Back Pain Doctor
Scoliosis
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
Scoliosis is a sideways curvature of the spine with rotation of the vertebrae, most often first identified in children and adolescents around the pubertal growth spurt. The great majority of cases are idiopathic, meaning no cause is identified, and there is a familial tendency. Because it is usually painless, curves often go unnoticed until a growth spurt makes asymmetry more apparent: an uneven shoulder line, a rib prominence on forward bending, or a lean to one side. Australia does not run a universal school screening programme, so curves are generally picked up opportunistically by parents, GPs or during other health checks.
Assessment focuses on confirming the curve, estimating how likely it is to progress, and excluding other explanations for any pain. Examination includes a forward-bend test, which makes trunk asymmetry more obvious, along with a neurological assessment. A standing spine X-ray confirms the diagnosis and allows the curve to be measured in degrees, which is what determines whether monitoring, bracing or surgical referral is appropriate. How much growing remains matters as much as the current measurement: a curve in a child who is almost fully grown may not progress further, whereas a still-growing spine is more likely to see it increase.
For adults, the practical questions are usually different, whether the curve explains their back pain, what it means for pregnancy or an epidural, and what to do about bone health. In adults, a longstanding mild curve is often an incidental finding and not the source of symptoms, and treating the back pain on its own merits is usually more useful than treating the curve. Where a curve is large, progressive, or associated with neurological symptoms, referral to a spinal specialist is the right step. Children with suspected scoliosis are referred to paediatric orthopaedic or spinal services, where bracing and surgical decisions are made.
This page is general educational information and does not replace individual medical advice. Anyone with concerns should speak with their GP.
Common symptoms
- One shoulder or hip sitting higher than the other
- One side of the ribcage or back appearing more prominent on bending forward
- A visible lean to one side, or clothing that hangs unevenly
- Usually no pain at all, particularly in adolescents
Evidence for twelve treatment options in scoliosis
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation: diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan, with weight management where that is clinically relevant.
What the evidence shows
Every high-quality guideline says the same thing. The American College of Physicians makes a strong recommendation that chronic low back pain be treated first with exercise and multidisciplinary rehabilitation rather than drugs or procedures (Qaseem, Ann Intern Med 2017). An overview of 15 primary-care guidelines found consistent agreement on education, staying active, exercise and reassurance, and on discouraging routine imaging (Oliveira, Eur Spine J 2018). For neck pain the strongest effects also belong to exercise, with strengthening of the neck and upper quadrant showing a moderate short-term effect (Sterling, J Clin Med 2019). Adding pain-science education to exercise improves pain, disability and fear of movement over exercise alone (Bonatesta, J Pain 2021).
Pairing reviewed 2026-09-02.
Where it fits
Understanding why the back hurts, and moving well, does more than anything injected. Imaging is used to answer a specific question, not as a starting point. Degenerative findings are near universal and frequently unrelated to the pain.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Only if relevant
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with a very dilute local anaesthetic (0.02-0.08%) is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling (the same technique with nothing injected) is not offered here.
What the evidence shows
No trial evidence in scoliosis. Asymmetric muscular loading either side of a curve commonly produces tender bands, and those are treated as muscular pain.
Pairing reviewed 2026-08-30.
Where it fits
Occasionally used for a specific tender band that is limiting exercise. It does not change the curve.
Ultrasound-guided injections Guidance means the needle can be seen reaching the target. What goes into the needle depends on the diagnosis. Only if relevant
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
Injection does not alter a curve. In adult degenerative scoliosis a specific facet joint or sacroiliac joint can be the pain generator, and where that is the case an image-guided injection is used diagnostically and therapeutically as it would be in anyone else.
Pairing reviewed 2026-08-30.
Where it fits
Considered only where assessment points to one identifiable painful structure, and always alongside the exercise programme.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible: no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Myofascial pain only: one small trial
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue, including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
Used here as a treatment for muscle, not for the curve. A curve loads the muscles either side of it unevenly, and the resulting myofascial pain is what people usually feel. The one trial in this population fits that reading: 48 adults with idiopathic scoliosis and back pain randomised to five sessions of radial shockwave to the back muscles, therapeutic ultrasound or control, all alongside Klapp exercises. At two weeks pain fell more with shockwave (change -6.4 against -5.4 and -4.5 out of 10), with better quality of life, no difference in disability (Oswestry change -28 against -30 and -27) and no adverse reactions (Daia, J Clin Med 2021). It was unblinded with no sham arm, follow-up ended at day 14, and the curve was not measured. The only report claiming an effect on deformity is a single case in a 13-year-old whose trunk measures returned to baseline within three to five days of each session (Weiss, J Phys Ther Sci 2017), which cannot support that claim.
Pairing reviewed 2026-10-22.
Where it fits
Considered only where the assessment locates the pain in muscle and the exercise programme alone has not settled it, and treated on the same basis as myofascial pain anywhere else. It does not correct, halt or influence a curve, and it is not a reason to defer specialist review of a progressive one.
