Do poor postures cause scoliosis?

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Parents often ask us: “My child often stands crooked or sits with a curved back – could this lead to scoliosis?”

According to the most recent scientific research, the answer is no: scoliosis does not develop as a result of poor posture. Several scientific studies have observed that some young people with scoliosis tend to adopt particular postures, such as standing with the pelvis slightly tilted or sitting asymmetrically (for example, with one leg tucked under the body).

However, it is important to clarify a key point: these postures are not the cause of scoliosis, but are very likely a consequence of a spinal curve that is already developing.

Recent studies, including those published in Scientific Reports (Yang et al., 2022) and BMC Musculoskeletal Disorders (Chen et al., 2024), confirm that certain postural habits or asymmetrical sitting positions are more common in adolescents with scoliosis, but they do not cause the condition. At most, they may represent the body’s adaptation to an existing spinal deformity or, in some cases, a factor that could slightly influence the progression of a curve that is already present.

Idiopathic scoliosis, which develops during growth without a clearly identifiable cause, is considered a multifactorial condition, involving several elements, including:

  • Genetic predisposition
  • Rapid growth
  • Hormonal and neuromuscular factors
  • Mechanisms related to postural control

Posture, therefore, is not the origin of scoliosis, but may play only a secondary role within an already established condition.

That said, posture still matters.

While poor postures do not cause scoliosis, they may contribute to worsening an existing imbalance or making an already present curve more noticeable. For this reason, it is important to help young people maintain healthy postural habits: encouraging regular movement, avoiding long periods in the same sitting position, and paying attention to ergonomic conditions at school and during study.

Backpack use also deserves attention. School bags should not be excessively heavy and should always be worn on both shoulders, in order to avoid uneven loading. However, just like posture, backpacks do not cause scoliosis.

In summary

  • Poor postures do not cause scoliosis
  • They may be a consequence of the spinal curve or make it more noticeable
  • Idiopathic scoliosis has complex and multifactorial causes
  • Promoting good postural habits is beneficial for overall spinal health, but it is neither a treatment nor a prevention for scoliosis

For this reason, whenever there is doubt, the most important step is an early specialist assessment, which can distinguish between simple poor posture and true scoliosis and, if necessary, guide the most appropriate management pathway.

References

  • Chen Y, et al. Association between incorrect postures and curve in adolescents with idiopathic scoliosis. BMC Musculoskeletal Disorders. 2024. PMID: 38744512

From measurement to meaning: ISICO’s Award-Nominated research at SOSORT 2026

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When the international scoliosis community gathers in Turin, Italy, from 29 April to 2 May 2026 for the SOSORT International Congress, ISICO will be present with a rich and multifaceted scientific contribution.

Alongside the abstracts previously announced, an additional study —“A 3D Surface Topography-Derived Method for the Aesthetic Evaluation of Trunk Asymmetry in AIS” — has also been accepted for poster presentation, further expanding ISICO’s contribution to the congress (a total of 23 abstracts: 19 oral presentations and 4 poster presentations).

Among this body of work, two studies have been selected to compete for the prestigious SOSORT Award. Both focus on a theme that lies at the heart of conservative treatment for adolescent idiopathic scoliosis (AIS): aesthetic outcome. Not only how we measure it. But how patients experience it.

TRACE2: bringing precision to clinical aesthetic evaluation

The SOSORT Award nominee “TRACE2 (Trunk Aesthetic Clinical Evaluation, Version 2). The New Rasch-Compatible Scale to Enhance Aesthetic Evaluation in Clinical Practice and Research” represents a significant methodological evolution, aligning clinical observation with psychometric robustness. Aesthetic improvement is formally recognized by SOSORT as a primary goal of rehabilitation in adolescent idiopathic scoliosis (AIS). Yet, measuring aesthetics in a reliable and reproducible way has always been challenging.

TRACE has long been part of everyday clinical practice. With TRACE2, ISICO takes a decisive step forward. Developed through an international Delphi process and validated using Rasch analysis — the gold standard in modern psychometrics — TRACE2 expands the original 4-item scale to 13 items while preserving clinical practicality.
The new version increases measurement sensitivity and reliability, allowing clinicians to discriminate trunk asymmetry more precisely and to compare outcomes across patients and populations with greater confidence.

