The first assessment and how a session runs

Short answer: The process begins with a free fifteen-minute introductory call, and no examination takes place during that call. It is used to hear briefly what has been noticed, to ask which documents you already have, and to talk about whether an assessment makes sense at this stage. The first assessment is one-to-one and lasts 60 minutes. It covers the history, a look at posture and trunk symmetry, a check of flexibility and strength, an assessment of how the breath follows the curve, and questions about school and sport. Later sessions are built around a warm-up, self-correction work (the child actively repositioning the trunk against the direction of the curve, using their own muscles), three-dimensional breathing (directing the breath into the part of the rib cage that barely moves) and carrying what has been learned into ordinary posture. No number is given for what will happen in how many sessions. Diagnosis, imaging and any bracing decision belong to the physician; physiotherapy follows and supports that decision. The call and the sessions can be held in English.

What the free fifteen-minute call covers

Most families new to scoliosis want two things settled before they book anything: what will happen when they arrive, and whether this is the right step for their own child. The introductory call is fifteen minutes set aside for those two questions.

The call covers the child's age, when the asymmetry was first noticed and by whom, whether a physician has already been seen, and which documents are in your hands. If a physician has prescribed a brace, that is asked at the start, because the programme for a child wearing a brace is not built the same way as the programme for a child under observation without one.

The call is fifteen minutes of talking and nothing more. No diagnosis is made, nothing is measured, no exercise is given, and no prediction is offered about whether the curve will progress. There are three ways the call can end. An appointment for a 60-minute assessment is arranged; or, if what you describe calls for a physician's assessment first, you are asked to see the relevant physician before any assessment appointment; or your question turns out to have been answered without an appointment being needed at all. No judgement about the child's condition is reached on the telephone. The only thing settled is which step comes next.

Coming to the assessment

Come with the child. Almost everything that has to be looked at is on the child's trunk, so a parent arriving alone and describing the situation cannot take the place of an assessment. The documents that make the work easier are these:

• The report, discharge summary or examination note written by the physician.
• The spinal X-ray, if one has been taken. The film itself, a CD or a printout from the hospital system all work. Having the image alongside the report is useful.
• Older films and reports. The change between two measurements says more than a single measurement does.
• The brace itself, if one is being worn, together with the daily wearing time the physician set.
• Any exercise programme given previously somewhere else.

If you do not have a copy of the image, ask for one at the department where the film was taken rather than later on. Keeping the films and the reports in a single folder from the beginning saves a good deal of trouble in the years that follow, and it is the only way a comparison between two dates stays possible.

On clothing, the practical answer is something comfortable that leaves the back visible from behind. For girls a sports bra or a vest top is enough, and for boys it is enough that the T-shirt can come off. For the lower half, tracksuit bottoms or leggings work better, because the level of the hips and the position of the pelvis are looked at as well. It is also worth avoiding a heavy meal shortly before the appointment, so that the child is comfortable during the breathing work.

Why a physician's report and imaging are asked for

A physiotherapist does not diagnose and does not prescribe a brace, and the decision to request an X-ray is not theirs either. All of that sits with the physician. The reason the report and the image are still asked for is that two pieces of information needed to build the programme cannot be produced by a physiotherapist's own measurements.

The first is the Cobb angle (the degree of curvature measured on an X-ray). Under the 2016 SOSORT guideline, a diagnosis of scoliosis is made when the Cobb angle is 10 degrees or more and the spine can be seen to have rotated around its own axis. The scoliometer used in the clinic gives the rotation angle of the trunk as measured from the outside. That measurement is useful in follow-up, but it does not stand in for an X-ray.

The second is skeletal maturity, which usually appears in the report as the Risser stage. This is a number between zero and five describing how far the growth cartilage at the upper edge of the pelvis has ossified on the film. The higher the number, the less growth the child has left. The risk of progression is set by the remaining growth and the size of the curve together, and the guideline gives that risk at the peak of the growth spurt in steps according to the size of the curve. The Risser stage is not treated as a sufficient marker on its own either, and is read alongside the other findings. Where the curve sits, whether there is one curve or two, and where its apex falls change the choice of exercise directly. Two children with the same number of degrees are not given the same programme.

