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From Natural History to IS-GROWTH: ISICO’s New Tool to Predict and Communicate the Evolution of Idiopathic Scoliosis

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Understanding the natural history of idiopathic scoliosis—how the condition evolves in the absence of treatment— is the starting point for any effective care pathway. But to truly guide clinical practice, this knowledge must be translated into reliable predictions and into tools that facilitate communication with patients and their families. 

This is precisely the aim behind IS-GROWTH, the focus of our study entitled “The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool provides a reliable prediction useful to manage long-term treatment during growth”, which was awarded the 2025 SOSORT Award just a few weeks ago during the international conference held in Dubrovnik.

Today, IS-GROWTH is freely available to everyone through its dedicated website.  

Step One: Mapping Natural History through a Meta-Analysis

Until just a few years ago, the natural history of idiopathic scoliosis was described in a fragmented and inconsistent way. To address this, ISICO conducted a meta-analysis, published in 2018 (Di Felice et al., Am J Phys Med Rehabil), that reviewed 13 studies. This work clearly showed the lack of solid and coherent data, making it difficult to guide long-term treatment decisions.

To bridge this gap, ISICO launched a large-scale research project involving thousands of untreated patients. The goal was to build reliable prediction models based on real-world, untreated progression data.

Step Two: From International Collaboration to a Clinical Model

The next milestone was a study we published in 2023 in collaboration with Dr. Eric Parent from the University of Alberta (Canada).
Titled “Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth”, this research aimed to predict curve progression based solely on X-rays taken before the start of any treatment.

The study won the 2022 SOSORT Award, confirming the feasibility of predictive modelling. However, while statistically robust, the model’s limitation was that it only allowed for short-term projections.

The recently awarded study builds directly on that work, transforming a retrospective analysis into a dynamic, visual, customizable tool for use in everyday clinical practice.

Step Three: IS-GROWTH

IS-GROWTH (Idiopathic Scoliosis Graphical Representation Of Worsening Trend of natural History) is a visual model that illustrates the expected progression of a scoliosis curve in each patient, segmented across the different growth phases (pre-pubertal, pubertal, post-pubertal).

Developed using 3,184 radiographs from 1,818 untreated patients, it was later validated on another 552 cases, achieving 95% accuracy after adjusting for radiographic measurement error. The resulting graph displays a range of expected progression (between minimum and maximum scenarios), into which the patient’s real-time clinical data is gradually added.

A Tool to Understand, Decide, and Communicate

“We initially focused on building a scientifically solid foundation, based on rigorous data,” explains Professor Stefano Negrini, first author of the study and Scientific Director of ISICO.
“But we soon realized that wasn’t enough. We needed a tool that could support everyday clinical communication. In idiopathic scoliosis, the best outcome is often not improvement, but simply avoiding progression.
This is a hard concept to convey without something that clearly shows the natural course of the curve in the absence of treatment.
That’s why we developed IS-GROWTH—a model built using alternative methods, specifically designed to be shared with patients. From the beginning, we’ve clarified that it offers a plausible projection, not an absolute prediction.”

IS-GROWTH was designed to:

  • help clinicians understand the expected evolution of the curve;
  • motivate patients—especially adolescents—by showing how even stabilization can be considered a success;
  • visually demonstrate the impact of treatment over time, incorporating new data at every follow-up.

The model has proven especially useful in clinical follow-up: 79% of doctors in ISICO use it to motivate patients, and 84% consider it valuable for monitoring progression and interpreting outcomes

ISICO sets a record at the SOSORT Congress: here are the final two studies nominated for the AWARD

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Once again this year, ISICO stands out at the international SOSORT Congress, scheduled to take place in Dubrovnik from 23 to 26 April. Among the 12 studies accepted for the congress as oral or poster presentations, no fewer than four were selected among the 10 contenders for the SOSORT AWARD, the most prestigious recognition for research in the field of rehabilitative treatment of spinal disorders.

