The TSM™ Framework of Idiopathic Scoliosis
Idiopathic Scoliosis is commonly described as a curved spine, but this definition misses the most important truth…
Idiopathic Scoliosis is not the curve itself – it is a progressive neurological and biomechanical condition.
At Scoliosis Centers, we use a proprietary model called the TSM™ Framework to explain why scoliosis develops, why it progresses, and why outcomes vary so widely between patients.
TSM™ stands for:
- Trajectory
- Switches
- Mechanics
Together, these three factors determine how scoliosis behaves over time.
Trajectory – The Direction and Speed of Scoliosis Progression
Trajectory refers to the path a scoliosis curve follows over time, including:
- Whether it is stable or progressing
- How fast is it changing
- When progression is most likely to occur
Two patients can have the same degree of scoliosis today, yet experience very different futures.
That difference is Trajectory™.
Factors that influence trajectory include:
- Growth spurts and skeletal maturity
- Puberty and adolescent development
- Past rate of curve progression
- Family history and genetics
- Neurological control of posture and balance
Trajectory explains why “watch and wait” often fails – because it focuses on where the curve is, not where it is going.
Switches – The Biological Drivers Behind Curve Progression
Switches are the internal biological factors that can accelerate, stabilize, or worsen scoliosis.
These switches are not simply on or off – they act more like dimmer switches, influencing progression intensity.
Common scoliosis-related Switches include:
- Genetics associated with scoliosis risk
- Hormonal changes (puberty, pregnancy, menopause, andropause)
- Neurotransmitter imbalances
- Vitamin D deficiency and bone density changes
- Chronic inflammation and metabolic stress
Switches help explain:
- Why scoliosis often worsens during puberty, childbearing years, menopause, and andropause
- Why is it more common in females
- Why adult scoliosis can worsen years after growth ends
- Why do some curves progress despite bracing or exercise alone
Most traditional scoliosis treatments do not evaluate or address these biological drivers.
The TSM™ Framework does.
Mechanics – How the Spine and Body Adapt to Scoliosis
Mechanics refers to the physical and structural forces acting on the spine and nervous system.
This includes:
- Vertebral alignment and rotation
- Disc degeneration and asymmetrical loading
- Rib cage distortion
- Pelvic imbalance
- Postural and muscular compensation patterns
The body constantly adapts to keep the head level, eyes forward, and balance intact.
These adaptations may help in the short term — but they reinforce scoliosis progression over time.
Mechanics explain:
- Why does one scoliosis curve lead to additional curves
- Why pain often appears years after diagnosis
- Why adult scoliosis continues to progress
Why the TSM™ Framework Matters in Scoliosis Care
Most conventional scoliosis approaches focus on mechanics alone – bracing, surgery, or exercise.
The TSM™ Framework recognizes that scoliosis progresses when:
- The trajectory is accelerating
- Switches are biologically activated
- Mechanics reinforce spinal distortion
Effective scoliosis management must address all three.
The Goal of TSM™-Based Scoliosis Care
The goal is not simply to reduce a curve on an X-ray.
It is to:
- Slow or alter scoliosis progression
- Reduce neurological and postural stress
- Improve spinal stability and function
- Support long-term quality of life
Scoliosis is a whole-body condition, not just a spinal deformity.
The TSM™ Framework provides a clearer, more personalized roadmap for care.
Summary: The Three Drivers of Scoliosis Progression
Scoliosis is influenced by:
- Trajectory — how the curve changes over time
- Switches — the biological signals driving progression
- Mechanics — the physical adaptations that reinforce it
Understanding these three drivers allows for earlier intervention, better decision-making, and more individualized care.
Developed by Dr. Dunsky: The TSM™ Framework (Trajectory–Switches–Mechanics™) was developed by Dr. Joshua E. Dunsky, a chiropractic physician with decades of clinical experience treating adolescent and adult scoliosis. After evaluating thousands of scoliosis cases across growth-related and degenerative patterns, Dr. Dunsky, DC identified consistent drivers of progression that extended beyond curve measurements alone. The TSM™ Framework reflects real-world clinical behavior—integrating time-based progression, biological influences, and spinal biomechanics – to guide more precise, individualized scoliosis care.