Swimming has traditionally been recommended as a conservative management and rehabilitation strategy for scoliosis due to its low-impact nature and potential to promote symmetrical muscle activity. However, emerging evidence challenges this assumption, suggesting a possible association between swimming and a higher prevalence of spinal deformities. This review aims to assess the prevalence and potential mechanisms of adolescent idiopathic scoliosis (AIS) among swimmers. Studies have reported a scoliosis prevalence of approximately 4.1% in adolescent swimmers, with mean thoracic and lumbar curvatures of 15.7° and 13.7°, respectively (Aydın et al., 2020). Comparative analyses indicate that competitive swimmers exhibit greater risks of trunk asymmetry, hyperkyphosis, and hyperlordosis than non-swimmers (Zaina et al., 2015). Proposed mechanisms include muscle imbalances caused by repetitive unilateral movements, rotational loading during certain swimming strokes, and preexisting scoliosis among swimmers advised to engage in aquatic therapy. Sex-specific differences, particularly in female swimmers, may further contribute to spinal deviations and back pain. Although swimming offers general musculoskeletal benefits—such as improved endurance, flexibility, and cardiovascular health—it does not demonstrate significant corrective effects on spinal curvature progression. Therefore, while swimming can be part of an integrated exercise plan, it should not be solely relied upon as a therapeutic intervention for scoliosis. Multidisciplinary management involving physiotherapists, spine specialists, and coaches is recommended to tailor training programs and monitor spinal health. Future longitudinal studies are required to elucidate the causal relationship between swimming participation and scoliosis development.