- Are There Natural Treatments for Ankylosing Spondylitis?
- Ankylosing spondylitis – Natural therapies to help
- Autoimmune disease
- Gut Connection
- Low starch Diet
- Natural therapies
- www.superpharmacy.com.au Australia’s best online discount chemist
- New approaches in ankylosing spondylitis
- Medical treatment
- Treatment of non-radiographic axial spondyloarthritis
- New therapies
- Foods to eat and avoid with ankylosing spondylitis
- 8 Natural Ways to Relieve Ankylosing Spondylitis Pain
- 1. Stretch and get regular exercise
- 2. Practice good posture
- 3. Check your sleep posture
- 4. Take a warm soak
- 5. Try acupuncture
- 6. Get a massage
- 7. Practice yoga
- 8. Consider transcutaneous electrical nerve stimulation (TENS)
- Other Tips for Ankylosing Spondylitis Pain Relief
Are There Natural Treatments for Ankylosing Spondylitis?
There isn’t a cure for AS. It’s a lifelong condition, but effective treatments are available. Treatment goals are to minimize pain and stiffness and reduce flares. Natural treatments may be used on their own or with traditional AS treatments.
These 10 natural therapies may help relieve symptoms:
Stretching helps build flexibility and may reduce pain. Consider adding the spine stretch or the low-back rotation stretch to your daily routine.
2. Heat therapy
Apply a hot water bottle or heating pad to the affected area to reduce stiffness and pain. You may also use moist or dry heat. A warm bath may also help, especially before exercise. Don’t use heat therapy without consulting your doctor if you have diabetes, deep vein thrombosis, vascular disease, an open wound, or a skin condition such as dermatitis.
3. Cold therapy
Applying an ice pack, cold gel pack, or a bag of frozen vegetables to painful joints can help reduce swelling. After exercise, cold therapy may help reduce inflammation. Don’t apply ice for more than 20 minutes at a time. Don’t use cold therapy without consulting your doctor if you have circulation problems.
Acupuncture is an ancient remedy for pain. It involves inserting thin needles into specific points in your skin. This is thought to activate your body’s pain-relieving hormones. Some people report acupuncture relieves AS pain.
5. Massage therapy
Massage helps you relax. It may also help you feel more flexible or “loose” so that you can exercise or stretch. Massage may cause pain at tender points around your spine. If this happens, avoid those areas and only use light massage techniques until the pain improves.
The more you sit, the stiffer you’re likely to feel. Get up, move around, and stretch regularly. If you have a desk job, take a “get up and move” break every hour.
Gentle exercise programs such as yoga and Pilates are great for AS because they incorporate stretching. Swimming may also be beneficial because it’s easy on your joints. Strengthening exercises with weights can help build muscle, which supports joints affected by AS. Talk with your doctor or a physical therapist to determine the best exercise plan for you.
8. Alexander Technique
AS often leaves you hunched over. Practicing good posture is critical. The Alexander Technique teaches you to be aware of your posture throughout your day. It also teaches you how to correct poor posture and may be helpful for people with AS. To find a qualified teacher, visit the official website.
9. TENS therapy
TENS stands for transcutaneous electrical nerve stimulation. This therapy uses electrical current to stimulate nerves through the body for pain control. Electrodes are usually applied at the pain site and connected to a TENS machine. It’s thought that when TENS stimulates nerves, it overrides pain signals. The TENS technique is usually taught by a physical therapist and may be continued at home.
10. Stop smoking
Smokers, especially men, are at risk for greater spine damage from AS than non-smokers. Quitting smoking not only helps reduce AS damage, but also improves your overall health.
Check out: Most effective ankylosing spondylitis exercises “
Ankylosing spondylitis – Natural therapies to help
Ankylosing spondylitis (AS) is an autoimmune condition affecting mostly the spine. It is an inflammatory condition that causes stiffness usually in the joints of the lower spine and where it attaches to the pelvis, the sacroiliac joint, but it can also affect the hips, neck, shoulders, eyes, lungs and bowel. This condition affects men more than women and usually between the ages of 15 to 45. It is marked by stiffness, back pain and immobility.
Autoimmune diseases are often from unknown causes but they can have a genetic component, in this case the gene HLA-B27 is considered responsible. This can mean if someone else in your family has AS your chances of getting it are greater, but doesn’t mean you will get AS.
