Medication helps slow down ankylosing spondylitis (AS). But it's not always enough to manage your symptoms.
Exercise can help keep AS from getting worse, and it can make a big difference in how you feel. Other lifestyle changes and natural treatments may help, too. They might even reduce how much pain medicine you need.
What Kinds of Exercise Are Best?
Exercise is an important part of your treatment for AS. Do a combination of these four types to help you move better, boost your mood, and ease pain:
- Cardio. Bicycling, outdoors or indoors, is a great low-impact exercise if you have spine stiffness from AS. Swimming and water workouts are easy on your joints. Resistance from the water helps keep your muscles strong at the same time.
- If you can do tougher workouts, try high-intensity interval training a couple of times a week. You'll alternate short sprints of intense exercise with periods of less strenuous movement. It can ease fatigue as you build endurance.
- Try to do some cardio exercise most days, for a total of 75-150 minutes per week. Avoid high-impact activities if they cause pain, as well as those that involve physical contact with others.
- Strength training. Train two to four times a week, using weights, exercise bands, or your body weight as resistance. Include "core" exercises to strengthen the ab and back muscles that support your spine.
- Stretching. Range-of-motion and stretching exercises can help ease stiffness and pain and help you move better. They can also keep your joints flexible and improve your posture. A specialist in physical therapy can help you if you don’t know where to start. It's best to stretch every day.
- Balance exercises. Better balance cuts your risk of falls. That's important because AS can cause low bone density and raise your risk of broken bones. Try yoga or tai chi balance exercises, or simple moves like standing on one foot. Do balance exercises three to five times a week.
Some types of exercise have more than one benefit. Yoga, tai chi, and Pilates can all help with:
- Strength
- Balance
- Flexibility
- Posture
- Breathing
Formal exercise isn’t the only type of movement that helps. Throughout the day, find ways to sit less and move more. This helps you stay mobile and cuts your risk for bone fusion. Fusion happens when AS causes bone to grow between your vertebrae, joining them together.
Anti-Inflammatory Diet
There’s no single best diet for AS. But many foods that are part of the Mediterranean diet can help tamp down inflammation:
- Vegetables
- Olives
- Fish
- Fruit
- Nuts
- Whole grains
- Legumes
Highly processed foods, on the other hand, may increase inflammation. These are packaged or pre-prepared foods that tend to have lots of sugar, bad fats, and chemical additives.
Some early research has suggested that a low-starch diet could help ease AS symptoms. It involves avoiding starchy foods like pasta, rice, bread, and potatoes. We don’t have enough research to say whether this approach works. But some people think that it helps them.
Vitamins and Supplements
Omega-3s. Omega-3 fatty acids, found in nuts and fatty fish like salmon, are anti-inflammatory. A few studies have looked at whether people with AS could benefit from taking high doses of omega-3s. But we need more research. Ask your doctor about whether omega-3 supplements are a good idea for you.
Don’t take fish liver oil, such as cod liver oil. You could get too much vitamin A, which can react with the nonsteroidal anti-inflammatory drugs (NSAIDs) many people take for AS. This can cause bleeding problems.
Vitamin D. AS sometimes leads to thinning bones. Your bones depend on vitamin D, along with calcium. People with AS tend to have lower levels of vitamin D. This is especially true when you take steroid medications, which interfere with how your body absorbs the vitamin. Vitamin D may also help with inflammation.
Your doctor can check your vitamin D levels to find out whether you need a supplement. You can also get D from brief periods in the sun, and from foods such as sardines, eggs, and fortified milk or cereal.
Curcumin. This is the active ingredient in the spice turmeric. Nano curcumin is a processed form that your body can use more easily. Studies in people with AS have found that nano curcumin supplements cut inflammation. Ask your doctor if a curcumin supplement could help you, and which types are best.
Physical Therapy and Bodywork
Physical therapy. A physical therapist (PT) can teach you good body mechanics. This makes it easier to do everyday tasks. They might give you heat or cold therapy to relax your muscles and ease joint pain. And they can help you create an effective and safe exercise program.
Good posture. It eases pain and stiffness. When you're at your desk, keep your computer screen at eye level. Bring your phone up to your face rather than looking down. Pace yourself through the day so you don't get too tired to sit up straight. Some exercises can improve posture, too. A PT can work with you on your posture.
Alexander technique. It’s an approach to posture and movement that aims to put less stress on your body. Someone trained in the technique can show you how to become more aware the way you position and move your body. The goal is to improve your posture and help you move in a more efficient way.
Deep breathing. If AS affects your ribs and breastbone, you may have a hard time taking deep breaths. You can learn deep-breathing techniques from a respiratory therapist. They may be easier to do after a hot shower or warm bath.
Mindfulness. This is a selection of techniques that include yoga, meditation, tai chi, and others. Sometimes these approaches involve physical movement and sometimes not. Biofeedback uses a machine to “feed back” your emotional responses to you so that you can learn to control them. What these methods have in common is that they strive to calm the mind, often through a concentration on your breath. Research shows this can help with chronic pain from AS.
Massage. Some people get relief from gentle massage. But if not done correctly, it could trigger pain. There's not much research on whether massage helps people with AS. So be careful. Make sure your massage therapist has experience with ankylosing spondylitis.
Acupuncture. This is done by a skilled acupuncturist, who inserts thin needles at specific points on your body to ease pain. Studies have found it helps some people with AS but not others. But doctors generally think acupuncture is safe.
Transcutaneous electrical nerve stimulation (TENS). A TENS machine sends a low-voltage electrical current through your skin to stimulate your nerves and ease pain. Studies on people with AS have had mixed results. You can get TENS from a physical therapist.
What Not to Do
Avoid chiropractic. Ask your doctor if a chiropractor might help you. But if you have spinal fusion, osteoporosis, or low bone density, it's best to avoid manipulation by a chiropractor. It could lead to spinal fractures and nerve problems.
Don’t smoke. This can worsen AS and the breathing problems it sometimes causes. If you smoke, ask your doctor for advice on quitting.
