Have You Been Diagnosed With
Ankylosing Spondylitis?

Being diagnosed with Ankylosing Spondylitis (AS) can be scary. What is this lower back pain disease? How will my function be affected? What are the best treatment options and specifically what can I do to regain control?




What is Ankylosing Spondylitis?

AS is a chronic inflammatory disease that affects the spine, sacrum, and sacroiliac (SI) joints. The classic or hallmark of the disease is inflammation of the SI joints. AS is a systemic disease much like Rheumatoid Arthritis (RA), and Psoriasis Arthritis in that it is a chronic autoimmune inflammatory disease. Chronic inflammation of the joints of the spine leads to extreme stiffness and in prolonged cases, fusion of the spine. Because it is a systemic disease, other areas of the body can also be affected including shoulders, ribs, feet, and hips.


ankylosing spondylitis


What causes Ankylosing Spondylitis?

AS has a strong genetic cause with 90% of those afflicted having the genetic marker called HLA-B27. It is important to note that just because you have this marker does not mean you will contract AS. Males are three times more likely to have AS then women. Typically the symptoms and diagnosis occurs between the ages of 17 and 35.


Typical Symptoms of AS

Lower back pain and stiffness are the most common symptoms affecting those with AS. Most commonly the symptoms are associated with the SI joints, spine and hips. As the disease varies from person to person, severity of symptoms also varies.

Similar to Rheumatoid Arthritis, ankylosing spondylitis is more often characterized by episodes of ‘flares’ during which symptoms are elevated. During times of remission symptoms can be either minimized or nonexistent.

Similar to other inflammatory joint conditions, symptoms can be worse in the morning. As the day progresses and with typical movement, mobility and pain improves.

In significant cases, loss of motion of the spine, SI joints, hips can occur. This loss of motion most often can lead to a stooped or flexed posture as the mobility of the spine from the neck to the lower back become limited in its ability to extend.


Spinal posture


Typical Conservative Treatment

The most common treatment for AS is the use of NSAIDS (non-steroidal anti-inflammatory drugs). If these medications are not effective or if the side effects (especially Gastrointestinal) limit their use, other disease modifying medications will be recommended by your rheumatologist.

The use of heat and ice therapy can also be helpful in modifying symptoms. Only use heat during episodes of stiffness and no pain. Because pain is an indicator of increased inflammation, only ice should be utilized during painful episodes.



Physical Therapy Exercise

Physical therapy is a key component to the treatment of the symptoms of AS. As the spine, SI joints, and hips stiffen, mobility and function can become limited. Being consistent with your exercise program can help to limit loss of function and improve symptoms of pain and stiffness.

The key focus in maintaining mobility is to focus on postural muscles and joints. Mobility is often lost in the direction of extension, leading to a forward flexed posture. Exercises and activities that involve repetitive or sustained flexion of the spine should be avoided or at least minimized. These exercises can include biking (secondary to forward flexed posture), sit-ups, push-ups, and other chest and abdominal exercises.

Conversely, exercises emphasizing spinal extensors should be frequently utilized. Swimming is an excellent aerobic exercise choice as it works the spine extensors and keeps the spine in a neutral position.

Exercises that stretch the anterior or flexor muscles and strengthen the posterior or extensor muscles are the cornerstone of physical therapy treatment. Typical stretches for AS includes hip flexor stretches for the hip, prone on elbows stretches for the spine, and doorway stretch for the chest.


prone on elbows


Strengthening exercises include rows for the middle back, prone opposite arm and leg lifts for the spine, and bridges for the hips.

Click here for detailed information ankylosing spondylitis exercises.


Summary

• Ankylosing spondylitis is a systemic chronic inflammatory disease the most commonly affects the SI and spinal joints.

• AS has a strong genetic component.

• Lower back pain and stiffness can occur in times of active ‘flares’.

• Medical treatment focuses on anti-inflammatory medications.

• Physical therapy exercises focus on limiting spine flexion and emphasizing extension.

• Follow the recommendations in this exercise program to maintain function and limit pain: ankylosing spondylitis exercises.

Take control of your situation by being consistent with the treatment recommendations. In many situations, having a diagnosis of ankylosing spondylitis does not have to mean a life of pain and limitation.




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References

Curr Opin Rheumatol. 2011 Mar;23(2):142-7.Physiotherapy for ankylosing spondylitis: evidence and application.Passalent LA

Best Pract Res Clin Rheumatol. 2010 Oct;24(5):625-35.Are current available therapies disease-modifying in spondyloarthritis?Lories RJ, de Vlam K, Luyten FP

Ann Rheum Dis. 2011 Jun;70(6):896-904.2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis.Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D