The exact cause of AS and what triggers it to develop is unknown.
Autoimmune diseases become active usually from a misguided or inappropriate response by the immune system in the body. In ankylosing spondylitis the immune system starts attacking the joints, causing inflammation and resulting in abnormal bone growth around the joint structure. This then causes pain and stiffness and in severe cases, can cause the bones to fuse together and become immovable.
Studies have found a correlation between Crohn’s disease (CD) and AS, sharing some common clinical, genetic (the HLA-B27 gene), and microbiological components, namely Klebsiella pneumoniae microorganisms. Based on many studies it is suggested this could be the trigger for AS and CD.
Klebsiella thrive in a high starch environment, so by reducing the amount of starch in the diet could potentially remove this organism and reduce the symptoms of the disease.
Like most autoimmune diseases they can settle for a while and then suddenly flare-up. Environmental causes are suspected to be responsible for triggering the initial development and then maybe the following flare-ups. This can include stress and environmental toxins along with diet and bowel issues.
Like most disorders symptoms can vary from person to person the most common ones with AS are:
- stiffness felt in the buttocks, back and neck after inactivity or sleep
- stiffness that is reduces when active
- pain in tendons ( the tissue that connects muscle to bone)
- pain in ligament area around joints
There is no easy diagnosis. It is usually based on persistent lower back stiffness, pain and tightness in the chest over a certain period of time.
X-ray and/or MRI of lower back for inflammation of the sacroiliac joint, blood test for inflammatory markers will indicate inflammation but not necessarily from SA. Gene testing for HLA-B27 gene some of the common diagnostic criteria.
There is no cure for AS, treatment is aimed at reducing inflammation and pain and keeping flexibility.
Conventional treatment involves pain relieving and anti-inflammatory medications, including corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) and biological disease-modifying anti-rheumatic drugs (bDMARDs or biologics).
Exercise is considered one of the most important aspects of treatment for AS. Exercise keeps joints and muscles flexible, encourages circulation and can keep the spine mobile. Physiotherapist can suggest different types of exercise to strengthen the back, encourage movement in the spine and help to reduce pain.
Practice good posture
Don’t smoke smoking is obviously bad for your health anyway but if you have AS the effect on the lungs and breathing can be a real issue.
Low starch Diet
Starch is not easily digested or absorbed and can remain intact by the time it reaches the colon, where it can be broken down by the Klebsiella microorganism that thrives on this food. Reducing starch in the diet can basically starve this organism reducing its effects on the body. Most carbohydrate foods contain different forms of starch, some more than others and certain foods have been found to be tastier for the Klebsiella microorganism.
Foods to reduce or eliminate:
- Root vegetables (especially potatoes)
- Grains (this includes bread, pasta and rice)
- Legumes (this means beans)
A little experimenting is needed here on how much to remove or restrict to make a difference.
AS Ankylosing Spondylitis is an inflammatory arthritic condition, natural therapies suggestions are aimed at reducing joint inflammation and supporting stress, general health and well-being.
Pain and inflammation
Turmeric (Curcuma longa) Many studies have suggested the curcumin (active ingredient) from turmeric may be helpful to reduce inflammation due to its ability to block pro-inflammatory pathways in most chronic diseases.
Turmeric in combination with and Boswellia serrata has been shown to be more efficient than a standard dose of a selective COX-2 inhibitor in the treatment of osteoarthritis.
A recent meta-analysis found enough evidence for the use of turmeric as a therapeutic option in arthritis.
Boswellia (Boswellia serrate). A Cochrane systematic review concluded that preparations from BS were helpful in reducing pain in osteoarthritis with minimal side effects. Citing two high-quality and two moderate-quality studies demonstrating superiority compared to placebo in reducing pain and increasing functionality of joints.
Ginger (zingiber officinale) may help in its anti-inflammatory action. Ginger is well indicated for arthritic conditions. The active ingredients gingerols, shagoals and paradols in ginger root have been credited with its many of the anti-inflammatory actions. Incorporate fresh or dried ginger regularly in the diet and choose a supplement form when pain relief is needed.
White willow (Salix alba) has anti-inflammatory, analgesic and anti-rheumatic properties and is suggested for any systemic connective tissue disorders marked by inflammation -arthritis/rheumatism and muscular problems. It has been approved by commission E as an anti-rheumatic agent.