If you have arrived in Turkey recently and do not yet know how the route works here, it runs roughly like this. A family physician or a paediatrician is the usual first stop, and from there a child is referred on to orthopaedics and traumatology or to physical medicine and rehabilitation; imaging follows only if the physician asks for it. Both a state route and a private route exist, and the practical difference between them is usually waiting time rather than the steps themselves. Which of the two suits a family is their own decision. If the report in your hand is full of terms you have never met before, the diagnosis and follow-up page goes through them one by one.

When a family arrives with no documents at all, a trunk examination is still carried out and the findings are given to you in writing, and from there you are referred to a physician.

How the 60-minute first assessment runs

The first assessment is one-to-one and lasts 60 minutes. Roughly the first quarter of that hour is given to talking.

The history follows a fixed set of questions.

• When the asymmetry was first noticed, and in what circumstances.
• Whether anyone in the family has scoliosis or has had spinal surgery.
• How much the child has grown in height over the past year.
• In girls, whether the first period has come, and when.
• Whether there is pain, and whether that pain wakes the child at night.
• Whether any numbness or weakness is described.
• Which sport is played, and on how many days a week.
• How many hours of a school day are spent sitting.
• If a brace has been given, how many hours a day the child manages to wear it.

Height gain and the date of the first period are asked about because the growth a child has left is directly related to the risk of progression. In girls the first period is a clinical sign that the peak of the growth spurt has passed, and it is one of the things the physician weighs together with the Risser stage.

Pain is asked about in detail for a different reason. Most children with idiopathic (of unknown cause) scoliosis have no back pain, which is exactly why it tends to be noticed late. In a series of 2,442 patients reported by Ramirez and colleagues, about a quarter had back pain at first presentation, and in a small proportion of the children who had pain another underlying spinal condition was found. Marked pain is not a finding to be waved through as a natural part of scoliosis, and it is passed on to the physician.

How posture and trunk symmetry are examined

After the conversation the trunk examination begins. The child stands with the back uncovered and is looked at from behind. From that view the assessment covers the level of the shoulders, how far the shoulder blades stand out, whether the two waist triangles (the gaps between the arms and the sides of the trunk) match, the level of the hips, and where the head sits over the trunk. A trunk that has shifted sideways shows up in the same view.

The child then bends forward without bending the knees. This step, the Adams forward bend test, shows whether one side of the back stands higher than the other (the rib hump), and it makes the rotation of the spine around its own axis visible. Where a rib hump is present, the therapist measures the trunk rotation angle with a scoliometer and writes that number down.

Follow-up only works if the first day's number is in the file. Months later, if nobody wrote it down, there is nothing left to compare against. The steps you can carry out yourself are described on spotting the signs at home; what happens in the clinic is the same look, in more detail and with measurements.

Flexibility, strength and endurance

Some of what is examined in this part is not on the back at all. The tightness of the muscles behind the hip, shortness in the muscles at the front of the hip, the difference between bending the trunk to one side and to the other, the mobility of the rib cage and the openness of the shoulder girdle are assessed. How long the muscles of the trunk and around the hip can hold a position is added to that.

At the centre of scoliosis-specific exercise (PSSE, the abbreviation you will meet in the research literature) is a trunk position the child has to take up actively, with their own muscles. Reaching that position takes a degree of flexibility, and staying in it takes endurance. If a child cannot reach the position, flexibility is worked on first. If the child reaches it but lets go after a few seconds, the programme leans towards endurance. Two children who arrive with the same Cobb angle may therefore have first months that look nothing alike.

Why the pattern of breathing is assessed

In scoliosis the spine bends sideways and, at the same time, rotates around its own axis. Because that rotation takes the ribs with it, one side of the rib cage moves forward and outward while the other side falls inward. The result is that the breath is not distributed evenly through the cage.