After presenting two of the finalist studies in the March newsletter, in this issue we introduce the other two studies in the running for the prize: 

“The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool provides a reliable prediction useful to manage long-term treatment during growth” and “Wearing a brace for idiopathic scoliosis above 18 hours/day shows a dose-response effect on the outcomes improvement and end-of-treatment Cobb angle below 30 degrees”.

Two studies which, although very different from each other, focus on key themes for our daily practice: the effectiveness of bracing and communication with patients.

Over 18 hours a day: the “brace-effect” gets confirmed.

Our study “Wearing a brace for idiopathic scoliosis above 18 hours/day shows a dose-response effect on the outcomes improvement and end-of-treatment Cobb angle below 30 degrees” shows that wearing a brace for more than 18 hours a day leads to significantly better outcomes in the treatment of adolescent idiopathic scoliosis.
The findings of this research, conducted on 884 adolescent patients, reinforce what was already highlighted by the BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) study, but also show that the benefit does not stop at 18 hours: the more the brace is worn, the greater the chance of ending treatment with a curve below 30°, thus reducing the risk of problems in adulthood.
Key findings include:

  • Wearing the brace for over 18 hours a day avoids surgery in 97-98% of cases.
  • With strong compliance, exceeding the 50° Cobb threshold is highly unlikely 
  • The more time the brace is worn, the higher the likelihood of ending with a curve below 30° Cobb.
  • In the most compliant patients, curve improvement exceeds 60%.

    “This study settles a debate that has gone on for years: wearing the brace for longer, if well tolerated, produces better results. The progression of scoliosis is avoided and the curve is improved, in a therapeutic path based on decisions shared with patients and families,” highlights Professor Stefano Negrini, one of the study’s authors. “Working with a personalised and collaborative approach with patients has enabled us to achieve very high compliance, even exceeding what is commonly reported in the literature. It demonstrates that it is possible to be effective even in everyday clinical practice,” concludes Negrini.

IS-GROWTH: a new ally to predict and communicate scoliosis progression 

How can we explain to an adolescent and their family that even a worsening outcome in the rehabilitative treatment of scoliosis can be a good result? 

The new IS-GROWTH model (analysed in the study “The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of natural History”) was born to answer this challenge, improving communication and long-term treatment management.

When it comes to idiopathic scoliosis, communication is an integral part of treatment. For a rehabilitative pathway to succeed, it requires sharing, motivation, and awareness. 

It is precisely to support all this that ISICO has developed IS-GROWTH: a visual and predictive tool that graphically represents the natural progression of scoliosis during growth.

“In idiopathic scoliosis, often the best result is not improvement but simply not worsening. This concept is difficult to convey without a tool that clearly shows what the natural curve evolution would be without treatment,” explains Professor Stefano Negrini, author of the study.

The model was built using over 3,000 X-rays from more than 1,800 participants, from infancy through adolescence, and validated on 552 patients, with 95% accuracy after adjustment for radiographic measurement error.

Its objective? To provide a personalised graphical representation of the expected curve progression, divided by growth phases and updated over time. This allows clinicians to:

  • better understand the individual case trend;
  • strengthen dialogue with patients;
  • motivate them throughout the treatment pathway.

The model has proven particularly useful during follow-ups: 79% of doctors use it to motivate patients, and 84% consider it valuable for monitoring progression and interpreting results achieved.

“IS-GROWTH is not just a predictive model; it is above all, an ally for everyday communication. It helps us make patients participate and to build a more conscious therapeutic path,” – concludes Negrini.

Adult scoliosis and fracture risk: a frequently overlooked connection

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In elderly patients, the fracture risk is often attributed solely to bone fragility. However, one frequently overlooked factor is the presence of adult scoliosis, which can significantly increase the risk of falls and, therefore, fractures.

This condition, which may stem from progressive juvenile scoliosis, arises as “de novo” scoliosis in adulthood or is degenerative — that is, related to arthritic, degenerative phenomena and metabolic alterations — often leads to changes in postural alignment, particularly in the sagittal plane. The trunk leans forward, lumbar lordosis is lost, and the pelvis rotates backwards; thus, it develops what is known as a flexed posture, a typical condition of pathological ageing, which heavily impacts balance and mobility.

