Exercises for ankylosing spondylitis

7 Exercise Dos and Don’ts for Ankylosing Spondylitis

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Exercise is good for just about everybody. It can make us stronger, more flexible, and better able to handle the ups and downs of life. This is also true for people with arthritis — and especially for those with ankylosing spondylitis, a form of arthritis that primarily affects the spine and can lead to chronic pain and stiffness.

In fact, exercise is a more important part of the treatment equation for spondyloarthritis, including ankylosing spondylitis, than for any other type of arthritis, according to the Spondylitis Association of America. Exercise is crucial for maintaining joint motion and function. It can help ease pain, improve posture, tackle muscle imbalances, make it easier to breathe, and enhance your overall quality of life.

There are many exercise options that are effective, so you don’t have to worry about getting bored with your workout routine. “As long as it doesn’t make you feel worse, then any exercise is good,” says A. N. Shamie, MD, a professor and the chief of orthopedic spine surgery at the UCLA School of Medicine.

However, it’s important to make sure you’re exercising properly and that you’re careful, especially during flare-ups, to avoid aggravating your condition. Here are some general dos and don’ts for exercising with ankylosing spondylitis:

1. Do work with a physical therapist. A skilled physical therapist can help you create an exercise routine that works for you and is tailored to your specific needs. Ask your doctor or rheumatologist for a recommendation.

2. Do make time to exercise every day. Finding time every day to work on building or maintaining strength, flexibility, and function is essential. Set aside a regular time to exercise that’s right for you. For instance, if your joint pain and stiffness are worse in the morning, you may want to exercise later in the day, suggests the National Ankylosing Spondylitis Society. With 24 hours in the day, if you exercise for even 20 minutes, you’ll notice the benefits and still have a lot of time for other things.

3. Don’t stick to one form of exercise. Aim for a combination of stretching, posture-focus, range-of-motion, cardiovascular, and strengthening exercises, especially in the hips. Lan Boehme, a physical therapist for UCLA Health in Los Angeles says that if your hips are weak, your spine will try to to compensate — and that can lead to unhealthy posture and pain. “We can’t change the spine,” says Boehme, “but we can change the mobility of what the spine sits on.”

4. Don’t do movements that cause pain. Any exercise that requires you to twist your spine too much or that stresses your back and spine could cause problems. Carefully consider high-impact exercises, such as running, or jarring and twisting sports, such as tennis, squash, and racquetball. These could increase pain in the spine, hips, and knees.

5. Don’t assume some sports are automatically off-limits. If you love to run, you can probably continue to run — but maybe not during flare-ups. Advances in treatment and medication have allowed many people with ankylosing spondylitis to maintain their posture and strength and to continue to do the activities they love, says Dr. Shamie. However, if your neck and spine are stiff, certain activities, like contact sports, can increase your risk of breaking a bone in your spine, according to the National Ankylosing Spondylitis Society. If you’re considering a contact sport or other high-impact exercise, talk to your doctor or physical therapist first.

6. Do focus on good posture. Because ankylosing spondylitis primarily affects the spine, maintaining good posture with all of your exercises is essential. The Spondylitis Association of America recommends doing regular posture checks: Back up to the wall. Place your heels and buttocks against the wall. Can you get your shoulders back against the wall? Can you get your head back to touch the wall? Your physical therapist can recommend additional posture exercises.

7. Don’t overdo it. Start slowly, especially if you’re new to exercising or if you’re experiencing a flare. Disease activity fluctuates, so if pain and stiffness are worse, ease off on your activities. If you’re feeling okay, you may be able to increase the frequency or intensity of your exercise. If an exercise causes more than mild aches and pains, stop doing that exercise and talk to your doctor.

Make exercise a part of your life. And involve your family and friends. Walking is usually a comfortable activity, so take the kids and the dog for a walk. Just remember to work with your doctor and physical therapist before starting or changing any exercise program — they can help ensure you’re performing all exercises safely and provide modifications to suit your needs.

When you’re exercising, you’re doing something good for yourself. And chances are you’ll feel good, too. Enjoy it!

Physio Works – Physiotherapy Brisbane

What is Ankylosing Spondylitis Treatment?

Your GP and rheumatologist may prescribe medications to help control the inflammatory part of the disease. As well as seeing your GP or rheumatologist for check-ups, your physiotherapist plays an important role in helping you manage your ankylosing spondylitis.