During the assessment, which part of the cage expands on an in-breath, which part barely moves at all, and whether the child lifts the shoulders while breathing in deeply are checked by hand and by eye. Katharina Schroth's method is distinguished by what it does with that observation. Directing the breath deliberately into the part of the cage that barely moves becomes a component of the exercise itself. The pattern of breathing is therefore an assessment step that shapes how the exercise will be built. If you want the principles rather than the practice, the Schroth method page has them.

No study has isolated the effect of the breathing work on rib-cage asymmetry, so how much it contributes on its own remains an open question. Within the method's own definition it is a central component, and how that component is applied varies from child to child.

Everyday habits

The last part of the assessment covers the school desk, how the bag is carried, time spent in front of a screen, sleep and sporting habits. These questions are asked to see how the day is actually spent. A heavy bag or poor sitting is not the cause of idiopathic scoliosis, and correcting either of them does not undo a curve that is already there.

What the answers show is whether the programme will fit into the child's real day. The home programme for a child who sits for eight hours, spends two hours at a preparatory course in the evening and trains four days a week cannot be the same as the one for a child whose weekends are free. Exam periods matter here more than they may sound to a newcomer: in the Turkish school system the years before the national entrance examinations for secondary school and for university load a child's evenings with study, and a programme written without that in mind will simply be dropped.

On sport, the answer parents usually expect is a list of prohibitions, and the evidence points the other way. In a study following 785 adolescents wearing a brace full time, the group playing sport twice a week or more often were more likely to have a better medium-term outcome than the group playing less. That finding rests on an observational cohort and does not count as proof of cause, but it does leave the approach of stopping sport hard to defend. Sport gets a page of its own: school, sport and daily life.

Privacy, consent and where the parent sits

The assessment is carried out with the back uncovered. For a thirteen-year-old the real issue here is embarrassment, so how things will proceed is said out loud at the start.

A parent who wants to stay in the room stays. If the adolescent would rather they waited outside, that is also possible. It is the child's own decision and it is respected. The door stays closed, the room is used for the assessment only, and a cover is available.

Photographs are taken only with permission. An image of the trunk from behind and from the side is useful for follow-up, but if it is not wanted it is not taken and the programme is still built. Images stay in the file. They are not shared with anyone and are never used for promotion. If the child wants to stop at any step, everything stops. Saying no is an ordinary part of the process.

What is discussed at the end of the assessment

In the last part the findings are explained in plain terms, to the child first and then to the parent. Where the curve sits, which way the trunk has shifted, which side has fallen inward and why those things call for those particular exercises are explained by being shown. An adolescent who understands what is happening in their own body may find it easier to stay with the programme.

A realistic frame is then set out. The state of the evidence for scoliosis-specific exercise is not simple enough to put in one sentence, and it is passed on as it stands. Randomised trials have shown curve measurements running better in children who had scoliosis-specific exercise added than in control groups. Against that, a 2024 Cochrane review bringing together 13 trials and 583 participants concluded that the benefit of therapeutic exercise is uncertain and that the evidence remains of low certainty. The same review also reports that, in children wearing a brace, adding exercise to the brace may reduce the progression of the curve. In a 2025 meta-analysis pooling Schroth studies, the average improvement seen falls below the 5-degree threshold that is treated as clinically meaningful.

Put together, the picture can be summarised like this. Scoliosis-specific exercise may help to slow the progression of a curve, and it may support trunk symmetry and quality of life. There is no evidence that it removes a structural curve. Another meta-analysis found the effect of scoliosis-specific exercise on the Cobb angle not to be significant in curves of 30 degrees or more, and it rated the certainty of that body of evidence as moderate to low in the randomised trials. For that reason, where a physician has prescribed a brace, exercise is placed alongside the brace rather than in its place.

The daily load of the home programme is discussed in the same conversation, and the family is asked plainly whether they can carry it. If that question is not put at the start, whether the home programme fits into the daily routine can become a problem in the weeks that follow.