These biomechanical changes are not only aesthetic or functional issues; they are determining factors for static and dynamic balance and, therefore, significantly increase the risk of falls. Scientific studies confirm this: hyperkyphotic posture, for example, has been associated with a higher incidence of falls and, in a 2004 study involving over 1,300 adults, was found to be an independent predictor of mortality.

For an older adult with bone fragility, falling may result in a fractured femur, vertebra, or wrist — events that often lead to hospitalisation, loss of independence, and, in many cases, irreversible functional decline.

Worsening the clinical picture is often the presence of sarcopenia, the progressive loss of muscle mass and strength, common among older adults with scoliosis, as documented in the 2017 study “Sarcopenia and falls in patients with adult scoliosis”. This condition further reduces stability and reaction capacity, creating a vicious circle: less balance → more fear of falling → less activity → more weakness → even greater risk.

Even surgery does not represent a definitive solution: as reported by Glassman et al. (2016), even after the operation, sagittal alignment alterations may persist, maintaining a high risk of falls.

In light of this evidence, the message is clear: adult scoliosis cannot be considered a “benign” condition simply because it has stabilised. On the contrary, it requires clinical attention, monitoring, and personalised interventions. During adulthood, particularly between the ages of 40 and 60,the overall trunk alignment must be carefully monitored to detect the first signs of postural changes and take action to correct them. At the same time, the spine is still sufficiently mobile. When ageing progresses further and the older adult begins to bend forward, full recovery becomes difficult, and treatment aims to prevent further deterioration.

Fortunately, physiotherapy can offer effective responses: specific programmes to restore sagittal alignment, exercises for stability and postural control, pain management and functional improvement. Muscle strengthening and balance training have proven useful in reducing fall risk and, therefore, in preventing fractures and hospitalisation.

In conclusion, considering adult scoliosis as an independent risk factor for fractures — on par with osteoporosis — means acknowledging the importance of a multidimensional approach.

Early and targeted treatment of scoliosis can serve as a key lever in reducing fracture events, hospitalisations, and loss of independence in older adults. Fall prevention also starts with the spine.

SOSORT AWARD 2025: two of the four competing ISICO studies

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Among the 12 studies submitted and accepted as oral presentations or posters for the upcoming SOSORT conference, scheduled to take place in Dubrovnik, Croatia, from April 23 to 26, four are competing for the AWARD, the most prestigious recognition in the field of rehabilitative treatment for spinal disorders. This marks a record for ISICO, which has already won 11 AWARDs over the years thanks to its research.
Below, we present two of these studies; the remaining two will be featured in the April newsletter.

1. The Psychological Impact of Children’s Spinal Deformities on their Parents: How to Measure with a Rasch-validated Questionnaire

ISICO has developed a new questionnaire to assess the quality of life of parents of children with scoliosis undergoing conservative treatment. 

By analysing the content of the scoliosi.org blog, which has collected contributions and responses from 24 scoliosis experts over the years, an initial version of the questionnaire with 48 questions was created. 

This version was subsequently refined through repeated administrations to four different samples of parents and statistical analyses to improve its validity and reliability. After three revisions, the questionnaire was reduced to 18 questions, demonstrating good reliability and validity, with no significant differences based on the parent or child’s age or gender.

“Dealing with scoliosis is not just about the patient; it deeply involves the family as well,” explains Dr. Irene Ferrario, ISICO psychologist and one of the study’s authors. “Parents of children undergoing conservative scoliosis treatment can experience anxiety and stress, but until now, there were no specific tools to assess the impact of therapy on families. This new questionnaire represents an important step forward, offering a reliable means to better understand the difficulties faced by parents.”

The questionnaire will facilitate the identification of families’ emotional and practical needs, providing targeted support.
“At ISICO, we recognize how crucial family well-being is in the therapeutic journey of young patients. For this reason,” concludes Dr. Ferrario, “we continue to promote a comprehensive approach to scoliosis, considering not only the patient’s physical health but also their emotional balance and that of their loved ones.”

