Back, neck and spine
Scoliosis and postural pain
Posture is a much weaker predictor of pain than the industry selling posture correction would like. Here is what a curve genuinely explains and what it does not.
Two different things get treated under this heading and they should not be confused. One is an adult who has a known scoliotic curve and now has mechanical pain. The other is somebody with no structural curve at all who has been told their pain is caused by their posture.
The first is a real and treatable problem. The second is usually a much weaker explanation than it sounds, and treating it as though the alignment were the cause is how people end up doing corrective exercises for a year without much changing.
What the evidence on posture actually supports
Studies looking for a strong relationship between static posture and pain keep failing to find one. People with textbook alignment get back and neck pain; people who sit badly frequently do not. Forward head position, a rounded upper back and an anterior pelvic tilt are all extremely common in people with no symptoms whatsoever.
What does hold up is that sustained position matters, and that load tolerance matters. A body held in any single position for hours will complain, and a body whose tissues have low tolerance will complain sooner. That is a different claim from “your posture is causing this”, and it leads to different advice: move more often, and get stronger.
We say this plainly because it saves people a great deal of money. Postural correction is one of the most heavily sold things in this field and one of the least well supported.
Adults with a structural curve
A curve that has been present since adolescence and is now painful in middle age is usually painful for ordinary mechanical reasons — segments working harder than others, muscles fatiguing asymmetrically, and reduced overall capacity. It responds to the same principles as any other mechanical back problem, adapted to the asymmetry.
What treatment does not do is straighten the curve. An adult curve is structural and it is not going to be exercised away, and any programme promising otherwise is selling something. What can change substantially is the pain, the endurance and the walking and standing tolerance.
Progressive adult curves and those with neurological symptoms need an orthopaedic opinion, and we will say so.
Adolescent scoliosis: not us
Adolescent idiopathic scoliosis is a bracing and orthopaedic question with a specific evidence base and specific specialist programmes. A general physical therapy practice is not where curve management for a growing spine should happen, and we will refer rather than take it on.
If your child has been diagnosed and you want to know what to ask, telephone. We would rather spend fifteen minutes on that than book an appointment we should not be taking.
Physical therapy is not chiropractic, massage or medicine. Physical therapy is not chiropractic, not massage therapy and not medicine. We do not adjust or manipulate the spine as a chiropractor does, we do not prescribe, we do not inject, and we do not diagnose disease. We assess how you move, we treat what movement can change, and we say plainly when your problem is not one of those. Naming the edge of a scope of practice is not modesty; it is the part of the licence that protects you.
Included as standard
How we treat this
An honest account of what posture explains
Which is less than you have been told. We will not sell you a corrective programme for a problem the evidence does not support.
Curve assessed for what it changes clinically
Where the load is going, what fatigues first, and what your actual tolerance is — rather than a number on a film.
Strength and endurance as the mechanism
Capacity is the thing that changes symptoms in an asymmetric spine. It is trainable and it takes weeks.
Position-frequency advice, not geometry
Getting up every half hour beats any chair, and it is the part with the evidence behind it.
Referral for progressive or neurological cases
An adult curve that is progressing, or one with neurological signs, needs an orthopaedic opinion.
Adolescent cases referred, not taken on
Curve management in a growing spine belongs with a specialist bracing service. We will tell you what to ask them.
When to make an appointment
Signs this is worth an assessment
- You have a known curve and it has started to ache in a way it did not before.
- Standing for any length of time has become the problem rather than sitting.
- One side fatigues noticeably before the other during ordinary activity.
- You have been told your pain is postural and correcting it has not helped.
- You are considering an expensive posture programme and would like a view first.
- Your walking or standing tolerance has dropped over the last year.
Scoliosis & posture — how long a course usually takes
- A typical course for an adult with a known curve and mechanical pain. We do not treat adolescent idiopathic scoliosis as a curve-correction programme — that is a bracing and orthopaedic question.6 – 14 visits
This is a typical number of visits for this problem, not a quote and not a promise. You get an estimate specific to you, in writing, at the first appointment, and we reassess against the same measurements at visit four rather than at visit ten — so a course that is not working gets changed or stopped instead of extended. What each visit costs is published on the pricing page: $190 for the initial evaluation and $140 for a treatment visit if you are paying yourself, or your plan's copay if you are not. We do not sell blocks of visits in advance.
Questions we are actually asked
Scoliosis & posture — frequently asked
Can physical therapy correct my scoliosis?
Not in an adult. A structural curve is not going to be exercised straight, and a programme promising that is selling you something. What can change substantially is the pain, the endurance and how long you can stand and walk — which for most adults with a curve is what they came in for.
Is my back pain caused by bad posture?
Probably less than you have been told. The evidence for a strong relationship between static posture and pain is weak, and forward head position and rounded shoulders are extremely common in people with no symptoms. What holds up better is that sustained positions and low load tolerance matter, and both of those have different solutions.
Do you treat adolescent scoliosis?
No. Curve management in a growing spine is a bracing and orthopaedic question with its own evidence base and its own specialist services, and a general practice is not where it should happen. Telephone us and we will tell you what to ask a specialist — that conversation is free.
Should I buy a posture corrector?
We would not. Passive braces do not build the endurance that lets you hold a position comfortably, and some people find the tissue underneath gets weaker rather than stronger. The money is better spent on training, and the advice that works is to change position more often.
What would make you refer me on?
An adult curve that appears to be progressing, any neurological symptoms in the legs, or a presentation that does not behave mechanically. Those need an orthopaedic opinion rather than more physical therapy.
Related conditions
Often seen alongside this
Low back pain
The most common reason anybody walks through this door, and the condition where the gap between what sells and what works is widest.
6 – 12 visits
Neck pain
Desk necks, phone necks, slept-badly necks and the ones that are actually a shoulder. Telling them apart is most of the first appointment.
5 – 10 visits
Persistent pain
For pain that has outlasted the injury. Not a cure, not a lecture about it being in your head, and not something we will pretend is quick.
12 – 20 visits
Older adults
Strength training works at eighty. It works at ninety. The dose that works is heavier than almost anybody is offered.
12 – 24 visitsSixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.