TRACE2 does not complicate practice. It strengthens it. As Stefano Negrini, ISICO Scientific Director and first author of the study, explains: “We have always known that aesthetics matter deeply to our patients. TRACE2 allows us to measure trunk asymmetry with the rigor required by modern psychometrics, without losing the simplicity needed in daily clinical work”.
Watch the short video in which Stefano Negrini presents TRACE2. 

When improvement is visible — but not yet felt

The second SOSORT Award nominee, “Early Clinical Improvement, Delayed Patient Perception: Divergent Aesthetic Outcomes During Brace Treatment for Adolescent Idiopathic Scoliosis” explores a crucial and often overlooked dimension of conservative treatment: the relationship between measurable improvement and patient perception.

In a large cohort of 1,004 adolescents treated with rigid and very rigid “push-up” braces, clinician-assessed trunk aesthetics (TRACE) improved significantly within the first four months of treatment. Objective changes were clear, early, and statistically robust.

Patients, however, did not perceive a comparable improvement until the end of treatment, as reflected in the SRS-22 self-image domain.

This temporal divergence between objective aesthetic correction and subjective self-perception highlights an important clinical reality: physical changes and psychological adaptation do not necessarily evolve in parallel.
The findings suggest that clinicians should not assume that measurable improvement automatically translates into perceived benefit. Instead, actively sharing objective results during treatment may enhance patient awareness, motivation, and possibly adherence.

As Francesco Negrini, rehabilitation physician at ISICO reflects: “We often assume that when the body improves, the patient immediately feels better. Our data show that this is not necessarily the case. Recognizing and addressing this gap may help us improve communication and support patients more effectively throughout treatment”.

This study deepens our understanding of the patient experience during bracing and reinforces the importance of integrating objective assessment with patient-reported outcomes in everyday clinical care.

Brace adherence Influenced by geographic and personal factors: ISICO study published in children

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The ISICO study entitled “Geographic, Personal and Clinical Factors Influencing Brace Adherence in Adolescents with Idiopathic Scoliosis” has just been published in the journal Children (MDPI). The research also competed for the SOSORT Award 2025.
Brace therapy is an effective treatment for adolescents with idiopathic scoliosis (AIS), provided that adherence is high. While previous studies have objectively measured compliance using thermal sensors, the influence of geographic and socioeconomic variables—such as living in mountain versus seaside areas, in large cities versus small towns, or differences in income level—had not previously been investigated.

The study, led by Alessandra Negrini, physiotherapist at ISICO and author of the research, analyzed 1,904 adolescents(mean age 13 years; mean curve 35° Cobb). Adherence was measured using a thermal sensor (iButton) applied to the brace. The variables examined included age, prescribed brace-wearing hours, geographic area (Northern, Central, Southern Italy), gender, skeletal maturity (Risser), curve type, presence of back pain, income level, altitude above sea level, and distance from the sea.

Key Findings

  • 90% of patients demonstrated good adherence (wearing the brace for more than 75% of the prescribed hours).
  • Higher adherence was associated with:
    • Younger age
    • Female gender
    • A prescription of more than 20 hours per day
    • Residence in Northern Italy

The results suggest that climatic and social factors may influence treatment adherence.

As Alessandra Negrini comments:

“Through this study, we aimed to verify the influence of geographic, personal, and clinical variables — routinely recorded by doctors — on adherence to brace treatment. Understanding that certain factors can reduce adherence allows us to identify patients who may benefit from targeted strategies to improve compliance. Thanks to this type of research, we can enhance the personalization of therapeutic interventions, adapting them to patient characteristics to maximize treatment effectiveness.”

📖 The full article is available here

Returning to sport after scoliosis surgery: when and why physical activity is part of the treatment

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For an adolescent, the prospect of undergoing spinal surgery inevitably raises a fundamental question: “Will I be able to go back to the sport I love?”
In the past, an extremely cautious approach often prevailed. Today, however, scientific evidence clearly shows that returning to physical activity is not only possible but an integral part of the recovery process.