PHASE I – Pain Relief

Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include heat, electrotherapy, acupuncture, de-oading taping techniques, and soft tissue massage.

PHASE II – Restoring Normal ROM & Posture

As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal joint range of motion, muscle length, neural tissue mobility and resting muscle tension.

Treatment may include joint mobilisation and alignment techniques, massage, muscle stretches and neurodynamic exercises, plus acupuncture, trigger point therapy or dry needling. Your physiotherapist is an expert in the techniques that will work best for you.

PHASE III – Restore Normal Muscle Control & Strength

Researchers have discovered the importance of your muscle recruitment patterns with a normal order of: deep, then intermediate and finally superficial muscle firing patterns in normal pain-free people. Pain has an unfortunate side effect of ‘switching off’ your deep ‘core muscles’. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.

PhysioWorks has developed a “Core Stabilisation Program” to assist their patients to regain normal muscle control. Please ask your physio for their advice.

PHASE IV – Restoring Function and Return to Activity

During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their bodies that will determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.

PHASE V – Long-Term Management

Ankylosing spondylitis is a condition that requires constant management. Sticking to a regular stretching plan specific to your stiffness helps to get the most out of your body. Your physiotherapist will set you up with an appropriate stretching programme, will monitor your symptoms and make any adjustments to the programme as necessary.

The best advice is to keep active. Regular physical activity is one of the most effective treatments for AS. It is important to engage in a regular stretching program every day and do at least 30 minutes of moderate exercise on most days of the week.

What Results Can You Expect?

Symptoms may come (flare) and go (remission) for many years. For others, the symptoms and disability may gradually worsen over time.

Generally, people with AS can continue to work and perform daily activities, although certain changes may have to be made to allow a variety of positions and movements throughout the day.

Physiotherapy helps to provide pain relief and improve stiffness. Your physiotherapist can also provide you with a personalised exercise programme to help you manage your condition.


Surgery is needed only if the disease has caused nerve damage in the spine or if joint damage is severe.


Many patients find that soft tissue massage therapy is beneficial to assist your pain relief, muscle relaxation and swelling reduction. Please ask your physiotherapist if you would benefit from a massage.


Acupuncture can be helpful for the relief of your pain. If you are interested in trying some acupuncture, many of our therapists are trained in acupuncture. Please ask for their advice.


Carrying excessive body weight puts extra load on your joints and muscles, which predisposes you to increased pain.

General Exercise

General exercises are very important to keep your body moving. If you have a specific activity that you enjoy, please ask your physiotherapist if that activity will be beneficial to your long-term health.

For this particular injury, other patients have benefited from the following activities: hydrotherapy, pilates, yoga, walking, swimming, cycling, or tennis.

More Advice

If you have any concerns or have some specific questions regarding your condition, please ask your physiotherapist.

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General Arthritis Information

What is Arthritis?

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Rheumatoid Conditions – Overview

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Osteoarthritis – Overview

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Peripheral Joints
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Ankylosing Spondylitis Treatment Options

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Scapular Stabilisation Exercises
  • Closed Kinetic Chain Exercises
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Medications?
  • Orthotics
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Braces and Products

    Heat packs are often a wonderful way of easing away stiffness and pain associated with ankylosing spondylitis.

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    FAQs about Ankylosing Spondylitis

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
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  • Massage Styles and their Benefits
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  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Headache or Migraine… What to do?
  • Heat Packs. Why Does Heat Feel So Good?
  • How to Achieve the Best Standing Posture
  • Neck Headache? Free Online Test
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What are the Healthiest Sleeping Postures?
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  • What is Musculoskeletal Physiotherapy?
  • What is Nerve Pain?
  • What is the Correct Way to Sit?
  • What to expect when you visit PhysioWorks?
  • What’s the Benefit of Stretching Exercises?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
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    Exercise for Ankylosing Spondylitis

    Exercise may seem unappealing—even dangerous—when you have joint pain and stiffness associated with ankylosing spondylitis (AS). But, that couldn’t be further from the truth. If fact, people who don’t exercise may experience more fatigue and pain because a lack of movement leads to decreased joint motion, stiffness, and muscle weakness. Staying active will not only help you manage the symptoms of AS but also help strengthen your spine for years to come.

