Ankylosing spondylitis physical therapy

How Physical Therapy Helps Ankylosing Spondylitis

Even though medications provide much relief from AS symptoms and could even slow down its progression, physical therapy can be a valuable part of your ankylosing spondylitis care. Physical therapy components, like stretching, exercise, improving posture, and even strategies such as selecting the right mattress and workplace chair, focus in on your specific needs to improve your quality of life.

Since ankylosing spondylitis is an inflammatory disease that affects your spine and functions associated with your spine, using the supporting modalities make sense, says rheumatologist Daniel Clegg, MD, chief of the division of rheumatology the University of Utah Healthcare in Salt Lake City. “Physical therapy for range of motion and posture are really important, because if you aren’t in a good posture and have the unfortunate outcome of fusing in that position, that can be even more debilitating.” Physical therapy can help maintain your quality of life, adds Dr. Clegg.

Romanian researchers screening nearly 100 people with AS confirmed that a postural assessment along with correcting any misalignments should be part of the physical therapy strategy for people with ankylosing spondylitis.

The Benefits of Physical Therapy for AS

“The most important thing physical therapy can provide is helping with respect to self-management of ankylosing spondylitis,” says physical therapy expert and educator Maura Iversen, chair and professor in the department of physical therapy at Northeastern University in Boston.

“The main symptoms are loss of mobility of the spine over time, which can be very debilitating with respect to aerobic capacity,” says Iversen. If your vertebra and your ribs fuse, your rib cage loses flexibility, which means your lungs are less able to expand fully.

Physical therapy can also help with other symptoms including tendon pain and stiffness and painful joints. Correcting your habits of movement and positioning early on with AS can help maintain your long-term mobility and health. For example, uncorrected poor posture could result in a curved spine and, eventually, difficulty looking at level or up.

Physical therapists with AS skills can provide strategies to reduce AS pain, create exercise plans that will help you stay mobile and active longer, find ways to work around your changing mobility, and even restore mobility after you’ve lost it.

RELATED: What to Eat When You Have Ankylosing Spondylitis

According to research published in Current Opinions in Rheumatology, physical therapists have a role at various stages of AS. PTs can help you learn how to be active at home or in your free time, and also play a significant role in rehabilitation for patients with severe AS.

Specific strategies of physical therapy for AS include:

  • Posture education
  • Stretching exercises to keep joints healthy
  • Range of motion exercises
  • Strengthening exercises that help the muscles of your chest support you
  • Aerobic exercise to improve endurance
  • Developing a plan for activity, movement, and posture that will preserve mobility
  • Water-based programs to help with motion and pain

Making the Most of Physical Therapy for AS

Iversen says that paying for AS physical therapy can sometimes be a challenge for patients, so she plans her sessions in order to maximize time. That means teaching people stretches and exercises they can do at home without her and using their sessions with her to focus on activities that can’t be done outside of her office. She also might use computer or phone video chats to record patients walking in their usual, relaxed posture and then provide a comparison of correct movement and posture so they can self-correct at home.

Because ankylosing spondylitis is a progressive condition, you might be building a long-term relationship with a physical therapist or physical therapy practice, so it’s important to trust the PT you’re working with. Your doctor can help you decide if PT should be part of your plan and can help refer you to a therapist who understands the needs of AS.

6 Daily Stretches for Ankylosing Spondylitis that Can Help Ease Pain

Back pain is typically one of those aches that worsens when you bend or walk and feels better when you rest or recline. That’s not the case with ankylosing spondylitis. This inflammatory disease causes pain and stiffness in your lower back and hips — especially in the morning or after prolonged periods of not moving. (Read more about the difference between inflammatory and mechanical back pain here.)

Here’s why your back hurts when you have ankylosing spondylitis (AS), and how stretching and exercise helps relieve symptoms.

How Ankylosing Spondylitis Affects Your Spine

Ankylosing spondylitis (AS) is a form of arthritis that causes inflammation in the joints in your spine, or vertebrae. As the disease progresses, it impacts the sacroiliac joints (which connect the base of your spine and your pelvis), and can lead to severe and chronic pain, stiffness, and discomfort in your lower back and hips.

Inflammation may also occur in the connective tissue in your spine where tendons and ligaments attach to bone (caused the entheses); in the cartilage between your breastbone and ribs; the back of your heel; as well as your hip and shoulder joints. (Here are other symptoms of ankylosing spondylitis to be aware of.)

In more severe cases of AS, new bone forms in the spine as part of the body’s attempt to heal from the inflammation. The extra bone bridges the gap between vertebrae, reducing flexibility in your back. Eventually, bone grows at the sides of the vertebrae, causing sections of the spine to fuse together and become immobile, which can reduce your ability to turn your head, stand up straight, or bend. Bony fusions can also stiffen your rib cage, making it tough to take deep breaths.

Less often, fusion of the spine can cause it to curve forward, resulting in a hunched-forward posture.

There’s no cure for ankylosing spondylitis, but treatments — including medication (such as non-steroidal anti-inflammatory drugs, or NSAIDS, and biologics) and physical therapy — can lessen pain and stiffness, and possibly slow the progression of the disease.

How Exercise Helps Ankylosing Spondylitis

Besides seeing your doctor regularly and following your treatment plan, staying active is probably the best thing you can do to manage your AS. “Physical therapy and exercise can help relieve pain, maintain flexibility, and improve mobility, posture, and strength,” says Pranjali Sathe, PT, DPT, an Ohio-based board certified orthopedic physical therapist. In fact, most people with AS say pain improves after exercise or activity.

The best time to exercise: when you wake up. “Morning stiffness is very common with AS,” explains Dr. Sathe, who is also certified in the McKenzie Method of Mechanical Diagnosis and Therapy. Start with flexibility and range-of-motion exercises, and continue to stay active and exercise throughout the day.