The importance of staying active
Remaining physically active during adolescence is one of the best investments in long-term health. Young patients who stop practicing sport after surgery have a higher risk of developing chronic pain and functional limitations in adulthood.
Unfortunately, studies show that around 30–40% of patients do not return to their previous level of sporting activity. In most cases, this is not due to real physical limitations, but rather to fear (on the part of the patient or parents) or overly strict restrictions imposed by healthcare professionals.
One of the main challenges today for specialists dealing with spinal disorders is to break this vicious circle: a surgically treated body is a body that can — and should — move again.

A few words on surgical techniques
Several surgical techniques are currently available. The most commonly used include:
• Spinal fusion (arthrodesis): This is the standard technique. Although it involves immobilising certain segments of the spine, in the vast majority of cases, it allows a full return to most sporting activities.
• Vertebral Body Tethering (VBT): a more recent technique that does not “fuse” the vertebrae but uses a flexible cord. Available data indicate that patients undergoing VBT tend to return to school and sport slightly earlier, although these are often adolescents who were already very physically active before surgery.

The “roadmap” back to sport
Every patient is unique and follows a therapeutic and personal pathway that cannot be identical to that of another patient, even with the same diagnosis. However, the Scoliosis Research Society (SRS) — the oldest scientific society dedicated to this condition — has defined time-based guidelines that reflect the period needed for tissues and instrumentation to stabilise.

In general:

  • first 3 months: in most cases, it is possible to resume light sporting activities such as swimming, stationary cycling or gentle jogging, with the aim of rebuilding strength, coordination and confidence in movement.
  • around 6 months: many adolescents can return to more demanding dynamic sports such as football and basketball, provided there is no direct contact, gradually increasing intensity and duration.
  • 9–12 months: if recovery is smooth and clinical follow-ups confirm good progress, a return to high-impact sports such as rugby, judo and karate is generally allowed.

These indications are not rigid rules, but a reference framework designed to support a safe and gradual return to sport.
Many parents fear that an impact could damage the rods or compromise the nerves. The reality is reassuring: serious complications related to sporting activity are extremely rare.
The most common — though still infrequent — issues involve loosening of a screw or minor damage to the rods, and they tend to occur when recovery stages are rushed (for example, returning to snowboarding after only two weeks).
By respecting healing times and following a gradual progression, the risk remains very low. Surgeons and physiotherapists work together to build a genuine bridge back to normal life, based on trust and collaboration.

The real question is not whether to return to sport, but how and when to do so. Because movement is the medicine that protects the spine over time: returning to sport is not a risk to avoid, but the ultimate goal of every surgical intervention.

SEAS in France: Training Where We Once Went to Learn

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For the first time, at the end of January, SEAS — our exercise-based approach for the treatment of scoliosis — arrived in Marseille, involving 20 physiotherapists and one rheumatologist in an intense and highly engaging educational experience.

Hosted at the University School of Physiotherapy, the course represented a particularly significant moment for several reasons: it was the first SEAS edition in the region; it brought together a substantial number of professionals from an area historically distant from the most recent developments in conservative scoliosis treatment; and it combined theoretical lectures with practical applications.

Our Director of Physiotherapy, Michele Romano, who led the course, wished to share a brief personal reflection on this experience, describing its meaning and value also in light of the historical role France has played in scoliosis treatment.

“The treatment of scoliosis through exercises has undergone a fairly steady process of evolution in most parts of the world over the past twenty years.

During the same period, in France, there has been an unexpected and progressive decline — difficult to understand unless one considers political decisions related to public healthcare management.

France has long been considered a kind of international beacon in the treatment of this condition, thanks to the continuous development of casts, braces, and exercise methods that were, at the time, regarded as current and innovative.

Anyone who wanted to learn how to treat scoliosis or stay updated on new trends would go to France, making a kind of pilgrimage to the “Massues” Hospital in Lyon, and between a Camembert and a baguette, would return to their home countries with the latest developments.

