the vertebral fractures that sometimes trigger curve progression.
For functional scoliosis, early correction of leg length differences or addressing muscle imbalances can sometimes prevent curves from developing.
I remember working with Maria, a 67-year-old with early degenerative scoliosis. By focusing on bone-strengthening exercises, fall prevention strategies, and gentle yoga, we were able to stabilize her curve and significantly reduce her pain. Three years later, her X-rays show no progression – a real victory at her age.
At Evolve Physical Therapy in Brooklyn, we believe that while we may not be able to prevent all cases of scoliosis, we can absolutely influence its impact on quality of life. Our approach combines the latest evidence-based techniques with compassionate, personalized care to help each patient write their own success story.
Frequently Asked Questions About What Causes Scoliosis
Does scoliosis run in families?
You're not imagining things if scoliosis seems to appear in multiple family members. There's definitely a genetic component at play. Research shows about 30% of people with idiopathic scoliosis have a family member with the condition too. If you're a parent with scoliosis, your children have roughly an 11% chance of developing it—though daughters face a higher risk (29%) compared to sons (9%).
But genetics aren't as straightforward as passing down eye color. The National Institute of Health explains that scoliosis inheritance is complex: "Researchers suspect that many genes are involved in adolescent idiopathic scoliosis. Some of these genes likely contribute to causing the disorder. Others play a role in determining the severity of spinal curvature and whether the curve is stable or progressive."
What's fascinating is that even identical twins can develop completely different scoliosis patterns. This tells us that while genes matter, environmental factors are also part of the puzzle in determining what causes scoliosis.
Will my child's heavy backpack cause scoliosis?
This is one of the most common concerns I hear from parents at our Brooklyn clinic, but I can reassure you: heavy backpacks do not cause scoliosis. While that overstuffed school bag might cause temporary posture changes, muscle fatigue, or even back pain, it simply doesn't create the structural spinal changes that define true scoliosis.
As Dr. Paul Sponseller puts it: "Parents tend to ask what they could have done to prevent scoliosis, but scoliosis is a very interesting disease because there is currently no known cause or prevention method."
That said, I still recommend smart backpack habits for your child's overall spine health:
Use both shoulder straps (no one-shoulder carrying)
Keep backpack weight under 10-15% of body weight
Position it properly—centered on the back, not hanging low
Consider a rolling backpack for especially heavy loads
These practices won't prevent scoliosis, but they will help avoid unnecessary muscle strain and discomfort.
What ages are most at risk for curve progression?
When it comes to scoliosis progression, timing is everything. Not all curves worsen, but certain developmental stages carry significantly higher risks.
The danger zones for curve progression are primarily during growth spurts. For girls, this typically means ages 10-14, while boys face highest risk between 12-16 years. Girls who haven't started menstruating yet are particularly vulnerable to rapid progression.
Doctors measure skeletal maturity using the Risser sign (which looks at hip bone development on X-rays). Lower Risser scores mean more growth potential—and unfortunately, more risk for curve worsening.
Children between 4-10 years (juvenile scoliosis) need careful monitoring since their curves often remain stable until adolescence, then suddenly progress during growth spurts. Interestingly, some infantile curves actually resolve on their own, while others worsen.
Once we reach skeletal maturity, most curves under 50 degrees tend to stabilize—until around age 50, when a new risk emerges. After menopause, women particularly may see degenerative changes and bone density loss that can reactivate progression.
"While it may be a hard decision to make on behalf of your child, having surgery sooner rather than later is better. When done early, the surgery tends to be simpler, as less of the spine needs to be fused," notes Dr. Sponseller. This highlights why we at Evolve Physical Therapy work closely with orthopedic specialists to carefully monitor our younger patients during critical growth windows.
Timing interventions just right—whether that's specialized physical therapy, bracing, or in some cases surgery—can make all the difference in long-term outcomes.
Conclusion & Next Steps
Understanding what causes scoliosis is like piecing together a complex puzzle. While medical science hasn't found all the answers yet, we've made significant progress in recognizing that scoliosis typically stems from a blend of genetic factors, hormonal influences, growth patterns, and sometimes specific medical conditions.
After exploring the many facets of scoliosis, here's what we've learned: Idiopathic scoliosis—the most common form accounting for 80% of cases—likely results from multiple genetic and environmental factors working together, not a single cause. This helps explain why the condition can appear differently even among family members with similar genetic makeup.
We've also seen how different types of scoliosis have distinctly different origins. From vertebral malformations present at birth to the gradual wear and tear that leads to degenerative curves in adults, the "why" behind the curve varies widely from person to person.
Perhaps most importantly, we've debunked those persistent myths that cause unnecessary worry. Poor posture, heavy backpacks, and sports activities don't cause structural scoliosis—information that brings relief to many parents and patients who feared they might have somehow contributed to the condition.
While we may not be able to prevent idiopathic scoliosis, early detection remains our most powerful tool. Finding curves early, especially before major growth spurts, opens the door to more effective management strategies that can prevent progression and minimize impact on quality of life.
Here at Evolve Physical Therapy + Sports Rehabilitation in Brooklyn, we believe in turning knowledge into action. Our specialized Schroth method practitioners work with scoliosis patients of all ages, developing individualized treatment plans that address both the structural curve and the functional aspects of living with scoliosis.
We've seen how specialized physical therapy approaches can make a meaningful difference. Many of our patients report improvements in posture, pain levels, breathing capacity, and overall confidence—even when the curve itself can't be reversed.
Whether you're newly diagnosed with scoliosis or looking for better ways to manage a long-standing curve, our team is here to support you with evidence-based, compassionate care that evolves with the latest research.
While we may not fully understand what causes scoliosis in every case, we absolutely know how to help you live well with it. With proper support and specialized care, scoliosis doesn't have to define your life or limit your potential.
For more information about our scoliosis therapy options or to schedule a consultation with our specialized team, visit: More info about scoliosis therapy options