2. Geographic, Personal, and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis

Brace therapy is an effective treatment for adolescents with idiopathic scoliosis (AIS), and several studies have already investigated factors influencing treatment adherence using sensors. However, the role of variables such as geographic location (mountain vs. seaside, large city vs. small town, mountain vs. plain) or family income had not yet been explored.

“Through this study, we aimed to verify the influence of geographic, personal, and clinical variables—routinely recorded by doctors— on adherence to brace treatment,” explains Alessandra Negrini, ISICO physiotherapist and author of the research.

Researchers examined 1,904 adolescents with an average age of 13 years and an average scoliotic curve of 35° Cobb. Adherence was measured using a thermal sensor (iButton) applied to the brace, while the analysed factors included age, prescribed brace-wearing hours, geographic area (North, Central, Southern Italy), gender, skeletal maturity (Risser), curve type, presence of back pain, income level, altitude above sea level, and the distance of the residence from the sea.

The collected data showed that 90% of patients demonstrated good adherence to treatment (wearing the brace for more than 75% of the prescribed hours). Factors that positively influenced adherence included younger age, female gender, a prescription of more than 20 hours per day, and living in Northern Italy. The results suggest that climatic and social factors can influence treatment adherence.

“Understanding that certain factors can reduce adherence to treatment allows us to identify patients who may benefit from targeted strategies to improve compliance,” concludes Alessandra Negrini. “Thanks to this type of research, we can enhance the personalization of therapeutic interventions, adapting them to patient characteristics to maximize treatment effectiveness.”

Is scoliosis harmed by high-impact sports?

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Periodically, ISICO launches the “Concorsetto,” an initiative in the form of a competition in which patients share their experience with wearing a brace, demonstrating that they can do almost anything: horse riding, dancing, rhythmic gymnastics, skating, and much more. This proves that sports and scoliosis are not incompatible.

But what about high-impact sports? Can they make scoliosis worse?

When it comes to scoliosis, one of the most common questions we receive from parents and coaches concerns sports that involve impacts on the spine (shocks, falls, landings from jumps…). Activities such as horse riding, long jump, high jump, and running often raise concerns.

In the common imagination, it is believed that repeated shocks may generate compressive and torsional forces on the spine, worsening the scoliotic curve. In reality, the spine, thanks to its sagittal plane curves, joints, and tendon structures, has a highly efficient system for “absorbing” impacts and withstanding intense forces without negative effects on its three-dimensional structure.

A recent study of ours has shown that the more sports young people engage in, the lower the likelihood of scoliosis worsening and the greater the chances of improvement with physiotherapy treatment [source 1]. It is no coincidence that mild scoliosis is successfully treated with specific exercises aimed at improving posture and triggering corrective reactions in the curves—an effect similar to that of sports, albeit in a less specific and more global manner.

So, is there anything that can actually worsen scoliosis?

According to the available data, an asymmetrical load on the vertebrae promotes uneven spinal growth in individuals already predisposed to developing scoliosis, contributing to its progression in children and adolescents. This is known as Stokes’ vicious cycle.

What should be done, then?

It is essential to counteract these factors using the tools available. Combined with specific treatments such as physiotherapy exercises and/or a brace, sporthelps develop reflexive corrective automatisms, integrating them into daily life. All sports are suitable in these cases, but every case of scoliosis is unique. Since sport reduces the risk of curve progression, it is advisable to encourage young people to choose an activity they enjoy and are motivated to practise consistently.

Even asymmetrical activities, such as tennis, should not be demonised; in fact, they can be a valuable ally in preventing and managing scoliosis. Often, it is enough to combine them with targeted exercises that strengthen the spinal muscle groups under strain.

Sport and the brace: Can physical activity be practised while wearing a brace?

A recent study confirms that those who wear a brace and engage in sport more frequently achieve better results. Moreover, an ISICO study has shown that wearing a brace does not hinder physical activity.

We just remind you that, in case of doubt, it is important to consult your specialist doctor.