Fish Oil is well known as an anti-inflammatory for arthritic conditions but a study on it for AS found in large doses (4.55grams 3 times daily in supplement form) was able to reduce the activity of the disease.
Probiotics. Saccharomyces boulardii is a specific strain that may help in the elimination of Klebsiella pneumoniae microorganisms from the bowel and reduce digestive inflammatory mediators. Combine this with a low starch diet.
Heal and seal the gut with slippery elm or aloe vera juice.
B group vitamins for energy, digestion, stress and nervous system support
Herbs chamomile (matricaria recutita) and passionflower (passiflora incarnata) may be useful to help with stress and aid sleep.
Magnesium bath can help reduce tension in the body especially muscles and tendons.
Have a relaxing bath before bed to help with sleep. Magnesium is available as a topical spray or roll on for muscular relief.
Ankylosing spondylitis is an autoimmune disease with no cure. Keep symptoms at bay with by reducing or eliminating starch from the diet. Supplement with probiotics, anti-inflammatory herbs and nutrients for stress support.
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Gut-mediated and HLA-B27-associated arthritis: an emphasis on ankylosing spondylitis and Crohn’s disease with a proposal for the use of new treatment. https://www.ncbi.nlm.nih.gov/pubmed/21955846
Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis https://www.ncbi.nlm.nih.gov/pubmed/17062435
Phytomedicine in Joint Disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295114/
New approaches in ankylosing spondylitis
Exercise is paramount in the management of AS and the role of the physiotherapist in guiding and supporting patients is key.6 Individualised assessment, treatment and monitoring are essential to aid adherence to a lifelong exercise program.7,8 Extended-scope physiotherapists who have undergone further training in AS may also play a role in management.9
Registered nurses with specific training in rheumatology can provide care that includes monitoring of disease activity, impact on activities of daily living, psychosocial health, drug treatment and side effects.10 Nurse practitioners can also autonomously prescribe medications within their scope of practice, refer patients to other health professionals and perform examinations and procedures such as joint aspiration and injection (http://www.health.gov.au/internet/main/publishing.nsf/Content/work-nurse-prac).11 They also play a critical role in education about medication-related issues such as benefits and risks, management of complications, and drug administration. This is particularly important in maintaining patients safely on biological agents which are complex to administer and have potentially severe side effects, yet also bring great benefits when used appropriately.
Patient education is key to improving coping strategies and increasing self-care abilities,10 thereby achieving a greater sense of empowerment and, in turn, function. Further, education can address comorbidities such as cardiovascular disease, as well as general health issues such as smoking, diet and reinforcing the importance of exercise. Given the major effect of cigarette smoking as a risk factor for AS, and its association with increased disease activity, rate of spinal fusion and resistance to therapy, smoking cessation is one of the key management challenges in AS, and nurse practitioners are particularly effective in implementing such lifestyle modification programs. It has also been recognised that greater levels of knowledge were found in patients monitored by a nurse compared with those monitored by doctors.10
Non-steroidal anti-inflammatory drug (NSAID) therapy is more efficacious in AS-associated pain than for pain resulting from non-inflammatory causes, and thus most patients receive these agents. It is unclear at this point whether NSAID therapy retards progression of ankylosis in AS, but it is clear that any beneficial effect is modest and probably restricted to patients with ongoing inflammation as assessed by elevation of erythrocyte sedimentation rate (ESR) or CRP levels. Use of long-acting NSAIDs, particularly when given with an evening meal, is particularly effective at controlling morning symptoms and in assisting sleep, which is frequently disturbed in patients with AS due to pain and stiffness. In the 5–10% of patients who have coexistent inflammatory bowel disease, NSAIDs may cause flares of colitis. In this setting the NSAID etoricoxib, which unlike other NSAIDs does not exacerbate inflammatory bowel disease, may be useful.12
Other disease-modifying antirheumatic drugs that are effective in rheumatoid arthritis have little or no role to play in treating AS.13,14 Sulfasalazine may be effective in AS-peripheral arthritis (knees and below or upper limb), but its beneficial effects overall are modest.15 Hip disease is considered as a component of axial disease in AS. No trial evidence to support the use of disease-modifying antirheumatic drugs alone for hip disease has been reported to date, and therefore it cannot be recommended, as these therapies are undoubtedly associated with significant side effects. Hip inflammation in AS does respond to tumour necrosis factor inhibitor (TNFi) therapy. Sulfasalazine may also be useful in recurrent acute anterior uveitis,16 a condition that ultimately affects roughly 60% of patients. Methotrexate and sulfasalazine have no demonstrated efficacy in spinal or sacroiliac disease in AS and therefore should not be used for this indication.