    Shortly after you are diagnosed with AS, your doctor may recommend you meet with a physical therapist who will craft an exercise program that allows you to strengthen your body without aggravating your joints. Back-strengthening and stretching exercises that help improve your posture, aerobic movements that promote rib joint flexibility, and spine-friendly aquatic activities are all ideal for people with AS.
    Staying active will not only help you manage the symptoms of AS but also help strengthen your spine for years to come. Photo Source: 123RF.com.

    Optimal Activities to Help Manage Ankylosing Spondylitis

    When it comes to exercising with AS, the “no pain, no gain” philosophy is the wrong approach. Low- or no-impact activities, such as yoga, tai chi, swimming, walking, or cycling are best for people with joint pain.

    Exercises for AS may be done at home or in a gym, or in a group or individual physical therapy program. The activities below may be incorporated into your AS exercise program, but your doctor or physical therapist’s specific recommendations should be followed first and foremost.

    Breathing exercises
    These movements may not cause a sweat, but they are invaluable at maintaining flexibility in your rib joints to keep you breathing easy. Breathing exercises are a great way to begin and end your workout. One example of a breathing exercise is below:

    • Take a deep breath, filling your chest with as much air as possible
    • Hold the breath for three seconds
    • Slowly exhale through your mouth

    If you do yoga or tai chi, those exercises also focus your attention on deep breathing.

    Flexibility exercises
    Speaking of yoga and tai chi, they are among the top exercise programs to improve spinal flexibility. These activities use isometric training—that is, you strengthen muscles while holding a position rather than moving between different positions—to increase range of motion. Flexibility exercises gently stretch and extend your spine, keeping joints flexible and warding off stiffness.

    Strengthening exercises
    Strengthening exercises cannot be overvalued to spinal health. Strong back muscles support your posture, which is important for anyone with AS. Also, keeping your spinal muscles strong allows them to support your joints. You don’t have to lift heavy weights to effectively strengthen your back muscles—light hand weights and resistance training using your own body weight (eg, yoga) are effective.

    Cardiovascular exercises
    Low-impact cardiovascular exercises, such as walking or cycling, are great for joint health. But few exercises are as widely recommended for AS as aquatic activities, such as swimming or water aerobics. Water offers an anti-gravity environment that is easy on your joints, and the pool provides gentle resistance to help you comfortably build cardiovascular health.

    Special Exercise Precautions for People with Ankylosing Spondylitis

    As you consider an exercise program to manage your AS, keep in mind these two points: Regular exercise reaps the rewards, and gradually increasing your physical activity will help keep you injury-free.

    Protecting your joints while being physically active is a key consideration for people with AS. Exercise safely with the tips below:

    • If you feel stiff or sore prior to your workout, a hot bath or shower may help ease your joints.
    • Exercise when you feel most awake or in the least amount of pain.
    • Start each workout gradually.
    • Avoid exercises that encourage poor posture.
    • Walk on flat, level surfaces.
    • Invest in supportive gym shoes
    • Avoid high-impact exercises, such as running, that put pressure on your joints.
    • Stop exercising if you are in pain. Be careful not to take too much pain medication immediately before exercising, as it can make it hard for you to determine if you’re in pain.

    Ready to Get Started?

    Exercise is central to any ankylosing spondylitis treatment program and an investment in your long-term health. To get the most benefit, take things slowly and be dedicated to the practice of regular physical activity.

    Before starting your exercise program:

    • Talk to your doctor about whether you are a candidate for exercise (eg, you may have a separate medical condition that prevents you from safely exercising).
    • If you have not participated in a long-term physical fitness program, do not exercise without the supervision of a doctor or physical therapist.

    View Sources

    Running Pain-Free with Ankylosing Spondylitis Thanks to Chi Technique

    Thank you for creating ChiRunning. About a year and a half ago, I was diagnosed with Ankylosing Spondylitis (AS)… it’s a type of spinal arthritis, more like rheumatoid, where your body attacks itself, affecting mainly the sacroiliac joints and the joints in the spine.

    As a 27 year old male, it was devastating. I had run several marathons previous to diagnosis and running had become a part of who I am. In fact, during the diagnosis process I had been training for another race and initially, thought it was a running injury. Unfortunately, after about a year of severe pain sometimes forcing me to walk with a limp and countless doctor visits, I was diagnosed. Remaining active is one of the best things to keep AS from progressing. Running for many people with AS isn’t an option because of the impact it creates. But for me, giving up running was not an option.

