What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is a disease that 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.
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 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 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, 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 an array of 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 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
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 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 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 essential 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 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 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. Would you 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 an extra load on your joints and muscles, predisposing you to increased pain.
General exercises are fundamental to keep your body moving. If you have a specific activity you enjoy, 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.
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What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques, education and advice. Physiotherapists maintain physical health, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly skilled in prescribing the "best exercises" for you and the most appropriate "exercise dose" for you, depending on your rehabilitation status. Your physiotherapist will incorporate essential pilates, yoga and exercise physiology components to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports & Exercise Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstations set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your problem, please get in touch with your PhysioWorks team.
Article by John Miller
What is Pain?
Pain is the built-in alarm that informs you something is wrong!
Pain is your body's way of sending a warning to your brain. Your spinal cord and peripheral nerves provide an electrical pathway. Nerve messages travel between your brain and the other parts of your body. Pain travels along these nerve pathways as electrical signals to your brain for interpretation.
Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells. Most cells sense pain. Tiny cells send messages along nerves and the spinal cord to your brain when there is an injury to your body,
In general, pain receptors are classified according to their location.
Receptors that respond to injury or noxious stimuli are termed nociceptors and are sensitive to thermal (heat), electrical, mechanical, chemical and painful stimuli. Each nociceptor is connected to a nerve that transmits an electrical impulse along its length towards the spinal cord and then, ultimately, your brain.
It is your brain that informs you whether or not you are experiencing pain. Plus, your pain can plays tricks - especially when you suffer chronic pain.
Pain messages travel slower than other nerve stimulation.
Nerves can also be categorised according to their diameter (width) and whether a myelin sheath is present.
Three types of nerves are concerned with the transmission of pain:
A-beta fibres, which have a large diameter and are myelinated
A-delta fibres, which has a small diameter and also have myelinated sheaths.
C fibres have small diameters, are non-myelinated (slowing their conduction rate), and are generally involved in transmitting dull, aching sensations.
Nerves with large diameters conduct impulses faster than those with a small diameter. The presence of a myelin sheath also speeds up the nerve conduction rate.
One method of easing your pain is to provide your nervous system with high speed "good feelings", such as rubbing your injured area. This is the same principle that a tens machine (pain-relieving machine) utilises to provide pain relief.