Corticosteroid agents should be used with great caution. Compared with rheumatoid arthritis, AS is less responsive to oral or systemic corticosteroids. Further, AS is frequently complicated by osteoporosis, which combined with the increased spinal stiffness caused by ankylosis, leads to a significantly increased risk of spinal fracture. This spinal fragility is exacerbated by corticosteroids, further encouraging caution in their use. Intra-articular corticosteroids may be useful as a short term therapy for sacroiliitis or peripheral arthritis.
Treatment of non-radiographic axial spondyloarthritis
Clinical trials have confirmed that TNFi therapy, the gold standard treatment for established AS, is also effective in treating nr-axSpA.17 This is particularly true for cases that are of more recent onset (< 3 years symptom duration), with elevated ESR or CRP levels, or a positive MRI scan, providing objective evidence of inflammation. In such cases, the treatment response is similar to that seen with established AS, where TNFi treatment is highly effective. Despite this evidence, no biological medication has yet been funded for use in nr-axSpA, leaving a significant group of patients for whom there is no funded therapy available. Currently the Australian Pharmaceutical Benefits Scheme (PBS) restrictions for access to TNFi for AS include that the patient meets the modified New York criteria for AS, has failed to respond to NSAID treatment and a 3-month exercise program, has high self-reported disease activity (Bath Ankylosing Spondylitis Disease Activity Index > 4), and has high acute phase reactants (CRP > 10 mg/L, ESR > 25 mm/h).
A key question now is whether early treatment can lead to better long term outcomes for patients.18 There is now strong evidence to support this being the case in terms of reducing progression of ankylosis. While short term studies (up to 2 years of treatment) failed to show an effect of TNFi treatment on progression of x-ray changes,19 longer studies (4 years of treatment) have shown significant benefits, roughly halving x-ray progression.20 This benefit is greater the earlier TNFi treatment is initiated. Whether TNFi retards progression of nr-axSpA to AS is not yet clear, although there is suggestive evidence that successful suppression of inflammation can lead to treatment-free disease remissions.
Genetic discoveries early in the genome-wide association study era demonstrated that genetic variants in the interleukin (IL)-23 receptor pathway were strongly associated with AS,21 and the importance of the pathway has been confirmed by immunological studies in humans and animal models. This led to the repositioning of drugs targeting IL-23 and the related cytokine IL-17 for trial in AS.
These trials have been highly successful, with response rates at least equivalent to those of TNFi treatment, and with the medications being well tolerated.22 Secukinumab, an IL-17 inhibitor, has therefore recently been PBS-funded in Australia for AS, with the same indications as for TNFi. These agents have been found to be more effective than TNFi for treatment of psoriasis, which complicates 5–10% of AS cases,23 but have variable effects on inflammatory bowel disease, which complicates a similar proportion of AS cases.
Up to 60% of patients with AS will, over their lifetime, experience acute anterior uveitis;24 and while this is typically easily treated with topical steroids and mydriatics, in a significant subset of patients it is recurrent or chronic and can lead to glaucoma and visual impairment. TNFi treatment is effective in reducing the frequency of acute anterior uveitis, although etanercept is less effective than the other agents in this regard.25 Whether IL-23 pathway inhibitors are effective in this condition is unknown. The effect of IL-23 pathway blockade on rate of ankylosis is also unknown.
This increasingly diverse pharmacological armamentarium opens the possibility of personalised approaches to medical management of patients with AS, with optimal treatment varying depending on the particular disease features that a patient may experience. Head-to-head studies will be required to determine the relative efficacy of the new agents, but given that a significant proportion of patients, for reasons related to efficacy or toxicity, cannot be managed by TNFi, the availability of alternative agents is a welcome relief for them and their caring physicians.
