What is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is an inflammatory condition that mainly affects the spine, but it can also involve joints such as the hips, knees, ankles, shoulders, and rib joints.

It sits within the broader group of arthritis conditions that can affect how you move and function. Ankylosing spondylitis affects a small percentage of Australians. It is more common in men and often begins in the late teenage years or early adulthood.

Without appropriate management, ankylosing spondylitis may lead to progressive spinal stiffness. Over time, this can contribute to reduced mobility and changes in posture, including a forward-bent position.

The exact cause of ankylosing spondylitis remains unclear. However, there is a strong genetic association, particularly in people who carry the HLA-B27 gene.

Unlike many types of back pain, symptoms often develop gradually without a clear injury. Many people describe an inflammatory pattern that improves with movement and worsens with rest.

Common features include persistent back pain and stiffness, marked morning stiffness, and symptoms that ease with movement but worsen with rest. Some people may also experience sleep disruption, eye inflammation, or symptoms related to inflammatory bowel conditions.

What are the Symptoms of Ankylosing Spondylitis?

• Back pain and stiffness that develops gradually
• Early morning stiffness that restricts movement
• Symptoms that improve with activity and worsen with rest
• Sleep disturbance, often in the second half of the night
• Symptoms lasting longer than three months
• Temporary relief from heat, showers, or warm baths
• Eye inflammation causing pain, redness, or blurred vision
• Bowel symptoms such as bloating or diarrhoea

How is Ankylosing Spondylitis Diagnosed?

If ankylosing spondylitis is suspected, your physiotherapist may recommend referral to your GP for further assessment. This may include blood tests and imaging such as X-rays, MRI, or CT scans. When findings suggest ankylosing spondylitis, a rheumatologist is typically involved in confirming the diagnosis and guiding medical management.

What is Ankylosing Spondylitis Treatment?

Medical management is coordinated by your GP and rheumatologist, often involving medication to help manage inflammation. Physiotherapy also plays an important role by supporting movement, posture, and physical activity over the long term.

Compared with more common mechanical back pain, ankylosing spondylitis symptoms often feel worse after rest and better after gentle movement. This pattern can guide earlier assessment and appropriate referral.

Because AS is a form of inflammatory arthritis, your plan often needs a long-term focus on mobility, posture, and load management, alongside medical care.

Phase I – Pain Relief

Early physiotherapy aims to reduce pain and improve comfort. This may include heat, short-term electrotherapy, gentle mobility work, and soft tissue therapy.

Phase II – Restoring Range of Motion and Posture

As symptoms settle, treatment focuses on restoring joint mobility, muscle length, and spinal posture. This stage may include joint mobilisation, stretching, and movement-based exercises.

Phase III – Improving Muscle Control and Strength

Persistent pain can affect normal muscle activation. Your physiotherapist will assess movement patterns and prescribe exercises to support coordinated muscle control and strength relevant to daily activity.

Phase IV – Return to Activity

Rehabilitation goals differ for each person. Treatment is tailored to support functional tasks, work demands, and preferred physical activities.

Phase V – Long-Term Management

Ankylosing spondylitis requires ongoing management. Regular stretching and physical activity are strongly encouraged. Many people benefit from daily mobility exercises and moderate activity most days of the week.

What Results Can You Expect?

Symptoms may fluctuate over time, with periods of increased symptoms followed by remission. Many people continue working and participating in daily activities, although adjustments may be needed to manage posture, movement, and load.

Related Articles

1. Spondylosis
2. Rheumatoid Arthritis
3. Sacroiliac Joint Dysfunction
4. Osteoporosis

What to Do Next

If stiffness, pain, or reduced mobility is affecting your daily activities, a physiotherapist can assess your movement and discuss suitable management options.

External Resource

For a plain-language overview, see MedlinePlus: Ankylosing Spondylitis.

References

1. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82(1):19-34.
2. Ortolan A, Webers C, Sepriano A, et al. Efficacy and safety of non-pharmacological and non-biological pharmacological treatments in axial spondyloarthritis: a systematic literature review. Ann Rheum Dis. 2023.
3. Boudjani R, et al. Impact of different types of exercise programs on disease activity, function and mobility in ankylosing spondylitis: systematic review and meta-analysis. 2023.
4. Luo Y, et al. Effectiveness of exercise intervention in relieving symptoms of ankylosing spondylitis: systematic review and network meta-analysis. PLoS One. 2024.
5. Sveaas SH, et al. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis: a multicentre randomised trial. 2020.

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