    I knew about ChiRunning before my diagnosis but hadn’t given it much thought since I had been running for three years without problems. After my diagnosis, the first thing I did was buy the book and sign up for a seminar. I’ve been practicing ChiRunning for about a year now and there is absolutely no doubt in my mind that my ability to continue running is a result of ChiRunning. The emphasis on fluidness throughout the core and internal focus leaves me feeling better after a run than when I started. I can start a run with a stiff back and finish feeling great. ChiRunning has been a blessing to me. In fact, I’ve competed in several 10Ks since diagnosis and have set numerous PRs. I’ve also transitioned from marathoning to triathlons. This summer I will be competing in a series of Tri’s in Boulder, Colorado culminating with a half-ironman event. Without ChiRunning none of this would be possible. I thank you for your dedication and hope that my story can inspire others to get out and enjoy a run.

    Chris Van H.

    9 Exercises That Are Perfect for People With Ankylosing Spondylitis

    Ankylosing spondylitis is a form of arthritis that affects the spine. Most commonly felt as pain in the lower back, it can be easy to miss or attribute to something else. If you notice persistent spinal pain, and there is no known cause such as injury, then you may have ankylosing spondylitis. As with all forms of arthritis, inflammation is the predominant cause. Low-impact exercises can help reduce this inflammation and improve your pain and mobility.

    Exercising daily can strengthen joints and muscles, which will ultimately improve mobility and flexibility. It’s also a great way to reduce inflammation and pain. In addition to this, supplements with krill oil can help to reduce inflammation as they contain beneficial omega-3 fatty acids which fight oxidative damage and inflammatory chemicals. There is not a cure for ankylosing spondylitis, but with combined treatment of low-impact exercises and high-quality krill oil, you will notice improvement right away.

    The Best Exercises for Ankylosing Spondylitis

    Exercising may seem like the last thing you feel like doing with joint or lower back pain, but when it comes to ankylosing spondylitis, exercise is good. Being physically active and in shape is one of the best ways to reduce joint pain and inflammation, and reduce the symptoms associated with ankylosing spondylitis. Exercise will improve flexibility, mobility, and balance, while also reducing pain levels.

    When it comes to exercising with ankylosing spondylitis, you need to remember that moderation is essential. You do not want to overdo it or exert yourself and cause further pain or injury. What matters is to be consistent with low-impact exercises, which gradually improve your strength and reduce aches and pains. Here are a few great exercises for anyone who suffers from ankylosing spondylitis.


    This is something you want to aim to do every day. Stretching is critical for muscle health and posture. By keeping your muscles flexible, your posture improves, which reduces lower back pain associated with ankylosing spondylitis. You’ll notice your condition gets worse if you have a job that requires you to sit most of the day. Finding time to stretch during the day will be the best way to counteract the sitting, and keep your spine and posture healthy.


    Start off with short walks during the day or on breaks. Even getting 5 to 10 minutes a day will start the healing process. You want to aim for thirty minutes a day, but it’s important to start slowly, gradually introducing your aching joints to the movements. Walking is a beneficial low-impact exercise, and great for arthritis and overall cardiovascular health. Be sure to only walk at a pace that is comfortable so as not to aggravate your condition.


    Swimming and water aerobics are great for aching joints and inflammation caused by ankylosing spondylitis. Because the water holds your weight, you can move almost effortlessly. The support from the water allows you to move your body without strain as there is no pressure placed on any aching joints. Swimming and aquatic exercise have been proven to be effective for physical therapy, and works wonders for those with any form of arthritis.

    Tone up

    Improving flexibility is part of the battle. You also need to improve the strength of the muscles supporting your arthritic bones. By using free weights or machines, you can do strength training to build up muscle strength. The stronger your muscles are, the better able they are to keep the pressure off your bones. Just remember to start gradually so as not to cause injury and more pain.

    Tai Chi

    This ancient Chinese practice uses subtle and deliberate movements, as well as controlled breathing to improve your mind and body. People notice improved balance, stability, and reduced back pain.