Despite these advances, management of AS lags behind that of the other major common immune-mediated arthropathy, rheumatoid arthritis, with fewer therapeutic options, no treatment yet convincingly shown to induce disease remission, and with less impact on slowing disease progression. This probably relates to the disproportionately low research attention AS receives in the academic sector and pharmaceutical industry relative to the burden of disease the condition causes. Given the major advances in basic research in AS, including in genetics, immunology and metagenomics, it is to be hoped that sufficient resources are made available to translate these advances into benefits for patients.
Foods to eat and avoid with ankylosing spondylitis
People with ankylosing spondylitis may find that the foods and nutrients in this section can help ease the symptoms of the condition.
However, one 2018 review advised that only very limited evidence supports a link between diet and ankylosing spondylitis. Many of the studies were too small and unreliable to confirm any conclusions.
People with ankylosing spondylitis can try using diet alongside conventional treatments to reduce the symptoms. Unless a person has intolerances or allergies, these dietary changes should be safe to try.
Omega-3 fatty acids
A 2012 review of research indicates that a diet high in these essential fats has a consistent but modest positive effect on the joint inflammation associated with rheumatoid arthritis.
The following foods are good sources of omega-3 fatty acids:
- chia seeds
- fatty fish, such as salmon, sardines, and tuna
- flaxseed oil
However, this review took place quite some time ago, and its format is limited. For this reason, more research is necessary to confirm how effective omega-3 fatty acids are for inflammation in people with ankylosing spondylitis.
Fruits and vegetables
Eating a variety of fruits and vegetables each day ensures a high intake of many of the vitamins and minerals necessary for overall health. These foods also tend to be low in calories and high in fiber.
The National Ankylosing Spondylitis Society of the United Kingdom recommend eating fruits and vegetables of different colors. These contain a wide array of antioxidant compounds that help protect against disease.
Whole grains — including brown rice, corn, quinoa, buckwheat, and oatmeal — are high in fiber and nutrients. According to one 2018 meta-analysis, they may also help reduce inflammation across the body.
However, some people may find that grains containing gluten — such as wheat, rye, and barley — trigger their ankylosing spondylitis symptoms.
Ankylosing spondylitis weakens the bones, which is why calcium-rich foods are so important. Calcium is essential for improving bone strength. Food sources high in calcium include:
- dark leafy greens, such as watercress and kale
- Chinese cabbage
- low fat dairy products
- fortified plant milks
- canned sardines with bones
- fortified tofu
- fortified cereals
Vitamin D allows the body to absorb calcium and is another vital nutrient for healthy bones.
One 2015 review of research reports that higher levels of vitamin D are associated with a lower risk of developing ankylosing spondylitis. Also, people with higher vitamin D levels are less likely to have symptoms related to the condition.
The body gets vitamin D from sun exposure and foods such as:
- fish and seafood
- egg yolk
- cod liver oil
- fortified products, such as juices, cereals, dairy, plant-based milk, and tofu
Herbs and spices
Certain herbs and spices may also be anti-inflammatory, including:
Garlic: Some compounds in garlic exhibit anti-inflammatory properties, according to a randomized trial from 2009.
Ginger: People have used ginger as an anti-inflammatory remedy for centuries. Recent research supports this.
Turmeric: One of the main components in turmeric is curcumin, which is a compound that may help reduce inflammation.
In this article, learn about the progression of ankylosing spondylitis.
8 Natural Ways to Relieve Ankylosing Spondylitis Pain
Yoga is a great natural pain reliever for ankylosing spondylitis — start with very basic poses. Getty Images
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One of the most frustrating things about ankylosing spondylitis is experiencing pain not from exertion but from doing nothing more than trying to get a good night’s sleep.
Back pain — the most common symptom of ankylosing spondylitis — and stiffness get worse with rest, so they’re probably at their worst in the morning, just when you want to get your day started. You might also have pain and stiffness in other areas of your body, such as your neck, shoulders, hips, or feet.
While it’s important to work with your doctor to find the right ankylosing spondylitis medications for you, there are also some natural pain-relief strategies you can try to help manage your back pain and other symptoms. The best part: You can use many of these every day.
