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
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.
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.”