In conclusion

Sport should be experienced as a moment of relaxation and recharge. The impacts on the spine that are inevitable when practising sports should not be a cause for concern, as they do not worsen scoliosis. The brace should not excessively restrict the patient’s movement and freedom but should support them in counteracting spinal deformity.

With the guidance of a scoliosis specialist, each patient can find the best way to manage physical activity—whether with or without a brace—because the confidence and psychological well-being derived from engaging in sport are fundamental to the success of the therapy.

SEAS: A New Study Demonstrates Its Greater Effectiveness Compared to Other Methods

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The SEAS approach, developed over 20 years ago by ISICO in Italy, has emerged as the most effective in reducing the Cobb angle, according to a significant meta-analysis recently published by Wang et al., “Comparative efficacy of six types of scoliosis-specific exercises on adolescent idiopathic scoliosis: a systematic review and network meta-analysis” (2024).

This study compared six of the most widely used scoliosis-specific exercise methods worldwide for adolescent idiopathic scoliosis: SEAS (Italy), Schroth (Germany), DoboMed (Poland), Side-shift (United Kingdom), Active Self-Correction (Italy), and FITS (Poland).

It is important to note that various exercise-based scoliosis treatment methods and approaches originated in Europe in the last century and have since spread globally. While the effectiveness of bracing in preventing scoliosis progression and the need for surgery is well-documented, the definitive effectiveness of specific exercises has yet to be fully proven.

Out of 465 studies initially identified in the meta-analysis, only 24 met the rigorous inclusion criteria, analysing a total of 1,069 subjects. The meta-analysis highlights that SEAS achieves the best results in reducing the Cobb angle, while Active Self-Correction and the Schroth method are more effective in reducing the Angle of Trunk Rotation (ATR) and improving quality of life.

SEAS exercises themselves are based on an active form of self-correction, enabling SEAS to deliver positive results on multiple fronts: reducing both the Cobb angle and ATR, while also ensuring a good quality of life for the patient. This was confirmed by a study published a few years ago, “Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: a practical clinical trial”, which also contributed to lowering the risk of requiring a brace and/or experiencing scoliosis progression.

“These results confirm the importance of the SEAS approach in the conservative management of adolescent idiopathic scoliosis,” says Alessandra Negrini, physiotherapist at ISICO. “However, for SEAS to be definitively recognised as a treatment capable of altering the natural progression of scoliosis, further high-quality studies with long-term follow-ups are needed.”

This study marks a significant step forward in research on the effectiveness of scoliosis-specific exercises. The findings are encouraging and reinforce the importance of an evidence-based approach in the conservative treatment of adolescent idiopathic scoliosis.

Degrees of curvature and height: is there a relationship?

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Our patients’ questions are often opportunities to provide useful information to them and others.

Francesco’s questions prompted us to examine the possible correlation between scoliosis, degrees of curvature, and height growth. 

“Let me start by describing my particular experience: at the age of 17 and a half, in a skiing accident, I injured my patellar tendon, which was operated on and then put in a brace for 30 days. Once I had recovered and regained full mobility, I had a physiatrist colleague of my father who examined me. During the examination, he measured my height (178 cm) and checked my back, remarking that I perhaps had very mild scoliosis (there was no talk of X-rays, much less of degrees of curvature and so on). Let’s just say that I took the information on board and left it at that.

This year, I had a checkup with the same physiatrist, who, upon seeing me, was immediately struck by how much taller I had grown: he measured me, and I was 184 cm.

I’m sure I’m not unique, but I would guess it’s rare for a boy of 17 and a half to gain another 6 cm.

He looked at my back and told me it was “a bit worse”. I was quite upset about that because, being completely ignorant on the subject (like anyone who has no direct experience of this deformity), I had imagined it was something that could be remedied by improving my posture or through physical activity. He reassured me that by now it should have stabilised (“stable until proven otherwise” as you say) and not to worry about it too much. This time, though, he recommended an X-ray. 

From the X-ray, I learned that my latest growth had done me more harm than good and had seemingly affected my scoliosis more than anything. Also, at the initial examination, I’d had a much chubbier, more child-like physique, which at the time might have helped to mask the scoliosis somewhat. Functionally, though, I have no pain (since, as you have told me, my curve is moderate), and fortunately, aesthetically, it is not too noticeable.

