What is PASE (Physical Activity and Exercise) for scoliosis?

What is PSSE for Scoliosis

PSSE (Physiotherapy Scoliosis-Specific Exercises) is a structured conservative treatment approach for idiopathic scoliosis that uses three-dimensional self-correction techniques, activities of daily living training, and stabilization of corrected posture to manage curves and prevent progression, particularly in growing children with curves between 10-45 degrees. 1

Core Components of PSSE

PSSE is built on three fundamental principles that distinguish it from general physical therapy 1:

• Three-dimensional self-correction: Patients learn to actively correct their spinal deformity in all three planes of space 1
• Training of activities of daily living (ADL): Integration of corrective postures into everyday movements and positions 1
• Stabilization of the corrected posture: Strengthening and neuromuscular re-education to maintain the correction automatically 1

Clinical Indications and Role in Treatment

PSSE fits within a comprehensive scoliosis care model and is not used as an alternative to bracing or surgery, but rather as a complementary intervention 1:

• For curves 10-25 degrees: PSSE addresses the problematic "wait and see" approach that parents have complained about, providing active intervention during this critical window 1
• For progressive curves: PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, even more than a year after passing the peak of growth 1
• For non-progressive curves: Regular practice of PSSE can produce temporary and significant reduction of the Cobb angle 1
• Combined with bracing: PSSE is used alongside bracing according to individual patient needs and curve characteristics 1

Evidence-Based Benefits Beyond Cobb Angle Reduction

PSSE provides multiple clinical benefits that extend beyond simple curve measurement 1:

• Improved back asymmetry: Based on 3D self-correction and stabilization of corrected posture 1
• Correction of secondary muscle imbalance: Addresses compensatory muscle patterns 1
• Pain reduction: Helps manage scoliosis-related back pain 1
• Improved breathing function: Particularly beneficial in severe thoracic scoliosis cases 1

Major PSSE Schools and Approaches

Seven major international schools have developed specific PSSE methodologies, presented in historical order 1:

• Lyon approach (France)
• Katharina Schroth Asklepios approach (Germany)
• Scientific Exercise Approach to Scoliosis/SEAS (Italy)
• Barcelona Scoliosis Physical Therapy School/BSPTS (Spain)
• Dobomed approach (Poland)
• Side Shift approach (United Kingdom)
• Functional Individual Therapy of Scoliosis/FITS (Poland)

Integration with Multidisciplinary Care

PSSE should be delivered by physical therapists working as part of a multidisciplinary team that includes the orthopedic physician, orthotist, and mental health care provider, following SOSORT guidelines and SRS philosophy. 1

The complete scoliosis care model incorporating PSSE includes 1:

• Scoliosis-specific education
• PSSE interventions
• Observation or surveillance with radiographic monitoring (limited to once every 6 months per SOSORT) 2
• Psychological support and intervention
• Bracing when indicated
• Surgery for severe or progressive curves

Neurophysiological Rationale

The theoretical basis for PSSE addresses how the central nervous system (CNS) adapts to abnormal spinal alignment 3:

• During early scoliosis, the CNS automatically corrects abnormalities, but habituation occurs over time and the CNS begins treating the abnormal pattern as normal 3
• Any attempt to restore proper alignment is initially treated as an error by the CNS, which automatically restores the abnormal pattern 3
• PSSE aims to retrain the CNS to recognize and maintain corrected alignment as the new normal pattern 3
• The challenge is transferring the resulting correction to automatic maintenance of correct posture in vertical position 3

Critical Timing Considerations

Early implementation of PSSE is essential, as passive observation limits prevention possibilities and contradicts the principle of early rehabilitation intervention. 3

• Secondary prevention is needed in all patients to prevent development of abnormal postural habits that become part of a vicious circle 3
• PSSE should begin when curves are between 10-25 degrees, before bracing thresholds are reached 1

Limitations of Current Evidence

The evidence supporting PSSE is limited but growing 4:

• Research in conservative scoliosis treatment remains insufficient overall 4
• There is some evidence supporting scoliosis-specific exercises as part of rehabilitation treatment, though the evidence quality is poor 4
• Different PSSE methods are not well-known by most of the scientific community 4