Functional vs. structural scoliosis: What's the difference?

If you've been told you have scoliosis, you probably have some questions. Will it get worse? Is it safe to exercise? Does it always cause pain?

Many people with scoliosis live active, healthy lives. The two main types of scoliosis are functional and structural. Both refer to a curvature of the spine, though there are important differences between the two. Management strategies vary depending on the underlying cause and severity, but may include movement-based therapy and other conservative treatments such as heat therapy to help manage symptoms and improve function.

“Your spine is a strong, resilient structure,” says Matthew Turner, PT, DPT, a physical therapist at Hinge Health. “There's a lot you can do through regular movement and exercise therapy to support it and manage your scoliosis.”

Ahead, learn more about what functional and structural scoliosis are, how they're different, and how movement — especially targeted exercises recommended by Hinge Health physical therapists, can help.

What is functional scoliosis?

Functional scoliosis is a temporary curve in the spine that develops because of something outside the spine itself.

“It doesn't have anything to do with the bones or structure of your spine,” Dr. Turner says. “Instead, it’s usually related to things like how your muscles work together, your usual sitting or standing positions, or small differences in leg length. Muscle imbalances can create uneven pull on the spine, persistent postural habits can lead your body to compensate over time with a temporary curve, and a leg length difference can tilt the pelvis so the spine curves a bit to help keep you balanced.”

When the underlying cause is addressed, a functional scoliosis curve often improves — and in some cases may resolve — along with related symptoms. Physical therapy, strengthening exercises, posture changes, or treating a leg length difference can all help improve the curve.

What is structural scoliosis?

Structural scoliosis is a fixed curve in the spine caused by changes in the spine itself. “There is an actual rotation of the vertebrae that doesn't change when you move into different positions,” Dr. Turner says.

Most structural scoliosis is idiopathic scoliosis, meaning the exact cause isn't known. Less commonly, people are born with structural scoliosis or develop it because of certain neuromuscular conditions, such as cerebral palsy.

Structural scoliosis is often first noticed during adolescence, although some people aren’t diagnosed until adulthood.

A healthcare provider may suspect you have scoliosis during a physical exam if one shoulder or side of the rib cage appears higher than the other. They often perform the Forward Bend Test, asking you to bend forward while they look for differences in the shape of your back. An X-ray is then used to confirm the diagnosis and measure the size of the curve.

Although structural scoliosis cannot be reversed, many people successfully manage it with exercise, physical therapy, and regular monitoring. “You can live an active and comfortable life with either functional or structural scoliosis," Dr. Turner says.

Functional vs. structural scoliosis: An overview

Both types involve a curve in the spine, but they develop for different reasons. Here’s a quick functional vs. structural scoliosis diagram.

The Forward Bend Test is the main functional vs structural scoliosis test. “Movement and physical therapy can benefit people with either type of scoliosis,” Dr. Turner says.

How movement can help scoliosis

It can be tempting to avoid movement after learning you have scoliosis, especially if you’re worried about making the curve worse. But for most people, staying active is one of the best things you can do.

Movement keeps the muscles that support your spine strong, improves mobility, and helps prevent muscle stiffness that can contribute to discomfort.

“We’re not trying to straighten the spine through exercise,” Dr. Turner says. “We’re helping the muscles around the spine become stronger and more coordinated so they can better support you during everyday activities.”

A physical therapist can also tailor exercises to your specific curve pattern, helping improve strength, posture, balance, and confidence with movement.

Together, these exercises improve mobility, strength, balance, and coordination. Some focus on increasing spinal mobility, while others strengthen the core, hips, shoulders, and back so your spine has more support during everyday activities. The goal isn’t to change the shape of your spine. It’s to help you move more comfortably, build confidence, and stay active doing the things you enjoy.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment. 

Treatments for scoliosis

Treatment depends on whether you have functional or structural scoliosis, the size of your spinal curve, whether you’re still growing, and what symptoms you’re experiencing. Most treatments focus on helping you feel and function better in your daily life.

For children and teens who are still growing, some treatments (like bracing and certain scoliosis-specific exercise programs) may also help slow or limit curve progression. In adults whose bones are fully grown, most options — like exercise, heat, medication, and lifestyle changes — help manage pain, stiffness, and muscle tension rather than change the shape of the spine. For adults with severe or progressive scoliosis, surgery is usually the only treatment that can meaningfully change the spinal alignment.

• Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, strengthen and improve mobility in the muscles that support your spine. For children and adolescents, certain scoliosis-specific exercise programs may help slow curve progression. In adults, the main goals of exercise are to support your spine, reduce pain, and maintain or improve function rather than “fix” the existing curve. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Targeted exercises are designed to help with recovery, but any type of movement — like walking, stretching, yoga, or even household chores — can improve blood flow and help your spine feel better. Staying active helps keep the muscles that support your spine strong and flexible, which can make symptoms easier to manage. Find what feels comfortable for you to do regularly so you can keep your muscles warm and joints moving well.

• Apply heat or cold therapy. “Most people with scoliosis prefer heat, especially if their spine feels tight and stiff,” says Dr. Turner. But ice may feel good if you have a pain flare-up. These treatments don’t change the spinal curvature itself, but they can help ease pain and muscle tension so it’s easier to move and do your exercises. Consider trying both or stick to the method that works best for you.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have pain related to scoliosis. Other options are topical NSAIDs or pain relief creams. These medicines don’t correct the curve, but they can make daily activities and exercise feel more manageable. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are safe to take.

• Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. Many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your body can help you identify where small changes might make a difference. For example, you might notice your symptoms are less noticeable on low-stress days.

• Try complementary treatments. Talk to your provider if you’re interested in trying additional treatments for back pain relief, such as massage, acupuncture, or chiropractic care. These options don’t change the spinal curve, but they may help reduce pain, muscle tension, and stress so you feel more comfortable moving.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with conditions like scoliosis. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable. Like other pain-relief tools, TENS is aimed at symptom management, not changing the curve itself.

• Talk to your doctor about surgery if needed. Surgery is only recommended for a small percentage of people with structural scoliosis, typically when the curve is severe (often greater than 50 degrees), continues to progress, or causes significant pain or breathing problems. In children and teens who are still growing, bracing may sometimes be used to help slow curve progression, but after skeletal maturity, bracing is generally less effective and used less often. For adults with progressive or severe scoliosis, surgery is the primary intervention that can meaningfully change the spinal alignment; most other treatments focus on symptom management and function. “Most people with scoliosis never need surgery,” Dr. Turner says.

Tips to manage scoliosis

Small daily habits, from how you sit to how you sleep, can make a real difference in how your back feels on a daily basis.

• Switch positions frequently. No single posture is “perfect.” The key is to avoid staying in one position for too long. Alternating between sitting, standing, stretching, and walking throughout the day helps reduce stiffness and keeps your joints and muscles moving.

• Adjust your workstation. Simple ergonomic adjustments can make long workdays feel easier. Try keeping both feet flat on the floor, positioning your monitor at eye level, and sitting close enough that you don’t have to reach forward to use your keyboard.

• Stay consistent with exercise. Like any strengthening program, the benefits build over time. “It takes consistency,” Dr. Turner says. “Your body adapts gradually, so regular movement is much more important than trying to do everything perfectly.”

• Find movements that feel good for you. You don't need to avoid activities because you have scoliosis. Instead, pay attention to how different movements make you feel. You may notice that certain stretches help reduce stiffness or that taking short walking breaks throughout the day keeps your back feeling better. Those patterns can help you build a routine that works for your body.

When to see a doctor

Symptoms of functional and structural scoliosis often improve with simple treatments like physical therapy and targeted exercises. But if yours are severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have: 

• A spinal curve that appears to be getting noticeably worse

• Numbness, weakness, or changes in bowel or bladder function

• Symptoms that aren't improving after several weeks of consistent simple treatments

PT tip: don’t be afraid to move your body

It’s understandable to wonder whether exercise could make scoliosis worse. For most people, the opposite is true. Regular movement helps strengthen the muscles that support your spine, improve mobility, and build confidence in everyday activities. “The more active you are, the better your quality of life is likely to be,” Dr. Turner says. 

Rather than trying to avoid movement, focus on finding activities you enjoy and can continue long term. Remember, your spine is resilient — regular movement is one of the best ways to support its long-term health.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. AANS. (2024). Scoliosis. In AANS. https://www.aans.org/patients/conditions-treatments/scoliosis/

2. Li, M., Nie, Q., Liu, J., & Jiang, Z. (2024). Prevalence of scoliosis in children and adolescents: A systematic review and meta-analysis [Review of Prevalence of scoliosis in children and adolescents: A systematic review and meta-analysis]. Frontiers in Pediatrics, 12. doi:10.3389/fped.2024.1399049

3. Kelly, A., Younus, A., & Lekgwara, P. (2020). Adult degenerative scoliosis – A literature review [Review of Adult degenerative scoliosis – A literature review]. Interdisciplinary Neurosurgery, 20, 100661. doi:10.1016/j.inat.2019.100661

4. Marsiolo, M., Careri, S., Bandinelli, D., Toniolo, R. M., & Aulisa, A. G. (2023). Vertebral Rotation in Functional Scoliosis Caused by Limb-Length Inequality: Correlation between Rotation, Limb Length Inequality, and Obliquity of the Sacral Shelf. Journal of Clinical Medicine, 12(17), 5571. doi:10.3390/jcm12175571

5. Neuromuscular Scoliosis - OrthoInfo - AAOS. (2010). In Aaos.org. https://orthoinfo.aaos.org/en/diseases--conditions/neuromuscular-scoliosis/

6. Forward bend test: MedlinePlus Medical Encyclopedia Image. (n.d.). In Medlineplus.gov. Retrieved July 29, 2026, from https://medlineplus.gov/ency/imagepages/19465.htm

7. Dunn, J., Henrikson, N. B., Morrison, C. C., Nguyen, M., Blasi, P. R., & Lin, J. S. (2018). Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Review of Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task Force]. U.S. Preventive Services Task Force. https://pubmed.ncbi.nlm.nih.gov/29638297/

8. Wang Z, Zhu W, Li G, Guo X. Comparative efficacy of six types of scoliosis-specific exercises on adolescent idiopathic scoliosis: a systematic review and network meta-analysis. BMC musculoskeletal disorders. 2024;25(1):1070. doi:https://doi.org/10.1186/s12891-024-08223-1 

9. Wang, Z., Zhu, W., Li, G., & Guo, X. (2024). Comparative efficacy of six types of scoliosis-specific exercises on adolescent idiopathic scoliosis: A systematic review and network meta-analysis. BMC Musculoskeletal Disorders, 25(1), 1070. doi:10.1186/s12891-024-08223-1

10. Bracing | Scoliosis Research Society. (2025). Srs.Org. https://www.srs.org/Patients/Diagnosis-And-Treatment/Bracing