For families living in Bornova and Evka 3

Short answer: Turkey has no national screening programme for scoliosis. Where screening happens it runs at province level, under protocols signed between a provincial health directorate and a provincial directorate of national education, and it does not exist everywhere. The first person to notice a change in a child's back is therefore usually someone at home. When a family in Bornova does notice something, the route here begins with a family physician or a paediatrician, continues with orthopaedics and traumatology or with physical medicine and rehabilitation, and ends with a standing full-spine X-ray on which the Cobb angle (the degree of curvature measured on an X-ray) is measured. Physiotherapy comes after that, once a physician has made the diagnosis. Appointments are held at Erzene Mahallesi 113 Sokak No: 1/3, in the same neighbourhood as Evka 3 metro station, which is the eastern terminus of the M1 line, and consultations can be held in English.

How screening for scoliosis works in Turkey

The list of national screening programmes published by the General Directorate of Public Health covers newborn screening, hearing screening for newborns and for school-age children, vision screening for newborns and for pre-school and school-age children, developmental dysplasia of the hip, carrier screening for spinal muscular atrophy before marriage, and the haemoglobinopathy control programme. Scoliosis does not appear on that list. No routine programme running across the country looks at a child's spine.

This does not mean that scoliosis screening never happens here. It runs at province level, through protocols signed between a provincial health directorate and a provincial directorate of national education. The programme announced by the Samsun provincial health directorate in 2022 is a documented example of how that works: pupils in the fifth to eighth grades, together with children aged 10 to 15 who came to their family physician, were covered, physiotherapists carried out the examinations, and children in whom something was suspected were referred on to a physical medicine and rehabilitation hospital.

Whether a child is looked at for scoliosis therefore comes down to which province and which year that child happens to be at school in.

For a family who has arrived from a country where a school nurse or a routine adolescent check would pick this up, that is probably the single most useful thing to know about the system here. The check you may be expecting does not necessarily take place, and nobody will tell you that it did not.

Screening itself is not settled ground either. The US Preventive Services Task Force, the body that prepares preventive care recommendations in the United States, concluded in 2018 that the evidence available was insufficient to weigh the benefits and harms of screening adolescents between 10 and 18 for scoliosis. That statement means the long-term studies comparing screened and unscreened children have not been done, and it is not a judgement that screening causes harm. For a family living here the practical consequence points the same way in either case, which is that watching at home is more dependable than waiting for a screening at school. The same task force had recommended against screening in 2004, and it moved away from that position with the 2018 assessment.

How many children in Bornova are in the risk age range

Education statistics published by the Bornova district governor's office put the number of pupils in state and private schools in the district at roughly 83,000 in total. The figure carries no date, so treat it as an order of magnitude and not as a current count. The risk window for adolescent idiopathic scoliosis, the most common form and the one whose cause is not known, runs from about ten to fifteen years of age, and the Turkish screening study covered exactly that range. In the school system here it spans the last year of primary school, the whole of middle school and the first year of high school. The number of children in the district who are in that age range runs into the tens of thousands.

There is direct Turkish data on how common scoliosis is. In a study that screened 16,045 pupils in 85 schools across 40 provinces, adolescent idiopathic scoliosis was found in 2.3 per cent of them: 3.1 per cent of girls and 1.5 per cent of boys. Of the curves found, 90.5 per cent were in the 10 to 19 degree range that counts as mild.

Those two numbers belong together. One or two children in an average class having scoliosis is an ordinary expectation, which makes the assumption that it will not be your child a poor one. At the same time most of what is found is mild and sits far below the degrees at which surgery enters the conversation. The operation that the word scoliosis calls to mind is the reality for a small minority of cases, and for most families the whole of it is a measurement, a review date and a set of exercises.

What can be looked for at home

Scoliosis usually progresses without pain, and that is why it tends to be noticed late. The signs that can be looked for at home are simple, and the moment to look is whenever a child's back happens to be uncovered, after a bath or at the side of a pool.