    It’s important to learn the movements from an experienced instructor to ensure you do them correctly. Mixing them up or doing them wrong can cause strain and worsen your pain rather than reduce it.


    Beginner’s yoga is the best place to start, and like Tai Chi, its deliberate movements and stretching can improve balance and reduce pain. The gentle stretches improve muscle flexibility, which will help in providing support for your joints and back. Patients also report reduced stiffness and increased mobility as a result of practicing yoga.

    Like Tai Chi, yoga also benefits the mind as well as the body. Start with simple poses and work up to more challenging poses as you feel your body strengthen.


    This focuses on stretching and strengthening, like yoga, and benefits overall muscle and bone health. The controlled movements work to strengthen your core muscles, which will help reduce pressure on your spine.

    Along with increasing flexibility and mobility, Pilates is an excellent tool for ankylosing spondylitis, and can reduce pain and stiffness effectively.

    | Related: 5 Tips for Fighting Ankylosing Spondylitis Fatigue Naturally |


    Riding a bike is great for ankylosing spondylitis, you can get the same benefit from a stationary bike or hitting the open road. Cycling works your heart and your muscles without putting pressure on your joints.

    The best way to increase flexibility is to switch up your cardio exercises. Alternating between cycling, swimming, and walking works best for arthritis and ankylosing spondylitis pain.


    Dancing allows you to keep moving and have fun. You won’t even realize you’re working out when you dance. Try a Zumba class or any other organized lesson, and dance your lower back pains away.

    Pick a style and tempo that suits you, and you will get a great overall cardio workout. You’ll also notice a reduction in weight, along with decreased arthritis pain.

    The Bottom Line

    Being stagnant only decreases joint health. Exercise, so long as it’s gradual and low-impact, reduces stiffness and inflammation associated with being inactive.

    No matter what type of activity you choose, you’ll notice improved mobility and reduced pain. Additional support from high-quality krill oil will boost joint health and reduce inflammation, too. Don’t let ankylosing spondylitis slow you down. Keep moving and keep lower back pain at bay.

    READ NEXT >>> 15 Anti-Inflammatory Foods + Anti-Inflammatory Diet Tips

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    More than any other type of arthritis, ankylosing spondylitis calls for a treatment plan that combines medication and appropriate exercise. Ankylosing spondylitis causes inflammation in the spine, resulting in scar tissue and calcification. Without proper care, the spine can stiffen, compromising mobility and increasing risk for spinal fractures.

    Stiffness tends to worsen with inactivity and improve with regular low-impact physical activity, and while medication can reduce inflammation, exercise increases joint flexibility, improves posture, and reduces stiffness.

    Exercise has the added benefits of supporting cardiovascular health and keeping blood pressure and cholesterol within normal range. It also increases bone density and reduces stress, so why not get moving?

    The Spondylitis Association of America (SAA) recommends four types of exercise: range of motion, stretching, strengthening, and endurance (cardiovascular). All four types should be done regularly. Thanks to a pamphlet produced by SAA, you can easily plan and maintain a sensible exercise program.

    While not what many would call “exercise,” posture control is important for people with ankylosing spondylitis. Better yet, it’s easy. Stand straight, with spine and neck aligned, and do this consciously many times a day. Breathing deeply is also beneficial not only for respiration but also for the way it expands the rib cage.

    A posture-related exercise involves lying on the floor face down on a mat, head turned to one side. Hold that position for a minute or so, and then turn your head in the opposite direction and hold it for the same amount of time. The ultimate goal is 20 minutes.

    Swimming is also an ideal exercise for those with ankylosing spondylitis, according to Brian R. Kaye, M.D., chief of the division of rheumatology, at Sutter East Bay Medical Foundation, Berkeley, and clinical professor of medicine at the University of California, San Francisco.

    “Swimming is generally acknowledged to be an excellent exercise for patients with ankylosing spondylitis because of the excellent back flexion and extension that occurs without putting strain on the spine,” he advised.

    For people who don’t swim, benefits can be achieved by gently stretching in a warm pool. Recreation centers may have group aquatic therapy sessions for people with arthritis. Call local athletic facilities to see if they have an aquatic program for people with joint problems, or follow the guidelines provided by the Arthritis Foundation.