Focused shockwave (ESWT) A true shock wave converging at depth: for tendon, joint, ligament and bone. Plausible: no studies
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form used for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
No focused-shockwave study in scoliosis was found. Search: PubMed, shockwave terms with spondylolysis, pars interarticularis, pars defect, spondylolisthesis or scoliosis (10 records, all read), with a trial and systematic-review pass. The studies that exist used radial devices on the back muscles, not the curve: a 48-person randomised trial in adults with scoliosis and back pain (Daia, J Clin Med 2021) and a single case in a 13-year-old (Weiss, J Phys Ther Sci 2017); see the radial row.
Pairing reviewed 2026-10-22.
Where it fits
Not offered for the curve. Where a specific painful structure is identified on assessment, it is treated as that problem, not as scoliosis.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Usually painless, no contact. Plausible: no studies
What it involves
You sit with the applicator positioned over the area for a short session. It is usually painless and needs no gel or skin contact. It is usually given as a course, commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that could be identified. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative. A randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits
Not part of managing scoliosis. Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why it is described this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Only for a separate problem
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
No study of platelet-rich plasma as a treatment for scoliosis was found, and there is no reason to expect an injection to change a spinal curve. A PubMed search on 11 October 2026 pairing platelet-rich plasma, platelet gel, platelet concentrate, platelet lysate and platelet-rich fibrin with scoliosis, spinal deformity and kyphosis returned three records, none a treatment study: a general overview of children's orthopaedics that mentions PRP in passing (Al-Rumaih, Cureus 2026), a laboratory study of clotting in blood samples from scoliosis surgery patients (Shams Hakimi, Clin Appl Thromb Hemost 2017), and a laboratory report on a spinal implant for tuberculosis (Yahia, RSC Adv 2023).
Pairing reviewed 2026-10-11.
Where it fits
Not a treatment for the curve. Considered only where assessment finds a separate, clearly identified problem alongside it, such as a painful sacroiliac joint, and then judged on the evidence for that problem and used to support the exercise program.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. No study in this condition
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
No study of prolotherapy in scoliosis. A PubMed search on 16 October 2026 (prolotherapy, dextrose or hypertonic glucose with scoliosis and the other spinal conditions; 10 records) returned no trial, series or case report in which the curve, or pain from it, was treated with prolotherapy. The one record pairing scoliosis with a dextrose injection is a study of 36 people given dextrose with local anaesthetic around the superior cluneal nerves of the low back, in which pain coming back was more common in those with scoliosis; scoliosis was a finding there, not the condition treated (Wu, Insights Imaging 2023).
Pairing reviewed 2026-10-16.
Where it fits
Not offered for the curve, which an injection cannot change. Back pain in someone with scoliosis is assessed on its own terms, and a separate joint or ligament problem is weighed on the evidence for that problem.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not offered for this
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
A treatment for an arthritic peripheral joint. It has no application to a spinal curve.
Pairing reviewed 2026-08-30.
Where it fits
Not used for this condition.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve, not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Plausible: no studies
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
No study of perineural injection in scoliosis was found. Searching perineural injection, neural prolotherapy, subcutaneous and perineural dextrose, glucopuncture, Lyftogt and neurofascial terms against scoliosis and spinal deformity, with separate passes for randomised trials and systematic reviews, returned no treatment study in this condition. The only randomised trial retrieved added drugs to a nerve block for pain after scoliosis surgery (Reysner, Spine 2025), which is a different procedure for a different purpose.
Pairing reviewed 2026-11-04.
Where it fits
Not offered for the curve.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Trapped nerve, not the curve
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
No study of hydrodissection as a treatment for scoliosis was found, and the curve itself is not something it can act on. The nearest evidence concerns superior cluneal nerve entrapment at the iliac crest, a cause of low back pain that can sit alongside scoliosis. In 36 people with that entrapment, ultrasound-guided dextrose hydrodissection gave initial success in 77.7%, but symptoms returned in a quarter of those, and the people whose pain returned were more likely to have scoliosis (Wu, Insights Imaging 2023). Two case reports, one in a person with scoliosis, describe pain relief from an ultrasound-guided cluneal nerve block rather than hydrodissection (Reyes, Pain Med Case Rep 2026). None of these studies had a control group.
Pairing reviewed 2026-11-04.
Where it fits
Not offered for the curve. Considered only where examination and ultrasound find a trapped nerve alongside it, most often the superior cluneal nerve at the iliac crest, and with the higher chance of the pain returning explained.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments not offered, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So treatment plans are not built around it. Where an injection is the right call, the specific diagnosis and target are reviewed, what is being injected and why is discussed, the number is kept low, and it is paired with the loading work that changes the longer-term course.
When it might still be considered
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal: a trip, a procedure, a return to work
- Diagnostic use, where the response shows where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other back conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Frequently asked questions
What causes scoliosis, and what does not?
Does scoliosis cause back pain?
What treatments actually change a curve?
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