How a session runs

Sessions also last 60 minutes and are run one-to-one. Every session follows the same framework, and what goes inside it changes with the shape of the curve.

Warm-up and preparation. Work on joint mobility, movements that lengthen the trunk, and noticing one's own posture in the mirror. This part looks short, and it is the precondition for the next step, because reaching a corrected position with a tight trunk is hard.

Self-correction work. This sits at the centre of the method. Starting from the position of the pelvis, the child learns to reposition the trunk actively against the direction of the curve, and the shoulder girdle and the position of the head are then added. The correction here describes a body position taken up during the exercise and carries no claim of a lasting result. A mirror, a wall, a pole and the feedback given by the therapist's hand are used together at this stage. When the 2016 SOSORT guideline lists the principles that scoliosis-specific physiotherapy exercises should rest on, it puts three-dimensional self-correction first.

Three-dimensional breathing. While the position is held, the breath is directed into the part of the rib cage that moves least. Children are usually unable to do this at the beginning, and that is normal. In the first weeks the therapist's hand is placed on the target area and the child tries to send the breath under that hand.

Stabilisation. Holding the corrected position under an external load is worked on. Stabilising the corrected posture appears as a separate item among the principles the guideline lists, because taking up a position once and being able to keep it in daily life are different things.

Carrying it into daily life. In the last part of the session the posture that has been learned is transferred to ordinary movements: standing in a queue, sitting at a desk, carrying a bag, looking at a phone. Training in activities of daily living and patient education are also among the guideline's principles, because a posture that is performed correctly in the clinic and then forgotten on the way out of the school gate changes nothing about how the day is actually spent.

Going over the home programme. The session ends by working through together what is to be done at home that week. If a new movement has been added, the child performs it alone in front of the therapist at least once.

Why the home programme decides so much

What the home programme contributes reaches beyond the hour spent in the clinic. In the assessor-blinded randomised trial by Schreiber and colleagues, the programme applied was one supervised hour a week plus 30 to 45 minutes of home exercise a day. Over six months the children completed about 82 per cent of the home exercises prescribed, and attendance at sessions stayed at around 85 per cent. Those published results came out of a programme that was actually carried out at that level of adherence. Where adherence falls markedly below it, expectations have to be lowered as well.

The supervised session still does work a home programme cannot. In a randomised controlled trial carried out in Turkey, Schroth exercises were compared across three groups: children working in the clinic under the supervision of a physiotherapist, children doing the same exercises as a home programme, and a control group receiving no treatment. The children in the home group had also learned the exercises from a physiotherapist and carried them out at home. Even so, the significant improvement in measurements of trunk asymmetry appeared only in the supervised clinic group, while the curve progressed in the control group. That finding suggests the same exercises done at home alone do not reach the same result as a supervised session. The limits of the study should be read alongside it: the sample was small, with about 15 children in each group, follow-up ran for 24 weeks, and no difference was found between the groups in the quality of life measurements. For programmes run alone by watching a video, there is no direct data at all.

In practice the home programme is kept short and workable. A simplified version is prepared for exam periods, holidays and illness, because carrying on with less is preferred to dropping the programme altogether. In weeks when adherence falls, no blaming language is used. Most of the time the real problem is less the child's unwillingness than the programme not having been placed properly inside the day.

How the frequency and length are decided

Rather than giving a number, it is more accurate to say what sets that number. These are the factors:

• The child's age and the growth that is left. A child in the growth spurt is followed more closely.
• The size of the curve, whether there is one curve or two, and which region it sits in.
• Whether the physician has prescribed a brace and, if so, the daily wearing time.
• How quickly the child learns the exercise. A child who establishes self-correction within a few sessions and a child who takes longer will not have the same timetable.
• The family's travel and time constraints. A timetable that is not realistic will not be followed, however correct it looks on paper.

