Getting Physical to Ease Your Ankylosing Spondylitis

By Maura Iversen, DSc, as told to Hallie Levine

When you have ankylosing spondylitis (AS), an inflammatory disease that causes pain and stiffness in your lower back and spine, it’s important to stay as physically active as possible. That may sound counterintuitive: Why would you keep moving if it hurts to do so? But AS can get worse if you don’t. When you’re active, you’re less likely to stiffen up and have pain. As a physical therapist and behavioral scientist who focuses on rheumatological diseases like AS, I believe strongly that physical therapy is a crucial part of treatment that can be as important as medication. It can go a long way toward managing discomfort and help you get back into a regular routine again.

Support Your Spine

Over time, you may have progressive stiffness that makes it hard for you to turn your head, stand up straight, or bend. This is because AS leads to abnormal bone growth that causes the joints around your spine, hip, and pelvis to fuse together. It makes good posture difficult and can cause you to stoop forward. You may have trouble walking and fall more easily. People with AS sometimes have trouble breathing because the joints stiffen where their ribs and spine are, which limits their ability to take a deep breath.


With physical therapy, the goal is to make sure you’re actively engaging in movement around your spine. Strengthening exercises for your back and abdominal muscles do that. The stronger they are, the less stress on your spine, which can ease pain. Some of the best exercises to do include bridges and planks, but they can be hard if you don’t have much range of motion. Your physical therapist can modify, or change, exercises to make them as comfortable as possible for you. For example, if I have a client who is a parent of a young child, I may show them how to safely get down on the floor onto their belly, propped on their elbows. This sort of activity allows them to play with an infant or toddler and also stretches out shortened muscles in the back that impact pain. Other key moves are:

  • Wall sits, which strengthen your butt, back, and hips
  • Standing leg raises to help loosen tight hips
  • Chin tucks to stretch your neck

Since AS can also lead to your spine becoming “frozen,” posture training is very important. Most of us spend our days sitting in front of a computer, which weakens back muscles and encourages us to hunch forward. Your physical therapist can work with you on exercises, such as standing up against a wall, or even yoga moves like Mountain or Child’s Pose. Range of motion and stretching exercises, which can make you more flexible and lessen stiffness, swelling, and pain, are also key. These are particularly important because patients tend to limit movement whenever they have pain and stiffness around a joint, like during an AS flare. This lack of movement can raise the risk of fusion of the joints. And when a joint is inflamed, surrounding muscles often tighten around it, causing even more stiffness and pain.

Get Physical Outside of Physical Therapy

Module: video
funded classroom perspectives ankylosing spondylit
Exercises for Ankylosing Spondylitis While there is no cure for ankylosing spondylitis, exercising is key to keeping your mobility and flexibility. Learn what to do and how each type of exercise helps you.327

SUBJECT: Ankylosing Spondylitis,

or AS, is a rare type

of arthritis that causes

inflammation of the vertebrae.

AS shortens the spine

in your back, and it also causes

sections of the spine to grow

and fuse together,

resulting in stiffness

and immobility.

Although AS has no cure,

medicines, exercise

and a healthy lifestyle

can relieve your symptoms

and slow progression.

Regular exercise

is an important part of treating

the condition.

By improving posture, easing

stiffness, pain and fatigue,

exercise helps maintain mobility

and flexibility.

Staying active

is proven to optimize physical

and mental health in everybody.

There are four main types

of exercises recommended--


cardiovascular, strengthening

and balance exercises.

Daily stretching keeps muscles

flexible, strong and healthy,

and encourages better posture.

Stretching muscles and joints

through their full range

of motion helps reduce

stiffness, swelling and pain,

which helps to minimize the risk

of bone fusion.

You can do this stretch

anywhere, any time.

Start by standing or sitting

up tall.

Keep your spine straight

and shrug your shoulders up

towards your ears,

then move your shoulders back

and down.

Think about pulling

your shoulder blades together

and down in a rolling motion.

Then pull your shoulders back up

toward your ears.

Repeat a few times.

Another stretch to help lengthen

your spine is called Cobra Pose.

Lie on your stomach

with your legs behind you,

and slowly prop yourself up

on your elbows

so your chest is off

of the ground.

Straighten your arms

and hold for 15 seconds.

Repeat three to five times.

This next stretch eases back

pain and loosens your hip


Take a big step forward and sink

into a Lunge.

Move your knee down and rest it

on the ground,

while keeping your back upright.

You should feel this

in your quadriceps.

Hold for 20 seconds,

and repeat with your other leg.

Hold on to a chair for balance,

if needed.