• One shoulder sitting higher than the other.
• One shoulder blade standing out further than the other.
• The gap between the arms and the body looking different on the two sides.
• One side of the waist being more deeply indented, or a skirt or a trouser leg sitting long on one side all the time.
• One side of the back looking raised when the child bends forward.

The last of these is the home version of what is called the Adams forward bend test in an examination. The child stands with the feet together and the knees straight, lets the arms hang loose and bends forward. Whoever is looking stands behind and follows the line of the spine to see whether one side rises above the other. That rise is the outward trace of the spine rotating around its own axis.

In screening examinations this look is paired with a scoliometer measurement of the angle of trunk rotation. A scoliometer is a simple instrument laid across the back while the child is bent forward, and it reads the difference in height between the two sides in degrees. In the Turkish prevalence study, pupils whose trunk rotation measured 5 degrees or more, or who had a positive forward bend test, were sent for imaging. A threshold of 7 degrees is also used in the international literature. Lowering the threshold catches more children and also sends more healthy children for an X-ray they did not need, which is why there is no single correct figure.

Small asymmetries are common, and one screening study shows how common. Among a thousand high school students who were screened, 80 per cent had a trunk rotation of 3 degrees or more. A slight impression of a curve is not on its own a sign of illness.

A home check produces a reason to ask a question and nothing more than that. The diagnosis is made by a physician, and scoliosis is diagnosed when the Cobb angle measured on an X-ray is 10 degrees or above and rotation around the axis can be recognised. Asymmetries below that are not called scoliosis. The signs are described in more detail on the spotting the signs at home page.

The route followed in İzmir

For a child in whom scoliosis is suspected, the sequence in İzmir is the same as in the rest of the country. The family goes first to their family physician or to a paediatrician, and the child is referred from there to orthopaedics and traumatology or to physical medicine and rehabilitation. In the provincial screening protocols that could be verified, children in whom something was suspected were sent to physical medicine and rehabilitation. Paediatric orthopaedics is a third department that families use. The diagnosis is made by measuring the Cobb angle on a standing front-to-back (anteroposterior) X-ray of the whole spine.

In İzmir this assessment is carried out in the relevant outpatient clinics of the university hospitals, the training and research hospitals and the children's hospitals. Which centre a family ends up at depends on both the physician's referral and how easily the family can get there. For a family living in Bornova, the hospital inside the university campus in the district is geographically among the closest options, and the metro runs along the edge of that campus.

Different parts of the process can run in different places. Diagnosis, imaging and surgical follow-up are the work of physicians and hospitals. Keeping up a one-to-one exercise programme repeated a few times a week asks for something else: an appointment time that fits the school day, a home programme that someone follows up, and measurements repeated at set intervals. These are two parts of one process and not alternatives to each other, so a family ends up holding two calendars at once, the hospital review date on one side and the weekly session on the other.

If you are new to the health system here

A parent who grew up in Turkey knows this route without being told it. A postdoctoral researcher who moved to Bornova last autumn does not, and the gap is administrative, not medical.

A good first door is the family health centre (aile sağlığı merkezi) where you are registered, and the family physician there can examine the child and write a referral if one is needed. Families also book outpatient appointments at state and university hospitals directly through the national appointment system, while private clinics are booked with the clinic itself. The two routes differ mostly in waiting time and not in the measurement itself, and which of them suits a family is not a decision this page can make for you.

Whether your cover pays for a given appointment depends on the type of cover you hold, whether that is national insurance through employment, private insurance or student cover. That question is answered by your own insurer or by the patient services desk at the hospital, and it is easier to settle before the appointment than at the desk on the day.

There is one more practical matter that nobody mentions in advance. Hospital consultations are generally conducted in Turkish, and the report and the imaging you are given afterwards are usually written in Turkish as well. Whether an interpreter can be provided differs from one hospital to another and is worth asking about when the appointment is booked. Consultations at this practice can be held in English, including the free introductory call, and a Turkish report can be read through with you during the appointment so that the wording in it is clear before you next see the physician.

