What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a condition that causes inflammation and pain in the spine and other joints, such as the hips, knees, ankles, shoulders, and between the sternum and ribs. In Australia, up to 2% of the population is affected, which is three times more common in men than women. Ankylosing Spondylitis typically affects people in their late teenage years or 20s, but it can start as late as 45. Poorly managed AS can permanently stiffen the spine, causing the bones to fuse and resulting in a stooped posture.

The cause of Ankylosing Spondylitis is unknown, although it appears to have a strong genetic link, particularly in people who carry the HLA-B27 gene. Unlike other common back pains, the disease typically presents without a specific cause. Symptoms of AS include back pain and stiffness that gradually increase, early morning stiffness, and pain that decreases after exercise and increases after rest. Ankylosing Spondylitis can also cause sleep disturbance, inflammation of the iris within the eye, and symptoms of inflammatory bowel disease.

If a physiotherapist suspects Ankylosing Spondylitis, they will refer you to a GP for further testing, including blood tests and imaging such as X-rays, MRI, or CT scans. If testing confirms Ankylosing Spondylosis, a rheumatologist specialising in diagnosing and managing AS will be consulted.

Treatment of Ankylosing Spondylitis involves medication prescribed by your GP and rheumatologist to control inflammation. Physiotherapy can also be essential in managing AS by reducing pain and inflammation and restoring normal joint range of motion, muscle length, neural tissue mobility, and resting muscle tension. Regular physical activity is one of the most effective treatments for Ankylosing Spondylitis. It is recommended to engage in a regular stretching program daily and do at least 30 minutes of moderate exercise on most days of the week.

What are the Symptoms of Ankylosing Spondylitis?

• Back pain/stiffness came on gradually.
• Early morning pain/stiffness, which reduces movement.
• Pain/stiffness improves after exercise and is worse after rest.
• Sleep disturbance, particularly in the second half of the night.
• Persistence of the above symptoms for more than three months.
• Pain is relieved for a time after a shower, bath or heat treatment.
• Inflammation of the iris within the eye. This may include pain in the eye or brow region, exposure to light, blurred vision or a reddened eye.
• The bowel lining may also be affected, causing symptoms of inflammatory bowel disease such as diarrhoea and bloating.

How is Ankylosing Spondylitis Diagnosed?

If your physiotherapist suspects ankylosing spondylitis, they will refer you to your GP for further testing, including blood tests and possibly imaging such as X-rays, MRI or a CT scan. If testing suspects Ankylosing Spondylosis, you are generally referred to see a rheumatologist specialising in diagnosing and managing AS.

Please consult your physiotherapist or doctor for specific advice.

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 various treatment tools to reduce your pain and inflammation. These include heat, electrotherapy, acupuncture, de-loading taping techniques, and soft tissue massage.

PHASE II – Restoring Normal ROM & Posture

As your pain and inflammation settle, your physiotherapist will focus on 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

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

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

PHASE IV – Restoring Function and Return to Activity

This stage of your rehabilitation aims to return 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 get the most out of your body. Your physiotherapist will set you up with an appropriate stretching programme, monitor your symptoms, and make any adjustments as necessary.

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

What Results Can You Expect?

Symptoms may flare and go into remission for many years. For others, the signs and disability may gradually worsen over time. Generally, people with AS can continue to work and perform daily activities. However, specific changes may have to be made to allow various positions and movements throughout the day.

Physiotherapy

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

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

Massage

Many patients find that soft tissue massage therapy benefits pain relief, muscle relaxation, and reduced swelling. Would you please ask your physiotherapist if you would benefit from a massage?

Acupuncture

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

Weight-Loss

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

General Exercise

General exercises are fundamental to keeping your body moving. If you enjoy a specific activity, please ask your physiotherapist if that activity will benefit your long-term health.

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

Please consult your physiotherapist or doctor for specific advice.

Related Articles

1. Spondylosis – This article discusses degenerative spine conditions and how they relate to lower back pain, including the role of physiotherapy in managing such conditions​​.
2. Rheumatoid Arthritis – Offers insights into managing arthritis-related conditions, including Ankylosing Spondylitis, emphasising the importance of activity pacing, sleep health, and muscle treatment​​.
3. Sacroiliac Joint Dysfunction (SIJ) – Details the causes, relief, and treatment for SIJ issues, which can be closely related to the symptoms and discomfort experienced by those with Ankylosing Spondylitis​​.
4. Osteoporosis – Since bone health is crucial for individuals with Ankylosing Spondylitis, this article provides information on managing and improving bone density, which can be beneficial in the long-term management of the condition​​.