Next, aerobic exercise,

or cardiovascular conditioning.

It includes activities

like swimming, walking, running,

or cycling.

Doing this type of activity

will increase blood flow

through the heart

and improve your overall health.

People with AS who engage

in aerobic exercise have better

breathing function, endurance

and mood, with less disease

activity, pain and fatigue

than people who don't exercise.

You want to aim for this type

of exercise three to five times

a week

for a total of 75 to 150 minutes

per week.

The most important muscles

to strengthen in AS are the core


Having strong core muscles

has been shown to reduce stress

in the spine and can minimize

back pain.

Grab a yoga mat

and kneel for a Plank.

Put your forearms on the ground,

push your legs out behind you,

and balance on your toes.

Squeeze your stomach and butt

muscles to hold your body

in a straight line.

Keep your neck in line

with your spine

and hold for a few seconds.

Repeat three to five times,

a few times a week.

Next, find a wall

and stand with your back

against it.

Put your feet shoulder width


Slowly slide your back down

the wall.

It may take time, but work

towards being able to get

to the point

where your thighs are parallel

with the floor,

like you're sitting in a chair.

Hold for 10 seconds,

and repeat three to five times,

a few times a week.

Finally, we have exercises

that focus on balance.

Balance exercises help reduce

the chances of falling

and should be performed three

to five times per week

for the best results.

First up, standing leg raises.

These loosen tight hips,

while helping build balance.

Hold the back of a chair

or railing.

Keep your back straight

with a slight bend

in your knees.

Slowly lift one leg out

to the side

so it's a few inches

off the ground, then lower it

back to the starting position.

Next, kick the same leg straight

behind you to 45 degrees.

Remember to keep good posture

and avoid bending over

at the waist.

Repeat 10 to 15 times

on each leg.

By working with your physician

and physical therapist,

you can set realistic goals

for yourself.

Choose exercises

or physical activities that are

safe and enjoyable,

and stick with a program that

optimizes your health.<br><br><br><br><br><br>,4500k,2500k,1000k,750k,400k,.mp412/14/2020 12:00:0018001200funded classroom perspectives ankylosing spondylit/webmd/consumer_assets/site_images/article_thumbnails/video/funded_classroom_perspectives_ankylosing_spondylitis_video/1800x1200_funded_classroom_perspectives_ankylosing_spondylitis_video.jpg091e9c5e820a7616

What you do outside of physical therapy is just as important. Try to do as much aerobic exercise as possible, ideally most days of the week for at least 30 minutes. People with AS have a higher risk of heart disease, so any

activity that helps heart function is important. It also improves lung capacity, which can ease some of the chest tightness that often comes with AS. Your physical therapist can help you figure out what workouts are best for you. If you love to bike, for example, you’re better off with a stationary bike where you stay upright rather than bending over. Swimming is another great activity, especially if you do the breast or back stroke. Both of these strengthen and stretch out your neck, shoulders, and back muscles. But honestly, you can make any type of exercise work. I had one patient who loved ice hockey, so we created a routine for him at his local ice skating rink. He’d skate around with a hockey stick, passing a puck from side to side, to encourage trunk rotation.

Make Time for Relaxation

People often ask me if complementary therapies like acupuncture or massage can help. They can’t hurt, but they probably don’t do much. These types of treatments are passive, which means the therapist is doing most of the work. It might make you feel better for a bit, but it won’t actively build strength and flexibility, which is what you need to manage AS-related pain in the long run.

What does help, and what I encourage my clients to do, are meditative exercises such as deep breathing several times a day, as well as before physical therapy and exercise. These relax your entire body, including your muscles, which makes it easier for you to move through an entire range of motion. Deep breathing also helps prevent the muscles around your spine and rib cage from getting too tight, which can impact breathing. I also recommend activities like yoga, Pilates, or tai chi several times a week. While there are no specific studies on their effects on people with AS, studies on back pain have found that people who do them regularly have significantly less pain and disability than those who don’t. These have meditative and breathing benefits, too.

It's important to remember that there’s no cure for AS. But the right treatments -- including physical therapy -- can go a long way toward reducing the pain and stiffness that come with the disease.

WebMD Feature



Maura Iversen, DSc; dean, College of Health Professions, and professor of public health & physical therapy & human movement science, Sacred Heart University, Fairfield, CT.

UpToDate: “Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics).”

Spondylitis Association of America: “Exercise.”

Cochrane Database of Systematic Reviews: “Yoga treatment for chronic non-specific low back pain.”

Seminars in Arthritis and Rheumatism: “Exercise for ankylosing spondylitis: An evidence-based consensus statement.”

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