Then, evolution slowly but inexorably came to a halt, and the trend moved in the opposite direction.
Thus, in recent years, with considerable ISICO pride, we have received requests to organize training courses in the very country where, in the past, we had all gone to learn.
Previous courses were delivered in Lyon and Paris. This latest training, however, took place in Marseille, responding to requests from professionals working in this region and in Corsica.

The course was held at the University School of Physiotherapy and generated great enthusiasm among the 20 participating physiotherapists and the rheumatologist, who attended the theoretical lectures and directly experienced the practical application of what they had learned on a group of real patients — adolescents and adults — who had been invited for the occasion.
While waiting to confirm the dates for the next course, already scheduled in Bordeaux, we left the transalpine country after visiting the wonderful MUCEM museum and filling a colorful bag with jars of Moutarde de Dijon.

Au revoir”.

From Patient to Physiotherapist: Simone’s Story

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Turning a difficulty into a resource, and a vulnerability into a life choice.
This is the story of Simone Priano, a former ISICO patient, who has recently graduated in Physiotherapy from the University of Novara, in north-western Italy, with a final mark of 108/110, defending a thesis focused on scoliosis and scoliosis-specific exercises for its treatment.

A topic that was anything but coincidental.

“It is often said that one should turn weaknesses into strengths. Fortunately, I have turned mine into my profession,” Simone explains. “Today I celebrate my graduation in Physiotherapy with a thesis on scoliosis. This subject is deeply personal to me because it is thanks to my experience as a former patient that I am here today. Bringing it to my final thesis was my way of honouring that journey and closing the circle.”

Simone began his therapeutic journey as an adolescent, while attending the ISICO centre in Turin and playing volleyball. He was diagnosed with scoliosis with a significant curve, requiring a demanding course of conservative treatment: 23 hours a day wearing a brace, combined with specific exercises. His treatment lasted five years, from September 2016 to June 2021.

Initially, however, his experience was not positive. Treated elsewhere, he had been told that conservative therapy would be ineffective and that surgery was the only possible option — a prospect that could have discouraged anyone. Instead, Simone encountered a different approach, based on consistent, structured work and a strong therapeutic relationship.

“He was already a serious and determined young man during his treatment,” recalls his ISICO physiotherapist, Martina Poggio. “Being able to support him later during his thesis work was an immense pleasure for me. Through therapy, we accompany young patients throughout their growth, often for many years, and inevitably form a bond with them. Seeing them again as adults — confident, aware and fulfilled — is truly special.”

The relationship did not end with the conclusion of treatment. On the contrary, it evolved into professional dialogue and scientific collaboration.

“The fact that he chose the same professional path and career means that, despite the evident challenges of therapy, he was able to go beyond them, finding motivation and support to overcome the condition. He is the second former patient whom I have met again, years later, as a colleague.”

Today, Simone is a young physiotherapist whose training combines academic study with direct personal experience — a valuable perspective that enriches both his clinical practice and his human approach to patients.

“I wish Simone a brilliant future,” his former physiotherapist concludes, “with the certainty that he will be able to pass on to other young people what he himself has experienced: that even a difficult journey can become a source of strength.”

Scoliosis and height: how much does spinal curvature affect stature?

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One of the most frequently asked questions regarding scoliosis concerns loss of height:
“My daughter has a 40° scoliosis… does that mean she is shorter than she would otherwise be?”

The answer is not straightforward. Reduction in stature associated with scoliosis does not depend solely on the angle of the curve; it is influenced by a range of structural and morphological characteristics of the spine.

The Cobb angle—commonly referred to as the curve angle—is the standard measure used to quantify the degree of lateral deviation in scoliosis. Over the years, several computational models have been proposed to estimate height loss attributable to scoliosis. However, formulae relying exclusively on the Cobb angle—such as the historical Stokes equation—have proved to be imprecise.

