Non-operative treatment of idiopathic scoliosis using physiotherapeutic scoliosis-specific exercises (PSSE): a state-of-the-art-review on behalf of scoliosis research society (SRS) comprehensive care committee

Abstract Purpose Physiotherapeutic scoliosis-specific exercises (PSSE) are widely used in the nonoperative management of adolescent idiopathic scoliosis (AIS). Although recommended in international guidelines, uncertainty remains regarding their effectiveness, indications, and long-term clinical relevance. This state-of-the-art review aimed to critically synthesize current evidence on PSSE, identify areas of agreement and controversy, and clarify their role in contemporary conservative scoliosis care. Methods A structured literature review was conducted prioritizing randomized controlled trials (RCTs), prospective controlled studies with a minimum follow-up of 12 months, and recent systematic reviews. Studies were categorized as PSSE used alone or combined with bracing. Outcomes included Cobb angle, curve progression, escalation of treatment (bracing or surgery), and patient-reported outcome measures, with emphasis on progression avoidance as a clinically meaningful endpoint during growth. Results Evidence for PSSE as exclusive treatment in mild AIS (< 25°) was mixed, as only one RCT followed patients through skeletal maturity, demonstrating sustained benefit. Prospective controlled studies more consistently reported reduced progression rates and lower need for bracing, though adherence and inclusion criteria varied. For moderate curves (25–40°), PSSE combined with bracing showed potential additive benefit, but evidence is limited by the scarcity of RCTs and the absence of brace-only control groups in most studies. Recent systematic reviews generally reported positive effects of PSSE, although conclusions differed depending on outcome prioritization and follow-up duration. Conclusions PSSE are a valuable component of nonoperative AIS management when delivered within structured, supervised programs with sustained adherence. However, heterogeneity in study design and limited long-term follow-up warrant cautious interpretation. High-quality studies extending to skeletal maturity and focusing on progression prevention are needed to better define the role of PSSE in conservative scoliosis care.