The types of exercises your doctor or physical therapist may recommend include:

Posture training: Practicing good posture techniques helps you avoid slouching forward so you reduce the amount of strain on your spine.

Flexibility exercises: Gentle range-of-motion and stretching exercises help keep the spine and other joints from getting stiff, improve mobility in your joints, and help keep your back flexible.

Deep-breathing exercises: The goal is to expand your chest so you can breathe better.

Strengthening exercises: Making your back and core muscles stronger can help maintain proper posture and keep your body stable. Strengthening back muscles also provides better support to bones and joints, which may reduce pain.

Balance exercises: “Loss of balance is seen in advanced AS,” says Dr. Sathe. Poor posture can make you less steady on your feet, which can increase your risk of falling when you walk.

Aquatic exercises: Water aerobics can help decrease joint pain and improve mobility.

Stretches Exercises to Help Ankylosing Spondylitis Pain

If you’re new to exercise, always talk to your doctor before starting. Your doctor or physical therapist can make sure the exercises are safe for you. Start slowly and move gently. And if any activity increases joint pain, and if pain continues for several days after exercise, it’s time to stop. Talk to your doctor about what pain is normal and when it’s a sign of something more serious.

The following stretches and exercises were recommended by Dr. Sathe, who is the author of the APTA’s “Physical Therapist’s Guide to Ankylosing Spondylitis.”

Physiotherapy for ankylosing spondylitis

How well does physical therapy work for treating ankylosing spondylitis and how safe is it?
To answer this question, scientists working with the Cochrane Musculoskeletal Group found and analyzed 11 studies testing over 700 people who had ankylosing spondylitis (AS). Studies compared people who did exercises at home, went to group exercise programs, went to spa or balneotherapy, performed different exercise programs or had no therapy at all. These studies provide the best evidence we have today.

What is ankylosing spondylitis and how can physical therapy help?
AS is a type of arthritis most typically affecting the joints and ligaments of the spine, and results in varying degree of pain, stiffness and disability. Physiotherapy is an important treatment to maintain or improve movement in the spine, improve fitness and decrease pain.

How well does physical therapy work?
Four studies compared individual or supervised exercises to no therapy at all. They found that both individual and supervised exercise programs improve spinal movement more than no therapy. The exercise programs were done for two to six months.
Three studies compared home exercises to supervised group exercises. They found that group exercises improve movement in the spine and overall well-being, but did not improve self-reported physical function more than home exercises. Exercises were done for three weeks to nine months, and included strengthening, aerobic exercises, hydrotherapy, sports activities and stretching.
One study compared two groups who both did weekly group exercises for 10 months, but one of the groups also went to a spa resort for three weeks of physiotherapy. Spa therapy plus weekly group exercises improves pain and overall well-being more than just weekly group exercises. One study compared balneotherapy and daily exercises with only daily exercises, and another study compared balneotherapy with fresh water therapy. Both these studies showed improvements after treatment for several outcomes, but no significant differences between the groups were found. One study compared a four-month experimental exercise program with a conventional program. Both groups improved, but the experimental exercise group improved more on spinal mobility and physical function than the conventional exercise group.

Did physical therapy harm patients?
Harms to the patients were not reported in the studies.

What is the bottom line?
Physiotherapy or exercises are helpful to people with ankylosing spondylitis.

There is “silver” level evidence ( that exercise programs, home-based or supervised, are better than no exercises and improve movement and physical function. Group exercises are better than home exercises, and improve movement and overall well-being. Adding a few weeks of exercising at a spa resort to weekly group exercises is better than just weekly group exercises. Balneotherapy in addition to exercise program did not show additional effect, nor did balneotherapy compared to fresh water therapy. An experimental exercise program showed more improvement on mobility and physical function than conventional exercises, but differences between groups were not statistically significant. We still need more information about the different types of physiotherapy and exercise, and how long, how intensive and how often physiotherapy should be done for the most improvement.

AS is a chronic inflamatory disease, and a form of arthritis that affects the spine. It happens when the body’s immune system attacks healthy tissue. As the spine tries to heal, the vertebrae fuse together, causing stiffness, pain, and restriction of movement. The signs and symptoms of AS usually occur in adulthood, and can cause a forward flexed posture and difficulty breathing.

Symptoms of AS

The severity of the symptoms varies for each individual. Some of the typical symptoms are:

  • Gradual onset of back pain and stiffness
  • Early-morning stiffness and pain, reducing during the day with movement
  • Pain lasting for more than 3 months
  • Weight loss
  • Exhaustion
  • Feverish and night sweats

“Physiotherapy and exercise can have a big effect on the outcome of your AS.” -Canadian Spondylitis Guidebook

You can manage AS by a combinanation of medication and exercise to reduce pain and inflammation.

Practical Advice

  • Keep good posture. Think tall all day!
  • Get a suitable chair. The seat shouldn’t be too long. Avoid low, soft chairs as it will encourage bad posture and increase pain.
  • Stand up, walk around, and stretch! Try not to sit for too long.
  • Reduce pain and stiffness by trying a hot bath or shower first thing in the morning or before bed.
  • Decrease swelling with ice packs.

Physiotherapy and Excercise Will Manage Your Pain!

Some of the ways your physiotherapist can help:

Create a personal exercise and stretching routine to manage pain and stiffness.

Correct your posture to manage pain.

Maintain good range of movement so you can accomplish daily tasks easier.

Design cardiovascular exercises to improve chest expansion, decrease fatigue, and improve sleep.

Provide education and other therapies to relieve pain.

———- —– ———- Students from the School of Physiotherapy created a printable info sheet on this topic in partnership with the Saskatchewan Physiotherapy Association.Click here for the info sheet.

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