    People who prefer land-based exercise should ask their doctor before undertaking a low-impact exercise like gentle yoga, which involves stretching, bicycling, or walking. Dr. Kaye advises anyone with ankylosing spondylitis to avoid high-impact activities like contact sports and jumping on a trampoline, which could cause harmful spinal compression.

    Maintaining an ideal body weight will reduce stress on the spine, so diet also plays a role in better health, according to Dr. Kaye.

    “There are no nutritional factors that have been scientifically demonstrated in a double-blind fashion to improve or worsen the outcome in ankylosing spondylitis,” he advised. “Nevertheless, one should eat a healthy, well-balanced diet for general health.”

    “Because we have much to learn about the effects of nutrition on ankylosing spondylitis, I would encourage patients to ‘listen to their body’ and avoid foods they feel make themselves worse on a consistent basis,” he said.

    Listening to your body and giving it the exercise and nutrition it needs can go a long way to improve your quality of life, whether you’re living with chronic illness or not. If you have ankylosing spondylitis and are thinking of adding some of these exercises into your daily routine, it’s a good idea to consult your doctor first.

    Ankylosing Spondylitis

    Basics of ankylosing spondylitis

    Ankylosing spondylitis primarily affects the spine or back. In a person with ankylosing spondylitis, the joints and ligaments that normally permit the spine to move become inflamed and stiff. The bones of the spine may grow together, causing the spine to become rigid and inflexible. Other joints such as the hips, shoulders, knees, or ankles also may become involved.


    Almost all people with ankylosing spondylitis can expect to lead normal and productive lives. Despite the chronic nature of the illness, only a few people with ankylosing spondylitis will become severely disabled. The management of pain and the control of inflammation can reduce the daily problems that may occur with ankylosing spondylitis. By watching posture and body position and by doing exercises daily, the individual can control many of the effects of the disease.

    Ankylosing spondylitis is rarely crippling and the symptoms can be managed in most people. Keep in mind that each person with ankylosing spondylitis responds to treatment differently; what works for another person may not work for you. Be patient and actively participate in your care. Even though a cure is not known at present, you can do a lot on your own to control your symptoms.


    Ankylosing spondylitis is not a fatal condition.

    Fertility and pregnancy

    Pregnancy in women with ankylosing spondylitis does not usually involve any special problems for mother or baby. However, some medications can be harmful to unborn children. If you are pregnant or planning to become pregnant, you will need to discuss the use of medication with your doctor.


    Symptoms of ankylosing spondylitis appear most frequently in young men between the ages of 16 and 35. It is less common in women, whose symptoms are often milder and more difficult to diagnose.

    About five percent of ankylosing spondylitis begins in childhood; boys are more likely to have it than girls. When children develop ankylosing spondylitis, it usually begins in the hips, knees, bottoms of heels, or big toes and may later progress to involve the spine.

    The gene is present in eight percent of healthy white Americans and two to three percent of healthy African Americans. About 300,000 Americans (less than one percent of the adult population) have ankylosing spondylitis. The disease is three times more common in whites than in African Americans.


    Heredity seems to play a role in determining who gets ankylosing spondylitis.: approximately one in five people affected by ankylosing spondylitis have a relative with the same disorder. A genetic “marker” called HLA-B27 is present in most people who have AS. However, most people (about 80%) who test positive for the marker never develop the disease. What “triggers” the disease in those patients who may be susceptible to it (i.e. patients who test positive for HLA-B27) is not well understood.


    Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

    Adapted from the pamphlet originally prepared for the Arthritis Foundation by Frank C. Arnett, M.D. Professor of Internal Medicine, University of Texas Medical School at Houston. This material is protected by copyright.


    Ankylosing spondylitis is a systemic disease, meaning it can affect the entire body in some people. It can cause fever, loss of appetite, and fatigue, and it can damage other organs besides the joints, such as the lungs, heart, and eyes. Most often though, only the low back is involved.

    The eye is the most common organ affected by ankylosing spondylitis. Eye inflammation (iritis) occurs from time to time in one-fourth of people with ankylosing spondylitis. Iritis results in a red, painful eye that also leads to photophobia, increased pain when looking at a bright light. It is a potentially serious condition requiring medical attention by an ophthalmologist. Luckily, it rarely causes blindness but it can affect vision while the inflammation is present.