So, here are my two questions:

  • Given that the human body generally declines with age, does that mean I am at risk of becoming, in the future, one of those old men you see with a walking stick, bent over and crooked? In other words, even though my scoliosis shouldn’t get worse in adulthood, am I more likely than someone without scoliosis to end up like the kind of elderly person I just described?  
  • Is there a relationship, however approximate, between the number of Cobb degrees and the number of cm lost in height? I have read that you lose 1 cm in height for every 10° of Cobb angle, and therefore that you can divide your degrees of curvature by 10 to work out how much height you’ve lost”.

Here is our response.

First of all, it’s not unusual for males to gain a few more centimetres after reaching the age of 17. In fact, height growth is linked to skeletal maturation, a process that in boys begins and therefore also ends a few years later than in girls. Scoliosis is a pathology that, to worsen, exploits bone growth, accentuating the vertebral deformity; this could explain the clinical findings from your latest examination.

As regards height “lost” due to scoliosis, I would say that having reached around 1.85 m, you can’t really complain …! That said, to answer your question, with a 30° curve you lose 1–1.5 cm at most.

Some international scientific journals have published mathematical formulas for calculating centimetres lost due to scoliotic curvature(s) of the spine.-

These calculations also take into account the ratio between height when seated (trunk and head) and height when standing.

The studies published on this topic evaluated scoliosis cohorts (between 140 and 1500 subjects enrolled) and reported an average height loss of 3.38 cm for females and 2.86 cm for males.

The formulas providing the most valid estimates of height loss are those of Kono and Stokes, according to which a scoliotic curve of 80° seems to lead to a loss of between 3.5 and 5.5 cm, while one of 100° appears to correspond to between 4.5 and 8.5 cm in lost height. The greater the curve, the more the estimates produced by the two formulas differ; instead, they give comparable results for smaller curves.

Patients with severe curves also tend to ask surgeons about height, but in terms of gain, asking: “How many extra cm of height will this operation give me?” The answer to this question is less certain, because there are too many factors at play, so many in fact that no pre-surgical prediction can be considered reliable.

As for your concerns about adulthood and old age, you will understand that I can only reply in very general terms. With curves of around 30° at the end of growth, the risk of the condition worsening over future decades is very low.

It’s like someone with slightly raised cholesterol or high blood pressure asking me: am I going to have a heart attack in a few decades’ time? Although high cholesterol levels, systemic arterial hypertension, a sedentary lifestyle and other factors are associated with increased cardiovascular risk, it isn’t possible to translate estimates of the risks associated with a specific disease into a clear prediction for an individual case.  

In terms of prevention, in adults with scoliotic curves similar to yours, regular physical activity is recommended in order to maintain good general muscle tone, able to counteract the worsening effect that gravity would otherwise have on the curves over the years.

SEAS: How it trains active self-correction

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Physical exercises, whether in a sporting or rehabilitative context, are motor actions repeated to improve a function or skill. This function may be as simple as muscle strength or joint mobility or as complex as balance or coordination.

SEAS, our approach to scoliosis-specific exercises, was conceived with a different perspective compared to most other specific treatment methods.

In other approaches, unlike SEAS, the exercise involves adopting a position to achieve the maximum possible spine realignment and reduction of curves. This correction is typically static and passive, focusing primarily on achieving the best geometric realignment of curves, with little regard for movement.

Achieving this outcome often necessitates external aids, such as unusual body positions or physical supports. In other treatment methods, tools like pushing against a rigid instrument such as a stick, hanging from wall bars, or placing a support under the pelvis are commonly used to assist in aligning the scoliotic spine. These actions are identified as exercises and serve as a shortcut to achieving the best passive correction of the curves.

In the SEAS approach, the focus is on training active self-correction of curves. Exercises are designed to progressively destabilise this active (rather than passive) correction, compelling the patient to stabilise and regain it when necessary.

