Why does adolescent idiopathic scoliosis matter—not just clinically but also in terms of long-term health and wellbeing for young people? 

Adolescent idiopathic scoliosis (AIS) is diagnosed during a critical period of physical, psychological and social development, often imposing significant psychosocial stress on both patients and families. 

Non-surgical management, such as bracing, may negatively affect self-image and social integration, while frequent medical follow-ups and interventions (eg, spinal surgery) can disrupt academic and extracurricular activities. 

Effective management of AIS requires a holistic approach that addresses both clinical and psychosocial needs. 

There’s been extensive debate about the role of exercises in scoliosis. 

What did your review reveal about the effectiveness of scoliosis-specific exercise programs like the Schroth Scientific Exercises Approach to Scoliosis? 

Low-certainty evidence suggests that physiotherapeutic scoliosisspecific exercises may help maintain Cobb angles and delay curve progression in AIS but the optimal dose and patient adherence remain unclear. 

In contrast, bracing has a well-established dose– response effect in reducing curve progression and surgical risk (Dolan et al 2020, Negrini et al 2021, Negrini et al 2025). 

Further research is needed to clarify the dose–response relationship of physiotherapeutic scoliosis-specific exercises. 

Bracing remains the standard conservative treatment but surgery is still required for some. How should clinicians and families weigh up when to observe, when to brace and when to consider surgery? 

The 2016 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment guidelines provide a pragmatic framework for the clinical management of AIS (Negrini et al 2016), including recommendations on surveillance intervals and treatment modalities. 

Clinical decision-making should be individualised, taking into account curve magnitude, skeletal maturity, remaining growth potential and the goals and preferences of both patients and their families. 

Other surgical considerations include the psychological wellbeing of the patient, family support and the impact of AIS on physical function and daily activities. 

Shared decision-making ensures that management strategies align with the individual needs and circumstances of each patient. 

You highlight the effects of AIS on body image, self-esteem and mental health. What practical steps can physiotherapists and the wider healthcare team take to alleviate them? 

To assess self-image and mental health, clinicians can rely on validated questionnaires such as the Spinal Appearance Questionnaire, Trunk Appearance Perception Scale and Scoliosis Research Society-22. 

Providing balanced information on the benefits and risks of available treatments supports shared decision-making and if psychological issues are affecting family dynamics or individual wellbeing, timely referral to a mental health professional is essential. 

Technology is rapidly advancing scoliosis care. Which innovations do you think have the most potential to change practice in the next decade? 

Professor Arnold Wong

EOS imaging offers advantages over traditional X-ray including 3D reconstruction capabilities and reduced radiation exposure. 

The integration of artificial intelligence with clinical and sociodemographic data holds promise for predicting curve progression and stratifying patients for optimal management such as observation, physiotherapeutic scoliosis-specific exercises or bracing. 

Identifying high-risk groups enables targeted resource allocation and early education, supporting psychological preparedness for patients and families. 

The adoption of artificial intelligence and wearable technologies presents the potential for real-time feedback and gamification to enhance adherence to exercises and bracing in children with AIS. 

No single innovation is paramount for AIS detection or management but advances in artificial intelligence and technology are likely to transform future care pathways. 

If you could set the research agenda, what are the top priorities to improve care for adolescents with scoliosis worldwide?

Several research priorities merit attention over the next decade. 

The cost-effectiveness of AIS screening remains contentious, with some countries implementing programs and others suspending or forgoing screening due to economic concerns. 

Non-radiative methods for monitoring curve progression, muscle morphometry and function should be explored to minimise radiation exposure. 

The psychological wellbeing of patients and parents, particularly at diagnosis and during progression, is critical yet often overlooked. 

Research to enhance adherence to bracing and exercise is also needed as it remains a significant challenge. 

Social determinants of health significantly affect access to care, with many children in low- and middle-income countries or disadvantaged families lacking high-quality management. 

Future research should focus on developing cost-effective, culturally sensitive and sustainable healthcare models to address global disparities in AIS care. 

>>Arnold Wong is a physiotherapist and professor at the Hong Kong Polytechnic University, specialising in spinal research. He serves as treasurer of the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment and is recognised among the world’s top two per cent most-cited orthopaedic scientists.

Email inmotion@australian.physio for references.