A study by Gardner et al. (2016) demonstrated that the original formula contained an error and emphasised that scoliosis is a three-dimensional deformity that cannot be summarised by a single parameter to estimate height loss. Similarly, Lonner et al. (2016) reported that the Cobb angle alone is insufficient to predict accurately the loss of stature: the true length of the deformed vertebral arc, the number of vertebrae involved and the degree of vertebral rotation all contribute. In other words, two patients with identical Cobb angles may nonetheless exhibit markedly different statures.

Stature is also relevant from a functional and respiratory perspective. Two recent studies from K Politarczyk et al. (2021) have shown that, in individuals with severe scoliosis, measured height may not reflect true body length, thereby affecting the interpretation of pulmonary function tests. In particular, height influences assessment of parameters such as forced vital capacity (FVC)—the total volume of air forcefully and completely exhaled after a full inspiration—and forced expiratory volume in one second (FEV₁). Consequently, in patients with severe scoliosis, it is necessary to correct the recorded height to avoid underestimating actual respiratory capacity.

In summary:

  • height loss in scoliosis is non-linear and cannot be estimated solely from the Cobb angle;
  • simple formulae, such as the Stokes equation, are now regarded as approximate;
  • a more accurate appraisal should incorporate morphological parameters of the curve and trunk, in addition to the Cobb angle;
  • for respiratory function testing, consideration of a corrected stature is particularly important in severe cases.

These studies underline that scoliosis is a complex three-dimensional deformity that affects not only appearance and stature but also clinical and functional outcomes. For this reason, assessment and treatment must be individualised and based on a thorough analysis of the curve and the patient’s growth.

Bibliographic references:

Medications and Low Back Pain: an ISICO commentary of a Cochrane review

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The Cochrane review “Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews” has recently been published. This extensive and methodologically robust work significantly updates our understanding of the effectiveness—and the limitations—of the medications most commonly used for low back pain: from paracetamol to NSAIDs, as well as muscle relaxants, opioids, antidepressants, and antiepileptics.

Alongside the review, an editorial commentary by Prof. Stefano Negrini, ISICO Scientific Director, and Dr. Carlotte Kiekens, physiatrist, has also been published.
Their contribution offers a valuable interpretative perspective, helping to clarify what these findings really mean for clinicians working daily with spinal disorders and rehabilitation.

What the review shows

The central message is clear: medications alone play a very limited role in the management of low back pain.

Paracetamol is no more effective than placebo; NSAIDs provide only mild and short-term relief; muscle relaxants may help in the immediate phase but come with relevant adverse effects; and opioids show an unfavorable risk–benefit profile. For many other drug classes, the evidence remains insufficient.

The review does not deny the usefulness of medications in acute phases, but it highlights how they do not represent a long-term solution nor a first-line treatment.

“Low back pain is not a condition that can be treated with a pill. Medications may have a role, but they do not address what truly generates pain,” explains Negrini. “They do not improve function, they do not modify motor behavior, they do not change movement quality.
The real risk is prolonging the search for quick relief while postponing the interventions that actually work: exercise, rehabilitation, and education”.

Kiekens emphasizes the complexity of low back pain, particularly when it overlaps with structural conditions such as adult scoliosis: “Low back pain is generally multifactorial. It is the result of an interaction between muscles, joints, posture, degeneration, and lifestyle. This is why it is unrealistic to expect medication to resolve it. In clinical practice, what truly works is a multimodal approach: movement, awareness, load-management strategies, and active rehabilitation pathways.”

Medications may therefore have a role as a support, but they cannot guide the treatment: rehabilitation is what truly enables patients to get better. An active, multidisciplinary approach—combining medical care, rehabilitation, and lifestyle strategies—is essential for restoring function and achieving long-term improvement. This is exactly what patients can expect at ISICO.

Chronic Pain: diet also may play a significant role

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What we eat can influence not only our overall health, but also the way we perceive pain. A recent Australian study has revealed a surprising connection between a balanced diet and the reduction of chronic pain, extending beyond the simple association with obesity.

Chronic Pain: A Multidimensional Challenge

Chronic pain is a complex condition affecting millions of people worldwide. Although it is often associated with specific injuries or diseases, scientific evidence shows that less obvious factors — such as lifestyle and diet — can modulate the perception of pain.

