Ankylosing Spondylitis

Ankylosing Spondylitis

Article by Alex Clarke

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a disease which causes inflammation and pain in the spine and other joints such as the shoulder, hips, knees, ankles and between your sternum and ribs.

Ankylosing spondylitis affects up to 2% of Australians and is about three times more common in men than women. It commonly presents in the late teenage years or 20s, although it can start as late as 45 years old.

The word spondylitis refers to inflammation of the spine; ankylosis means fusion or the melding of two bones into one.

Poorly managed ankylosing spondylitis can lead to permanent stiffening of the spine. New bone can grow around the spine, which results in the bones fusing and limits movement. It also results in a characteristic stooped posture.

What Causes Ankylosing Spondylitis?

The cause of ankylosing spondylitis is unknown, although it appears to have a strong genetic link. This is particularly the case in people who carry what is known as the HLA-B27 gene.

Recently, two new genes (IL23R and ARTS1) have also been found to be associated with ankylosing spondylitis. Still, the medical community is not yet sure what this means for passing on the condition.

Only carrying the genes does not mean that you will get ankylosing spondylitis; in fact, only one in eight carriers of the HLA-B27 gene ends up with the condition.

Ankylosing spondylitis usually presents without a specific cause, which makes it different from many common back pains. It does not seem to be caused by particular jobs or movements and is usually not the result of specific injuries, infections or other medical conditions.

What are the Symptoms of Ankylosing Spondylitis?

  • Back pain/stiffness which 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 relieved for a time after a shower, bath or heat treatments.
  • Inflammation of the iris, within the eye. This may include pain in the eye or brow region, pain associated with exposure to light, blurred vision or a reddened eye.
  • The lining of the bowel 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, you will be referred 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 on to see a Rheumatologist, who specialises 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 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.

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