    Less frequently, ankylosing spondylitis may be associated with a scaly skin condition called psoriasis. In rare cases, typically when the ankylosing spondylitis has been present for many years, ankylosing spondylitis may cause problems with the heart or lungs. It can affect the large vessel called the aorta that moves blood from the heart into the body. Ankylosing spondylitis can cause inflammation where the heart and aorta connect leading to possible enlargement of the aorta.

    Symptoms similar to that seen in ankylosing spondylitis may also may occur along with such conditions as psoriasis, inflammatory bowel disease, or Reiter’s syndrome. It is thought that bowel inflammation is somehow tied to the development of ankylosing spondylitis and this is the reason that people with inflammatory bowel disease, i.e. Crohn’s disease or ulcerative colitis are at an increased risk of the illness.


    The inflammation in ankylosing spondylitis usually starts around the sacroiliac joints, areas where the lower spine is joined to the pelvis. The pain associated with ankylosing spondylitis is worse during periods of rest or inactivity. People with ankylosing spondylitis often awaken in the middle of the night with back pain. Typically, symptoms lessen with movement and exercise.


    Over a period of time, pain and stiffness may progress into the upper spine and even into the chest and neck. Ultimately, the inflammation can cause the sacroiliac and vertebral bones to fuse or grow together. When this occurs, the normal flexibility of the spine, including the neck, is lost and the whole spine becomes rigid. Similarly, the bones in the chest may fuse, causing a loss of normal chest expansion when breathing.

    The hips, shoulders, knees, or ankles also may become inflamed and painful and eventually lose their mobility. if these joints are damaged to the point where daily activities become compromised or very painful, it is often possible to surgically reconstruct those joints with total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty. The heels may become affected, making it uncomfortable to stand or walk on hard surfaces.


    Doctors usually base their diagnosis of ankylosing spondylitis on symptoms (pain, stiffness) and X-rays showing inflammation of the sacroiliac joints at the back of the pelvis.

    Diagnostic tests

    If your symptoms or X-rays suggest ankylosing spondylitis, but the diagnosis is uncertain, your doctor may perform a blood test to check you for the HLA-B27 gene. About 90 percent of people diagnosed with ankylosing spondylitis do test positive for this gene.


    Treatment for ankylosing spondylitis should be designed to reduce pain and stiffness, prevent deformities, and help you maintain your normal activities.

    The basics of treatment include:

    • Education
    • Attention to posture
    • Exercise
    • Medications

    Should these approaches fail to provide adequate relief and should the spine, hips, knees or shoulders become damaged or painful, there are a number of reconstructive surgical procedures available, including spine surgery, total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty.

    Health care team

    You should choose a doctor experienced in treating arthritis. Your doctor will work with you to decide when you need the help of other health professionals, such as physical or occupational therapists.

    Effective treatment of ankylosing spondylitis relies on a partnership between you and your care providers.

    Exercise and therapy

    Regular exercise is an essential part of the overall management of ankylosing spondylitis. Your physical therapist with arthritis experience can design a program of exercises to meet your needs. Exercises that strengthen the back and neck will help maintain or improve your posture. Deep breathing exercises and aerobic exercises will help keep the chest and rib cage flexible. Swimming is an excellent way to exercise since it promotes flexibility of the spine; movement of the neck, shoulder, and hip joints; and deep breathing.

    If you sometimes feel too stiff and sore to exercise, try taking a hot bath or shower to loosen up. Begin your exercises slowly and plan to do them when you are the least tired or have the least pain.

    Whether your overall medical condition would permit an exercise regime would be a good topic for you to discuss with your internist, family doctor, or rheumatologist. The initiation of a fitness program in someone who has never participated in one before certainly should be done under the guidance of a physician or physical therapist.

    Physical therapy is not believed to prevent progression of AS, but it may minimize symptoms in some patients.


    Make every effort to keep your spine straight. Sleep on a hard mattress. Try to sleep on your stomach without a pillow under your head. You also can try sleeping on your back with a thin pillow or one that supports the hollow of your neck. Keep your legs straight rather than sleeping in a curled position. If you find it difficult to sleep in these positions, talk to a physical therapist about other possible options.

    When walking or sitting, keep your spine as straight as you can with your shoulders squared and your head up. A test for correct posture can be done by standing with your back against the wall; your heels buttocks, shoulders, and head should be able to touch the wall all at once. Be sure that chairs and work surfaces are designed so that you don’t slump or stoop.