Correct and Controlled Exercises

The key role of the experienced therapist is selecting the appropriate level of destabilisation. As in any active training, the exercise should progressively increase the challenge of the targeted action.

An exercise is “correct” when it is selected after a thorough assessment of the level of destabilisation the patient can handle. It is “controlled” when it is neither excessively destabilising—risking loss of correction control—nor insufficiently destabilising, rendering it ineffective for training the ability to maintain correction in more complex situations.

The World Organisation for the Conservative Treatment of Scoliosis (SOSORT) recommends exercises focused on self-correction: movements that counteract spinal curves, stabilising and integrating them into daily life. In the SEAS method, exercises involve actively reaching and maintaining the self-corrected position despite various challenges. Gradually, through continuous practice, patients learn to integrate self-correction into everyday activities such as eating, walking, or doing homework.

A Practical Example

Long-term training, gradually increasing both distance and speed, is essential to prepare for a marathon and build sufficient strength and endurance to run 42 kilometres.

In our approach, exercises represent progressively chosen challenges to destabilise appropriate corrections. If the correction becomes too simple and the disruption fails to adequately destabilise it, the exercise cannot effectively train the ability to manage self-correction in more complex situations.

How Much Time Should Be Spent on Exercises?

The recommended daily practice is 20 minutes, with one rest day per week, totalling approximately two hours per week. Although this represents a significant commitment, especially given the duration of therapy, keeping a balance is crucial. Some parents, especially at the start, ask whether more practice is possible. Our response is that the training should be sustained without causing fatigue in a therapy that may span years.

Learning a musical skill is a practical comparison that illustrates the importance of consistency. A pianist cannot master complex pieces in a week but must practice daily with dedication, gradually progressing. Similarly, the SEAS approach requires continuous and progressive training, continuing until skeletal maturity reduces the risk of scoliosis progression.

Through the SEAS method, patients can actively train self-correction, transforming it into a stable and enduring skill that supports their daily life.

The Body

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Chiara Castiello is a psychologist expert in adolescence and social innovation, with a deep passion for photography, writing, and jazz music. Chiara wore a brace for many years, from the age of ten until she was 18. Even today, she continues to care for her back and is one of our adult patients.
Chiara has shared with us her experience as a young girl wearing a brace, but above all, she has offered a reflection as an adult and psychologist on the importance of body perception and both physical and mental health. Thank you!
Below is her text, “The Body” by Chiara Castiello.

“Are you an only child?”
To my astonishment, it was the second time I repeated, “Yes, I am.”
And it couldn’t be otherwise. It was either a blessing or a necessity that I was. At ten years old, the vertebrae in my spine decided not to align perfectly but instead to take on a C-shape, like the initial of my name. After narrowly avoiding a plaster cast, an orthopaedic brace was the treatment recommended by doctors from a Northern region of Italy. Long and repeated car journeys, endless waiting times, and fittings of this “garment” made of rigid plastic and aluminium, with pressure applied to the hips and behind one shoulder.

At first, it really feels like a tailored outfit, and the sensation is even somewhat pleasant. Standing in a room with your arms resting on two poles that help keep them supported and away from your chest. A tight-fitting gauze in a butter colour is slipped onto you, and then warm plaster strips are applied, shaping your body. The “garment” takes shape, solidifies, and suffocates you in a very short time. Then scissors cut it under the armpit, opening it like a door, and you emerge, naked and cold.

The orthopaedic brace teaches you endurance. It teaches you to sleep on your back on the hard surface of the plastic, to bear the cold touch of the aluminium in winter. To appreciate shade and cool places in the summer. It teaches you discipline; in my case, I could only remove it for one hour a day for a long time. It teaches you not to scratch mosquito bites, as they are unreachable, locked inside your “box”! It instils moderation, compressing your stomach if you eat too much.
It teaches you to cover yourself for fear of being found out. Not to follow fashion, because you can’t. To button the collars of your polo shirts, buy them in a larger size. To pick up things from the floor with your feet so you don’t have to bend too often. To quickly dart through security gates at museum entrances to avoid setting off alarms. To dodge hugs from boys, while secretly yearning for them.

