Adult scoliosis is widespread yet frequently overlooked in general practice, affecting over thirty-seven percent of adults and rising significantly after age sixty. Patients often present with non-specific low back pain, radiculopathy, or pelvic asymmetry, leading clinicians to mismanage cases as simple mechanical dysfunction. Clinicians must first differentiate between adolescent scoliosis in the adult, which originates during youth and progresses slowly, and degenerative de novo scoliosis, which arises after age fifty from asymmetric disc degeneration, progresses rapidly, and often induces spinal stenosis. Accurate evaluation requires obtaining adolescent medical histories, conducting meticulous height measurements to detect trunk collapse, performing standing radiography, and evaluating sagittal balance. Positive sagittal shift is a stronger predictor of disability than Cobb angle magnitude. Conservative chiropractic management should prioritize pain control, halting curve progression, and active rehabilitation over passive manipulation. Small adult curves require immediate intervention, as initial curve size does not predict progression rates. Clinicians must implement curve-specific exercises, trunk endurance training, and adult corrective bracing when appropriate. When documented progression exceeds five degrees, or when patients develop severe neurological deficits, progressive sagittal collapse, or intractable stenosis, prompt referral to surgical or scoliosis specialists is essential.