    Corsets and braces, in general, are of little value in treating ankylosing spondylitis. You are much better off maintaining good posture by exercising properly.


    Medication is usually an essential and ongoing part of treatment. While medications do not cure ankylosing spondylitis, they do relieve pain and stiffness, allowing you to exercise, maintain good posture, and continue normal activities.

    Several types of medication help treat ankylosing spondylitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and relieve pain. Typical NSAIDs include indomethacin, piroxicam, or naproxyn. Side effects of NSAIDs include stomach upset, leg swelling and rarely ulcers or bleeding from the stomach. Newer NSAIDs, known as the COX-2 inhibitors (rofecoxib, celecoxib) may be able to relieve inflammation and pain with fewer side effects. Aspirin has been found to be of little use in treating ankylosing spondylitis. Higher doses of NSAIDs are usually required to relieve the inflammation in addition to the pain.

    A medication called sulfasalazine has been shown to reduce the inflammation and symptoms of ankylosing spondylitis, but it is not known whether sulfasalazine may slow or halt the progression of the disease. Some of the new medications that affect an inflammatory substance called TNF are being investigated as possible agents that may affect the course of the illness.

    Whichever medications your doctor prescribes for you, be sure to take them as directed, even when you seem to be feeling fine. Also, talk to your doctor about possible side effects and what to do if they occur. If your symptoms worsen, call your doctor.

    Surgery is a rare measure used in the management of ankylosing spondylitis. Joint replacement surgery is enabling many people to regain the use of joints that have been affected by ankylosing spondylitis and other forms of arthritis. Hip, knee, and shoulder replacements can be successful in ankylosing spondylitis. Rarely surgery can be done to straighten the spine but requires a significant expertise and should only be done by those with experience in the this area.

    Strategies for coping

    People who develop a chronic illness such as ankylosing spondylitis learn over time to cope with emotional ups and downs.

    Learning to cope with ankylosing spondylitis often requires accepting changes. You may need to make changes in your relationships, work habits, and leisure-time activities. You may have to deal with changes in your appearance. All of these possible changes may leave you sad, stressed, depressed, or angry. Sometimes it helps to talk about these feelings with a family member, close friend, counselor, or someone else who has ankylosing spondylitis.

    Asking for help

    There may be times when you and your family are faced with problems caused by your disease that you do not know how to solve. You might want to talk to a counselor who has experience working with people who have arthritis. If so, your doctor probably can recommend one. It also may help to get to know other families who are living and coping with ankylosing spondylitis.

    There are several organizations devoted to educating and supporting people with ankylosing spondylitis. One of these is the Spondylitis Association of America. In addition, to find a rheumatologist (physicians who specialize in treatment of spondylitis) or to learn what is new in the understanding or treatment of ankylosing spondylitis, contact the American College of Rheumatology.


    The majority of people with ankylosing spondylitis are able to continue a productive, active work schedule. Whether you work in or outside the home, the following suggestions may help. It may be helpful to discuss your work with your rheumatologist.

    If your current job involves prolonged stooping or excessive strain on your back, you may want to contact a vocational rehabilitation agency in your state for guidance. The agency also may be able to help you if your experience, education, or training make it difficult for you to change jobs.

    Family and friends

    Most forms of arthritis do not limit one’s ability to enjoy romantic and sexual relationships. From time to time, however, problems such as pain and limited movement–especially of the hip joint–may get in the way of sexual enjoyment. Some extra planning may be all that’s needed.

    One of the most important aspects of a good sexual relationship is good communication. If you and your partner can comfortably discuss each other’s needs, you probably can overcome almost any difficulty.

    Adaptive aids

    If some of your joints have fused or if you already have limited joint mobility, you may find it helpful to use some adaptive equipment or self-help aids. For instance, long-handled shoehorn or sock aids can help if your back or hips don’t bend easily.

    When driving, always wear a seat belt with a shoulder harness and have the headrest in your car adjusted to support your neck. If a stiff neck or back makes backing into parking spaces difficult, try fitting your car with extra-wide mirrors.

    Because your neck and spine may be hurt easily, avoid activities that could cause falling or produce a sudden impact. Talk to your doctor or occupational therapist about ways to avoid injury and ways to improve your ability to function.

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