What can be done when the answer is "let us monitor"

At this stage the picture is usually the same. The measured angle is well under the level at which a surgeon would be involved, the physician gives a review appointment in six months, and the family goes home without anything concrete to do. That is the exact moment at which most parents start searching online.

The decision to monitor has a reason behind it. How a curve will behave while growth continues cannot be known in advance, and regular review is the way to catch progression in time. It does not follow that there is nothing for a family to do in the interval.

The clearest explanation of why this period is taken so seriously lies in the two thresholds the international guideline gives for adult life. Where skeletal maturity (the point at which the bones have finished growing) is reached with a curve above 30 degrees, the risk of progression in adulthood rises. Above 50 degrees there is consensus that progression in adulthood is almost certain. The aim of monitoring and of treatment during growth is therefore to bring a child to skeletal maturity at the lowest degree that can be reached, because that degree shapes a good deal of what follows.

A few things are worth doing in this interval. The child's height is measured at regular intervals and, in girls, the date of the first period is noted, because the estimate of remaining growth is the main thing that determines the risk of a curve progressing. The review appointment the physician set is not missed. A scoliosis-specific physiotherapy assessment can be carried out during this period and recorded alongside the findings the physician will be following. The diagnostic process and the follow-up calendar are set out on the diagnosis and follow-up page.

Not stopping sport is one of the concrete items of this period, and there is data behind it. In a cohort of 785 children and adolescents wearing a brace full time, those doing sport twice a week or more were reported to have a higher likelihood of improvement over eighteen months of follow-up. Sport did not worsen results even in children who were wearing a brace. The finding comes from a cohort followed over time rather than from a randomised trial, and the possibility that children who play sport differ in motivation or in how well they wear a brace cannot be set aside. Even so, the direction of the finding is clear enough that the familiar advice to keep a child with scoliosis away from sport has nothing behind it.

What exercise can and cannot do

Scoliosis-specific physiotherapy exercises are defined in the international guideline as an approach built on four principles: active self-correction, in which the child brings the curve towards a corrected position through their own muscle work; training in activities of daily living; stabilisation of the corrected posture; and patient education. The Schroth method is the most widely known school under that definition.

The evidence is mixed, and it has to be passed on as it is. Randomised controlled trials have reported results in a favourable direction, and a study from Turkey found that clinic sessions run under a physiotherapist's supervision produced better outcomes than a home programme on its own. Against that, a 2024 Cochrane review pooling 13 studies and 583 participants concluded that the benefits of therapeutic exercise are uncertain and that the evidence remains of low certainty. The average improvement seen in meta-analyses is around three degrees, which sits below the five-degree threshold treated as clinically meaningful in radiological measurement. In another 2024 meta-analysis, the effect of these exercises on the Cobb angle was not significant compared with control groups once curves were 30 degrees or above.

This much can be said with today's evidence. Scoliosis-specific exercises may contribute to slowing the progression of a curve, and they may support trunk symmetry and quality of life. There is no evidence that they remove a structural curve, and in a child for whom a brace has been prescribed they do not stand in its place.

The bracing data are firmer. The number of hours a child actually wears the brace decides more than the question of whether braces work at all. In children wearing it for under 6 hours a day on average, the success rate was the same as in the group wearing none. In those wearing it 12.9 hours a day or more it rose markedly. How bracing and exercise run alongside each other is covered on the bracing and exercise page, and the method itself on the Schroth method page.

Where physiotherapy sits in this picture

The limits of a physiotherapist's authority are clear, and stating them at the outset saves a family time. A diagnosis is not made here, an X-ray is not requested, a brace is not prescribed and a physician's decision is not overruled. Physiotherapy carries out and supports what the physician has decided.

The assessment covers the history, an examination of posture and trunk symmetry, measurements of flexibility and strength, a look at how breathing accompanies the curve, and a conversation about the school week and sport. Work is one to one and a session lasts 60 minutes. How a session runs is described step by step on the first assessment and how a session works page.

