For most adults with scoliosis, Pilates can be a safe and useful way to train, provided a doctor or physiotherapist has assessed your spine first and the sessions are built around your curve rather than a standard routine. It is not a treatment for scoliosis, and it will not straighten the spine or change the size of the curve. What it can do is give you a controlled way to work on what adults with scoliosis commonly deal with: one side of the body working differently from the other, stiffness and pain, a rib cage that moves less on one side, and the rotation that comes with the curve.
What does scoliosis change for an adult who trains?
Scoliosis is a three-dimensional change in the spine. It curves to the side, the vertebrae rotate, and the front-to-back curves of the upper and lower back are often altered as well1. Because of the rotation, the ribs on one side usually sit further back than on the other.
Asymmetric loading
When the spine is not stacked evenly, the muscles either side of it rarely share the work equally. One side may feel tighter, one hip may take more of your weight, or one shoulder may tire first. Albert, a powerlifter who trains with us, described scoliosis as part of the reason it was “much harder for me to hold weight and keep myself stable.”
Stiffness and pain
Back pain is more common in adults with scoliosis, though usually not disabling. Weinstein and colleagues followed 117 people with untreated idiopathic scoliosis for 50 years. At an average age of 66, 61% reported chronic back pain against 35% of matched controls, but most of those with pain called it little or moderate, and the group as a whole was functioning at a high level2.
Breathing and rotation
Koumbourlis, reviewing the respiratory effects, described how scoliosis restricts rib movement and puts the breathing muscles at a mechanical disadvantage, raising the work of breathing3. This is mainly a concern with larger curves: in the Weinstein study, breathlessness in everyday activity was linked to curves over 80° with the apex in the upper back2. In milder curves the practical issue is usually that one side of the rib cage expands less, and turning one way feels freer than the other.
Who should check my spine before I start?
Your doctor or physiotherapist, before the first session, especially if your curve is large, has been measured as progressing, or has been treated with spinal fusion or other surgery, and if you have pain travelling into the legs, numbness or any new symptoms. They can tell you whether anything should be avoided and, after surgery, what your surgeon allows. We work to that advice.
Spinal surgery does not automatically rule this kind of training out, but it changes what is appropriate. Charibelle, who founded the studio, grew up wearing a full upper-body brace for a severe spinal curvature, had spinal surgery in 1996 and has lived since with a spinal rod. She took up running and triathlon at 30 and is a Half Ironman finisher. A fused section of spine does not move, so the work is done around it, not forced through it.
How is a session adapted for scoliosis?
Our scoliosis programming incorporates the Scolio-Pilates approach and starts from an individual assessment: where your curves are, which areas are stiff, how you breathe, how you load each side, and what you want to be able to do, from lifting or running to daily life.
Breathing first
Breathing work comes early because it is gentle and shows where the rib cage moves less. Side-lying over the spine corrector or the ladder barrel opens one side of the rib cage, so you can practise directing the breath into areas that expand less. The SOSORT scoliosis guidelines recommend breathing exercises where needed, including side-specific breathing strategies4.
Side-specific work
A routine that treats both sides the same ignores the difference between them, so much of the work is done one side at a time. Single-arm and single-leg work on the stability chair and side-lying work on the trapeze table (Cadillac) let each side be trained on its own terms, with different Pilates equipment springs, ranges or repetitions where the assessment calls for it. Rotation is trained in a controlled range, seated on the reformer or the stability chair, so you learn to turn through the upper back in both directions without forcing the stiffer one.
Progressive loading
Sessions usually begin in supported positions on the trapeze table or the reformer, where the Pilates equipment springs can assist the movement, then move to seated and standing work such as step-ups on the stability chair. Peak Performance sessions are not purely Pilates: we combine Pilates principles with strength and conditioning principles and add strength and conditioning work depending on your goal, with more focus on control of movement. For Albert that meant work tied to his lifting, and Charibelle went to his gym to watch him lift and see where he was getting stuck. He later set his first personal bests in about three years, which he put down to “a combination of definitely the work in the gym, but also being able to move differently now.” That is one person’s experience, not a predicted outcome.
What does the research show?
Most scoliosis exercise research is in teenagers, and very little is on Pilates.
Consensus, mostly from adolescents. The 2016 SOSORT guidelines recommend scoliosis-specific exercise that is individualised, progressed according to ability and taught one-to-one, and say general sport is worth doing for its wider benefits but should not be prescribed as a treatment4. The 2024 Cochrane review by Romano and colleagues pooled 13 randomised trials (583 participants, mean ages 12 to 15) and found the evidence sparse and mostly of low or very low certainty. None of the trials measured adverse effects5.
Limited, for adults. Everett and Patel found only low-level evidence for physical therapy in adult scoliosis6. In one larger trial, Monticone and colleagues randomised 130 adults with curves under 35° to a 20-week programme of scoliosis-specific exercise, task practice and cognitive-behavioural therapy, or to general physiotherapy. Disability fell more in the first group and stayed lower a year later, while the difference in curve size was not clinically meaningful7.
Preliminary, and specific to Pilates. Gou and colleagues pooled 10 small trials (359 participants, nine of the trials in people aged 7 to 22) and reported less pain, more trunk movement, better quality of life and smaller curve measurements after Pilates, but judged the evidence poor and asked for caution8. A scoping review by Kuru Çolak and colleagues called it very limited1. Scolio-Pilates itself has not been tested in these trials.
Practical application. Individual assessment, one-to-one teaching, side-specific work, breathing and gradual progression follow the guideline principles. The aim is better control and comfort under load, not a change in the curve.
Does Pilates replace physio or strength training?
No. If a physiotherapist or surgeon is managing your scoliosis, they lead and our sessions follow their advice. Strength training still has a place, and because our sessions mix strength and conditioning work into the programme, the two can be planned together. We align with your doctor, physiotherapist, coach and gym trainer on goals and programming, so the studio work supports their plan.
Where to start
Get clearance from your doctor or physiotherapist, then start with an assessment rather than a class. The 55-minute initial consultation looks at how you move and breathe, how each side loads, what your medical team has advised and what you are training for. Your programme, a mix of Pilates and strength and conditioning work set by your goal, is then built, progressively loaded and reassessed, with exercises to take away between sessions.