CONFERENCE PREVIEW Red Flags and Game Plans:
Spotting Non-Surgical Risks in Adolescent Idiopathic Scoliosis Patients
Justin Favreau, DC, Head Clinician of ScoliCare Seattle Featured Speaker at the WSCA Connect ’25 Conference
Adolescent Idiopathic Scoliosis (AIS) often comes to a healthcare professional’s attention when a patient or parent notices postural changes, such as uneven shoulders or a more prominent rib on one side. AIS is defined as a lateral spinal curvature exceeding 10° on X-ray, typically identified during routine checks or through parental concern.
For general practitioners, nurses, and allied health workers unfamiliar with scoliosis, it may seem like a condition primarily managed by surgeons. However, most AIS patients rely on non-surgical approaches such as bracing and physiotherapeutic scoliosis-specific exercises (PSSE). Early diagnosis is critical for achieving the best possible outcomes and minimizing structural progression.
Beyond the spinal curve itself, AIS can lead to escalating pain, psychological strain, and functional limitations—factors that, if overlooked, can significantly impact a patient’s quality of life. Recognizing these red and yellow flags and responding promptly can make a substantial difference, even for healthcare providers without specialized scoliosis expertise. Below are key indicators and structured responses to enhance patient outcomes.
Red Flag 1: Escalating or Persistent Pain
Pain is less common in AIS than in adult degenerative scoliosis, but when present, it may indicate an underlying issue beyond idiopathic scoliosis. Adolescents may report persistent discomfort rated 4/10 or higher on the Visual Analog Scale, or stiffness after prolonged sitting or activity. Many AIS patients under- report pain, assuming it’s a “normal” part of scoliosis. Non- specialists may notice repeated visits for pain relief or parents mentioning disrupted sleep. Tackling all of these issues is part of a comprehensive management plan. At ScoliCare we ‘treat the human not just the spine’, making sure that each patient’s needs and goals are part of the management plan as much as possible.
22 www .ch ir oh ealth.or g Game Plan:
often does it hurt, and what makes it worse?”
healthcare professional trained in scoliosis assessment and management. Persistent pain may signal that the condition is not truly idiopathic.
helping the situation. For example, at ScoliCare, we offer a comprehensive rehabilitation program called ScoliBalance. The Scoliosis Rehabilitation Therapists that deliver the program are well trained to ensure that activities of daily living are incorporated into the program. Likewise, if a patient is wearing the ScoliBrace at night, the Clinician treating the patient is well equipped to look at sleep positions and assist with making sure the patient is getting good quality sleep each night.
Red Flag 2: Psychological Distress
AIS affects more than just posture; it may significantly influence self-image and mental health in some patients, particularly during adolescence—a time already filled with identity challenges. Concerns about body appearance, bracing, or treatment options can cause distress, anxiety, and social withdrawal.
Game Plan:
“How do you feel about your scoliosis?”
refer the patient to a mental health professional experienced in supporting adolescents with scoliosis.
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