It denies you a comparison with others because they are healthy, normal, and free. It deludes you into always feeling like a child and prevents you from thinking about your body, which is there but invisible. Artificially supported, it grows under compression. Its development, except for the worsening of the spine, remains imperceptible. And when the “garment” becomes tight, you rush back north to get a new one.

During these endless visits, my parents and I were transported by car for 620 kilometres, my body and its black-and-white photographs: the X-rays on which doctors, in white gowns with rulers and red pencils, recorded numbers and the degrees of curvature, marking the positive or negative progress of my condition. This body-object, so medicalised, observed, and adjusted, was a stranger to me. It grew, changed, betrayed me, worsened without my control and, after great effort and many years, healed.

As a patient and adolescent (now an adult) with scoliosis, I wish to shed light on the importance of working in parallel with one’s perception of body image. To perceive: to become aware of oneself. I am my body; it belongs to me, and I relate to the world through it. Despite the plastic “box,” I can live, connect, and experience this non-object outside its cage.
And there is more. The “Self” cannot be put on hold while waiting for the body to heal because the two are not separate entities. Put differently, it is essential not to neglect the wholeness of a person as the union of body and psyche. The well-being or suffering of both travels in the same carriage of the same train; they are interdependent. Sartre wrote that the “body is the ultimate psychical object, the only psychical object” (1943, p.429).

If this was understood, one wouldn’t feel so unprepared at the end of treatment, so afraid, fragile, defenceless, fragmented. Medicalising and isolating the body is a mistake still too often made in care practices, but the body lives and breathes as part of its whole being. We are our history, our experiences, from birth onwards; we are unique and, as such, deserve to be welcomed.
Only in this way can we truly consider ourselves healed and free.

Is Life Turning You Kyphotic? Here’s How to Prevent It

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The spine supports the torso and allows the head to stay upright, keeping the gaze towards the horizon. Proper alignment in the sagittal plane helps maintain the torso in the correct position with minimal energy expenditure and optimal load distribution along the spine.

Over time, particularly in older adults, a forward imbalance tends to develop, causing the torso to lean forward. Researchers have identified the age range of 50 to 60 as the period when this imbalance typically begins to manifest, progressively worsening with age. Compensatory mechanisms then come into play, creating a vicious cycle involving the pelvis and the entire spine, leading to specific degenerative changes.
The pelvis tilts backwards, lumbar lordosis decreases, and the upper torso bends forward. In some cases, these changes in sagittal alignment occur rapidly and progressively, developing into pathological conditions.
Certain factors may exacerbate this, such as the presence of scoliosis, disc disorders leading to reduced lordosis, or stiffness in the spine. Severe kyphosis or kyphosis resulting from vertebral fractures also contributes to forward collapse, as does weakness in the spinal extensor muscles, leading to forward lean.

Now, let’s consider our daily activities.
Most of what we do involves looking downward or at least keeping the head tilted forward. For example, how much strain is placed on the cervical vertebrae when the head is tilted forward at 30 degrees? (Remember that we usually tilt our heads much more than 30 degrees when we look at our phones.)

At this angle, the discs experience 400% more stress than when the head is upright and looking forward. The natural tendency towards forward collapse, combined with daily activities that increasingly involve static, flexed postures and potential degenerative spinal conditions, accelerates the forward tilt of the torso. This forward imbalance results in pain, reduced spinal functionality, fatigue, aesthetic concerns, and, most importantly, a decline in quality of life.

What Can We Do?

  1. Resist Gravity: Throughout the day, whether standing or sitting, try to sit or stand up straight and hold this position for a few seconds.
  2. Engage in Regular Physical Activity: Any exercise is beneficial, but activities that engage the trunk extensor muscles are especially helpful. Don’t stop moving! It’s also a good idea to vary your exercises over time, which will benefit your back as well.
  3. Seek Medical Advice: If you notice yourself leaning forward when tired, especially in the evening, or if those around you point out that you’re becoming more stooped, it’s time to seek a medical evaluation.

…And if life pushes us forward? Let’s straighten it out!