By Maura Iversen, DSc, as told by Hallie Levine
If you have ankylosing spondylitis (AS), an inflammatory condition that causes pain and stiffness in your lower back and spine, it’s important to stay as physically active as possible. This may sound counterintuitive: why keep moving if it hurts? But AS can get worse if you don’t. When you’re active, you’re less likely to get stiff and in pain. As a physiotherapist and behavioral scientist focused on rheumatological conditions such as AS, I firmly believe that physiotherapy is a crucial part of treatment that can be just as important as medication. It can go a long way in managing discomfort and helping you get back into a normal routine.
Over time, there may be progressive stiffness that makes it difficult for you to turn your head, stand up straight, or bend over. This is because AS causes abnormal bone growth that causes the joints around the spine, hips, and pelvis to fuse together. It makes good posture difficult and can cause you to lean forward. You may have trouble walking and fall more easily. People with AS sometimes have trouble breathing because the joints in the ribs and spine become stiff, limiting their ability to take deep breaths.
With physical therapy, the goal is to ensure that you are actively participating in the movement around your spine. Strengthening exercises for the back and abdominal muscles ensure this. The stronger they are, the less stress there is on your spine, which can reduce pain. Some of the best exercises are bridges and planks, but they can be difficult if you don’t have a lot of range of motion. Your physical therapist can modify or change the exercises to make them as comfortable as possible for you. For example, if I have a client who is the parent of a young child, I might show them how to safely get to the floor on their stomach and elbows. This type of activity allows them to play with an infant or toddler and also stretches shortened back muscles that cause pain. Other key movements are:
Since AS can also cause the spine to ‘freeze’, postural training is very important. Most of us spend our days sitting in front of a computer, which weakens the back muscles and encourages us to lean forward. Your physical therapist can work with you on exercises such as: B. standing against a wall or even yoga exercises such as mountain or child pose. Range of motion and stretching exercises, which can make you more flexible and reduce stiffness, swelling, and pain, are also important. These are especially important because patients tend to limit movement when they have pain and stiffness around a joint, such as during an AS flare. This lack of movement can increase the risk of joint fusion. And when a joint is inflamed, the surrounding muscles often contract, leading to even more stiffness and pain.
What you do outside of physical therapy is just as important. Try to get as much aerobic exercise as possible, ideally for at least 30 minutes most days of the week. So people with AS have a higher risk of heart disease
Activity that supports heart function is important. It also improves lung capacity, which can relieve some of the chest tightness that often accompanies AS. Your physical therapist can help you figure out which exercises are best for you. For example, if you enjoy riding a bike, you’re better off with a stationary bike, where you stay upright rather than stooping. Swimming is another great activity, especially if you do breaststroke or backstroke. Both strengthen and stretch your neck, shoulder and back muscles. But honestly, you can get any type of exercise to work. I had a patient who loved ice hockey so we created a routine for him at his local ice rink. He would walk around with a hockey stick and pass a puck from side to side to encourage trunk rotation.
I am often asked if complementary therapies such as acupuncture or massage can help. They can’t hurt, but they probably don’t do much. These types of treatments are passive, meaning the therapist does most of the work. It may help you feel better for a while, but it won’t actively build strength and flexibility, which is what you need to manage AS-related pain in the long run.
What helps and what I encourage my clients to do are meditative exercises such as deep breathing several times a day and before physical therapy and sports. These relax your entire body, including your muscles, making it easier for you to move through a full range of motion. Deep breathing also helps prevent the muscles around your spine and chest from becoming too tight, which can interfere with breathing. I also recommend activities like yoga, Pilates or Tai Chi several times a week. While there are no specific studies on its effects on people with AS, studies on back pain have found that people who exercise it regularly experience significantly less pain and disability than those who don’t. These also have meditative and breathing benefits.
It is important to remember that there is no cure for AS. But the right treatments – including physical therapy – can go a long way in reducing the pain and stiffness associated with the disease.