Recent studies, Pain trends among American Adults e Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016 conducted in the United States have demonstrated that an increase in body mass index (BMI) is associated with chronic pain, with prevalence rates ranging from 10% to 32%.
However, the relationship between adiposity and pain is not unidirectional:
“Pain itself can contribute to weight gain,” explains Dr Irene Ferrario, clinical psychologist at ISICO, “as many individuals tend to reduce physical activity or develop an increasing fear of movement.”

Within this context, another study conducted at the University of South Australia examined how diet influences bodily pain levels. The most noteworthy finding? The benefits of a healthy diet are not limited to individuals who are overweight but also extend to those with a normal BMI.

“It is important to understand that there is no single cause of chronic pain. Factors such as diet, physical activity and stress management should be viewed as components of an integrated care approach,” says Francesco Saveri, physiotherapist at ISICO.

Diet and Pain: More Than a Matter of Weight

Traditionally, body weight has been considered the main link between diet and chronic pain. Excessive weight can overload joints and promote inflammation, thereby worsening pain.
However, the Australian study showed that diet may play an independent role. Participants who followed a diet rich in fruit, vegetables, whole grains, lean meats and dairy products reported significantly lower pain levels, regardless of their BMI. This suggests that a balanced diet may positively influence inflammatory and oxidative processes that heighten pain perception.

“Educating patients to improve their diet is essential — not only to reduce pain, but also to promote a healthier long-term lifestyle. It is an investment in their quality of life,” adds Saveri.

Key Components of a “Pain-Reducing” Diet

Which foods should be included in a diet aimed at alleviating pain? According to experts, it is essential to prioritise:

  • Fruit and vegetables: rich in antioxidants and anti-inflammatory compounds.
  • Whole grains: due to their lower glycaemic impact, they help regulate blood sugar levels and reduce inflammation.
  • Lean proteins: fish and poultry provide essential amino acids for tissue repair.
  • Healthy fats: such as olive oil and nuts, which support the nervous system and reduce oxidative stress.

Why Diet Matters

The key lies in inflammatory processes. A diet high in simple sugars, saturated fats and ultra-processed foods increases oxidative stress and pro-inflammatory cytokines, thereby it may exacerbate pain.
Conversely, a balanced diet helps maintain an appropriate inflammatory equilibrium, improving not only general health but also overall quality of life.

“Further high-quality research is needed. Although the findings of the Australian study are of significant interest, the lack of temporal precedence due to the cross-sectional nature of the research prevents the exclusion of reverse causality or the influence of unmeasured confounding factors,” concludes Saveri.

Long-term stability in PWS scoliosis without surgery

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It is rare for a single case to so clearly demonstrate the power of a conservative approach. This is what emerges from the article published in the Journal of Clinical Medicine (Effective Conservative Management of Severe Scoliosis in a Girl with Prader–Willi Syndrome: A 20-Year Case Study Follow-Up, MDPI, 2024).

Prader–Willi syndrome (PWS) is a rare genetic disorder characterized by muscle hypotonia, obesity, and cognitive difficulties, often associated with severe scoliosis.
“In many of these cases, surgery is considered the only possible solution,” explains Dr. Francesco Negrini, author of the study. “In contrast, we present the clinical case of a young patient followed for twenty years with a conservative approach, based on scoliosis-specific exercises and customized braces, from Milwaukee to Sforzesco.”

Despite an initial curve exceeding 50° Cobb, the patient avoided surgery, maintaining long-term stability of the deformity and a good quality of life.

“This case highlights the potential of a well-organized, long-term conservative approach to managing scoliosis in PWS,” adds Negrini. “It suggests that, under specific conditions, surgery may be avoided or postponed. Most importantly, it underscores the need for further research to establish standardized protocols and to support clinical decision-making in the conservative treatment of scoliosis in PWS patients. We are already working on specific protocols for ambulatory patients with scoliosis secondary to neurological diseases,” concludes Negrini. “These protocols are urgently needed, as at present they do not yet exist.”