Where a curve is approaching surgical territory, or has progressed markedly over a short period, the physician takes priority. In that situation the family is directed to the relevant physician, and saying so plainly keeps the order of the process intact. Questions about what surgery achieves, what it risks and what recovery involves cannot be answered on this page and are not for a physiotherapist to answer. They belong to a spine surgeon. The surgery decision page sets out which of them to take into that appointment.

Where the practice is and how to reach it

The address is Erzene Mahallesi 113 Sokak No: 1/3, Bornova, İzmir. Evka 3 metro station falls within the boundaries of the same neighbourhood in the official record, which is to say that the station and the practice are in the same mahalle.

Evka 3 is the eastern terminus of the M1 metro line. A passenger coming from the western side of the city cannot miss the stop, because the train ends there. The station has two side platforms. For a family arriving with a child who is wearing a brace, or whose movement is limited for the time being, the lift and ramp arrangements at the station are a detail that matters. These can change over time, so the current station information from İzmir Metro is worth checking before setting out. Ege Üniversitesi station is the stop before Evka 3.

Families travelling on İZBAN, the suburban rail line, have no direct connection to Evka 3. Passengers coming from the Aliağa, Menemen and Karşıyaka axis, or from the direction of Torbalı and Selçuk, change to the metro at Halkapınar or at Hilal and stay on it as far as Evka 3. Halkapınar interchange is the main junction for that change.

Those arriving by bus use the Evka interchange next to the station, which is within walking distance of it. Route numbers are not given here because they change over time, and current route information should be checked from ESHOT, the municipal bus operator. There is parking around the station for those coming by car, although capacity and conditions can change and this too should be checked before travelling in.

Appointments, the school timetable and exam years

Work is by appointment and sessions are one to one. The process begins with a free fifteen-minute introductory call. No examination takes place in that call. You describe the child's situation briefly, you are asked which documents you already have, and whether an assessment makes sense at that stage is discussed. If what you describe calls for a physician's assessment first, the suggestion is to see the relevant physician before anything else.

For a school-age child, a session that fits around lessons is the practical condition for keeping the programme going. Appointment times are agreed against the end of the school day or against the family's transport arrangements. Turkey has national examinations at the end of middle school and at the end of high school that decide which school or university a student moves on to, and the preparation year takes over a family's calendar. In that year the load of the home programme is looked at separately. A home programme that is not built around what a family can genuinely manage stops being followed, so it is worth working out at the start how many minutes a day are realistic on an ordinary weekday.

Bring the X-ray film and report if you have them, any notes the physician has written, and the brace itself if one is being worn. A parent can be in the room, depending on the child's age and preference. How many sessions will be needed cannot be said before the first assessment has been done. The programme is built around the child's curve, their growth status and the shape of the family's week.

Both the introductory call and the appointment can be held in English.

Which findings need a physician without delay

Most children with scoliosis have no pain. In a study of 2,442 patients with idiopathic scoliosis, 560 of them (23 per cent) had back pain when they first presented, and 210 (9 per cent) developed pain during follow-up. The warning is in what was found among those 560 children. In 48 of them, a separate underlying condition unrelated to the scoliosis came to light. Among these were a fracture and slippage in the posterior elements of the spine (spondylolysis and spondylolisthesis), a growth disorder in which the upper back rounds forward (Scheuermann kyphosis), a fluid-filled cavity within the spinal cord (syringomyelia) and disc herniation.

Marked back pain should therefore not be waved away as the pain of scoliosis. It should be assessed by a physician. If any of the findings below is present, a physician should be seen without waiting for the next scheduled appointment.

• Back pain that wakes a child at night or does not settle with rest.
• Fever, weight loss or a general deterioration accompanying the pain.
• Weakness, numbness or tingling in the legs, or a change in the way the child walks.
• Any change in bladder or bowel control.
• Asymmetry that increases noticeably over a matter of weeks.
• A curve noticed before school age.

None of these belongs to physiotherapy and none of them tolerates waiting. Through the rest of a scoliosis process there is nothing to hurry. How it goes depends on two things: keeping the review intervals, and not losing sight of a child while growth continues.