Managing Scoliosis: When Maintenance Care Makes Sense (And When It Doesn't)

I need to have an honest conversation about something that makes a lot of PTs uncomfortable: maintenance care and patient dependency.

I have a patient, Anthony, who's been coming in roughly once a month for the past couple years for scoliosis-related pain management. Notice I said once a month, not weekly. That's an important distinction, and I'll explain why.

But first, let me tell you about Anthony's situation and what we're actually trying to accomplish.

What We're Actually Dealing With

Anthony is in his mid-40s, tall guy, plays pickup basketball, bowls regularly. He's got idiopathic thoracic scoliosis, meaning his spine has a lateral curve that developed during adolescence and is now just part of his structure. His curve is moderate (somewhere in the 25 to 30 degree range based on his old X-rays), which is common enough.

Here's the thing about adult scoliosis: we're not "fixing" anything. The curve is there, it's structural, and short of surgical intervention (which he definitely doesn't need at his curve magnitude), it's staying.

What we ARE managing is how his body compensates for that curve and how those compensations create muscle imbalances, joint stiffness, and occasional pain flare-ups.

Why He Still Comes In

When Anthony first came to see me about three years ago, he was having pretty significant mid-back pain between his shoulder blades. Standing for more than 20 minutes was uncomfortable. Basketball was making it worse.

We did a solid 8-week course of PT, twice a week initially, then once a week. Focused on:

• Strengthening the muscles that support his spine (especially core and scapular stabilizers)
• Improving thoracic mobility through the stiff segments
• Teaching him a home exercise program he could maintain independently
• Manual therapy to address the chronically tight areas (lats, paraspinals, QL)

By week 8, his pain was maybe 80% better and he had the tools to manage it himself.

So why does he still come in occasionally?

Because despite doing his home program reasonably well, certain areas, particularly where the curve is most pronounced, tend to get progressively stiff over time. The rib joints on the concave side of his curve get restricted. The muscles on the convex side get overworked and cranky.

When he starts feeling that familiar tightness building, usually every 4-6 weeks, he comes in for what I'd call a "tune-up." I do some joint mobilization on the restricted segments, release the chronically tight soft tissue, and reassess his home program to make sure he's still doing it correctly.

Then he's good for another month or so.

The Difference Between Maintenance and Dependency

Here's where I need to be really clear: there's a difference between appropriate maintenance care and creating patient dependency.

Patient dependency looks like:

• Weekly or bi-weekly visits indefinitely with no home program
• Patient reports they "can't function" without regular treatments
• Temporary relief that only lasts 2-3 days
• No progression toward independence or self-management
• PT becomes a passive recipient of treatment rather than an active participant

Appropriate maintenance might look like:

• Monthly or less frequent visits for chronic conditions
• Patient has a solid home program they do consistently
• Visits provide a "reset" that lasts several weeks
• Patient understands their condition and self-manages well between visits
• Treatment is about optimizing function, not basic pain relief

Anthony falls into the second category. He manages himself 90% of the time. The monthly (sometimes every 6 weeks) visits are about addressing the stuff he can't effectively do on his own, specific joint mobilizations and deep tissue work in hard-to-reach areas.

Could he get by without these visits? Probably. Would his function be as good? Maybe not.

What I Teach Every Scoliosis Patient

The goal with any chronic condition, including scoliosis, is to give patients the tools to manage themselves as much as possible.

For Anthony and others like him, that means:

• Daily stretching focusing on the chronically tight areas (usually takes 10-15 minutes)
• Core strengthening 3-4 times per week to support the spine
• Scapular stability exercises to prevent shoulder/neck compensation
• Body awareness, noticing when things are getting tight and addressing it early
• Activity modifications when needed (he learned certain basketball moves aggravate things more)

The manual therapy I provide is helpful, but it's supplemental to what he does for himself. If that ratio was flipped, if the manual therapy was doing most of the work, I'd be doing him a disservice.

The Billing Reality

Let me address the elephant in the room: insurance typically doesn't cover indefinite maintenance care, and honestly, they probably shouldn't.

Anthony pays out of pocket for these monthly visits. It's not cheap, $100-150 per session depending on what we do. He considers it worth it to stay active and pain-free, similar to how someone might budget for a gym membership or massage therapy.

I'm very clear with patients about this from the start. Once we're past the acute phase and into maintenance territory, we have an honest conversation about:

• What insurance will and won't cover
• The cost if paying out of pocket
• Whether maintenance care is really necessary or if they can manage independently
• What the visits are actually accomplishing

If someone can't afford or doesn't want to invest in periodic maintenance visits, we make sure their home program is rock-solid and they know how to self-manage effectively.

When Maintenance Care Crosses a Line

I've seen clinics that keep patients coming in indefinitely, sometimes 2-3 times per week, for conditions that should have progressed to independence months ago. That's not appropriate.

I've also seen PTs who refuse to ever see patients for maintenance because they view it as creating dependency. I think that's overly rigid.

The key is asking yourself: Am I helping this patient maintain a level of function they can't achieve on their own, or am I preventing them from learning to manage independently?

For Anthony, I genuinely believe the periodic manual therapy helps him stay more functional than he would be managing entirely on his own. But that's because:

1. He has a strong home program he does consistently
2. The visits are infrequent (monthly or less)
3. We're not chasing pain, we're optimizing function
4. He understands his condition and plays an active role
5. The financial arrangement is transparent and ethical

What About Other Scoliosis Patients?

Not everyone needs this model. Most patients I treat for scoliosis-related pain go through an initial course of PT (6-12 weeks) and then manage independently with occasional check-ins, maybe quarterly, maybe once a year, maybe never.

It depends on:

• Severity and type of curve
• Level of activity and demands
• How well they respond to self-management strategies
• Presence of other complicating factors (arthritis, disc issues, etc.)
• Their personal goals and preferences

Some people do great with just a solid home program. Others benefit from periodic professional intervention. Neither approach is wrong, as long as it's based on actual need rather than financial incentive or patient anxiety.

The Bottom Line

Scoliosis is a structural condition that can't be "fixed" with PT. But the functional limitations and pain that sometimes come with it can absolutely be managed, often very effectively.

The goal should always be maximizing independence and self-management while being realistic about what patients can and can't do for themselves.

For some people, that means occasional maintenance visits are genuinely helpful. For others, it means building a strong home program and checking in as needed.

What it should never mean is creating dependency on passive treatment or promising to "correct" curves that are structurally set.

If you're dealing with scoliosis and considering PT, whether for the first time or as ongoing maintenance, make sure you're working with someone who's focused on empowering you, not keeping you dependent.

And ask the hard questions: What's the goal? How will we know when we've achieved it? What's the plan for independence? What happens if I miss visits?

Those answers will tell you whether you're in the right place.

Dealing with scoliosis-related pain or stiffness?
At Spectrum Therapeutics of NJ, we focus on building your capacity to manage your condition independently, with periodic support when it genuinely helps.

Spectrum Therapeutics of NJ
601 Hamburg Turnpike, Suite 103
Wayne, NJ 07470

Phone: (973) 689-7123
Email: spectrum@spectrumtherapynj.com
Web: spectrumtherapynj.com

Let's figure out what you actually need, not what keeps you coming back indefinitely.