The 2016 SOSORT guideline describes frequencies ranging from two to seven days a week according to the complexity of the technique and the patient's motivation and ability, and states that long-term sessions are typically carried out two to four times a week. Against that, the arrangement used in the randomised trial reporting favourable Cobb outcomes was one supervised hour a week plus daily home exercise. The range the guideline describes therefore works as a frame that narrows and widens with how fast a child learns, rather than as a list of requirements. In practice the early period tends to be more frequent and the period after learning is complete more spread out.

The reason no number is given in answer to the question of how many sessions it takes to see a result is that the result depends on the size of the curve, the growth the child has left, whether a brace is being worn and adherence to the home programme. None of those is known on the first day.

How progress is followed

At set intervals the measurements taken on the first day are repeated and compared. What is looked at in follow-up includes the trunk rotation angle measured with the scoliometer, the symmetry of the shoulders and the waist triangles, the flexibility and endurance tests, the child's ability to establish and hold the self-correction position without help, adherence to the home programme and any complaint of pain.

Every one of those measurements is taken from the outside of the body. The Cobb angle is measured on an X-ray, requesting an X-ray is the physician's decision, and a physiotherapist does not take that decision. Follow-up in the clinic serves to show how things are going in the period between two appointments with the physician, and it does not replace the film.

Reading differences between measurements calls for care. In radiological measurement the threshold treated as clinically meaningful is 5 degrees, and differences below that may come from measurement variability rather than from a real change. The same caution applies to clinical measurements. For that reason no comment, favourable or unfavourable, is built on a small difference at a single review; the trend is judged across several measurements.

How the child and the family take part

The person who will do the exercise is the child, and that shapes how the whole thing is set up. Findings are explained to the adolescent directly, the reason the exercise is done in that particular way is explained to them, and room is left within the session for decisions of their own.

Deciding as a household what time the home programme will be done, having a suitable space at that time, and keeping the programme clear of sibling care or the evening meal all help more than a daily reminder does. A parent who checks up every evening tends to make things harder, and an argument repeated every evening can end with the programme being dropped completely.

Some children take to the process from the start and others resist for the first few months. Resistance of that kind is ordinary at this age. In adolescence everything to do with the body is sensitive, and scoliosis is one of those things. Parents ask a great many more questions than fit here, and the common ones sit on the questions parents ask page.

When you are referred back to the physician

There are situations within a course of physiotherapy that call for a return to the physician, and they are a sign that the process is working properly. With any of the following findings, a physician's opinion is sought before the programme continues:

• Back pain that does not settle with rest, wakes the child at night, or is steadily increasing.
• Numbness or weakness in the arms or legs, a change in walking, or loss of balance.
• An unexplained change in bladder or bowel habit.
• Back pain arising together with fever, or a general deterioration.
• An asymmetry that has visibly increased over a short period, or a marked change in the clinical measurements.
• A pressure sore under the brace, redness of the skin that does not heal, a brace that no longer fits, or wearing time that cannot be kept up.

In the series reported by Ramirez and colleagues, some of the children who had pain were found to have another condition: slippage of a vertebra (spondylolisthesis), a structural round back (Scheuermann kyphosis), a fluid-filled cavity within the spinal cord (syringomyelia) or a disc herniation. That is why pain is taken seriously. A physiotherapist is not obliged to tell those conditions apart; the obligation is to refer to a physician.

Appointments and practical details

Appointments are held at Erzene Mahallesi 113 Sokak No: 1/3, Bornova. The Evka 3 metro station is in the same neighbourhood as the practice and is the eastern terminus of the M1 line, so a passenger coming from the west of the city cannot miss the stop. Appointment times are arranged by telephone.

Everything, from the first call to the sessions themselves, can be in English. For a family who would otherwise be following a clinical conversation in a second or third language, that removes one layer of difficulty from a process that is unfamiliar to begin with. A report written in Turkish can be gone through in the appointment.

If you are new to the district, the page for families living in Bornova and Evka 3 covers transport, parking and the medical facilities nearby. Prices do not appear on the site, because the regulation governing advertising in healthcare in Turkey does not permit them; they are given directly by telephone or during the introductory call.