1. Stretch and get regular exercise
“If you have ankylosing spondylitis, you need to stay active to maintain your flexibility,” says Rochella Ostrowski, MD, an associate professor in the division of allergy, immunology, and rheumatology at Loyola Medicine in Maywood, Illinois. Exercising and stretching can help ease pain and stiffness in your joints, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. “The best exercises are those that avoid high impact,” says Dr. Ostrowski. She suggests working with a physical therapist who can design the right exercise and stretching program for you, including when to work out. Later in the day when you’re less stiff may be the best time.
2. Practice good posture
Over time, ankylosing spondylitis can cause your vertebrae to fuse together, putting strain on your spine and leading to a stooped posture. This can create a vicious pain-posture cycle, according to the Spondylitis Association of America (SAA) — you tend to bend over if you’re experiencing pain in your back, which can further increase strain on your spine. To help combat this, Ostrowski recommends checking your posture frequently at home and at work. “Make sure you’re well-aligned and that you do gentle range-of-motion exercises often to avoid long periods of immobility,” she says. Reinforce good posture by regularly checking your alignment against a wall, she adds. You don’t want your spine to stiffen into a bent position, so aim for tall and straight.
3. Check your sleep posture
“Sleep posture is also important,” Ostrowski says. “You need a firm bed and a pillow that supports your neck properly. Avoid a pillow that’s too high. Sleeping on your belly is best for your posture, but some people can only sleep on their side or back.” If you’re in that group, try spending a few minutes of your awake time practicing “prone lying,” the SAA suggests. This involves lying face down on a firm surface. For comfort, you can turn your head from side to side. This exercise helps promote better daily posture. Work up to 20-minute sessions to help with back pain relief.
4. Take a warm soak
“A warm bath or shower is a natural way to relieve the pain and stiffness of ankylosing spondylitis,” Ostrowski says. “Stretching to relieve pain and stiffness is also better after a warm shower. You should avoid stretching with cold joints and muscles.” Alternating hot and cold compresses on painful spots is another natural pain-relief strategy you can try, the Arthritis Foundation recommends.
5. Try acupuncture
This ancient technique that involves inserting thin needles through the skin may stimulate your body’s natural pain relievers. “Studies on acupuncture for back pain relief have had mixed results,” Ostrowski says. “But I don’t discourage it, and it’s helped some people with back pain.” A review of clinical trials published in September 2019 in the journal Medicina Clinica notes that acupuncture improved “pain and functionality” in people with low back pain, though more research is needed for its effects on ankylosing spondylitis. Acupuncture should be performed by a trained and licensed acupuncture professional.
6. Get a massage
“Massage therapy, when performed by a therapist accustomed to working with ankylosing spondylitis, may be helpful,” Ostrowski says. Massage may not only help relieve the pain and stiffness of ankylosing spondylitis but also help ease the stress commonly brought on by having a chronic condition, the SAA says.
7. Practice yoga
“Yoga is a great natural pain reliever for ankylosing spondylitis,” Ostrowski says. “You need to start with very basic poses and be patient, but if you work with an instructor who can modify the yoga positions for you, you can really benefit from this form of exercise.” Results from a clinical trial of yoga for chronic low back pain published in October 2019 in the Journal of General Internal Medicine found that yoga reduced pain and improved functionality while enhancing sleep quality in adults with the condition.
8. Consider transcutaneous electrical nerve stimulation (TENS)
TENS involves passing an electric current through the skin. It may work on the same principle as acupuncture — by bringing about the release of the body’s natural pain relievers, the SAA notes. Although there have been some studies on TENS for back pain, results are mixed. Ostrowski says physical therapists may use TENS for pain that’s not responding to exercise and stretching.
Other Tips for Ankylosing Spondylitis Pain Relief
Considering seeing a chiropractor? Chiropractic treatment generally is not recommended for ankylosing spondylitis, the SAA notes. “Chiropractic care isn’t advised for this type of back pain because changes from ankylosing spondylitis may increase the risk of injury during manipulation,” Ostrowski says.
But there are a few other small steps you can take to help manage ankylosing spondylitis pain naturally. “I recommend lots of deep breathing to keep your rib cage flexible, and I strongly advise against smoking,” Ostrowski says. “Avoid physical and emotional stress as much as possible, have a good support system, and make sure to get enough rest.
“Sometimes with ankylosing spondylitis,” she says, “you just need to take life a little slower.”
Additional reporting by Diana K. Rodriguez and Brian Dunleavy