By Maura Iverson, DSc, as told by Haley Levine
When you have ankylosing spondylitis (AS), an inflammatory disease that causes pain and stiffness in your lower back and spine, it’s important to stay as physically active as possible. This may seem inconsequential: Why do you keep moving if it hurts to do so? But AS can get worse if you don’t. When you are active, you are less likely to feel stiffness and pain. As a physical therapist and behavioral scientist who focuses on rheumatic diseases such as AS, I strongly believe that physical therapy is an important part of treatment that can be just as important as medication. It can go a long way toward managing your discomfort and helping you get back into a regular routine again.
Support your spine
Over time, you may have progressive stiffness that makes it difficult for you to turn your head, stand up straight, or bend over. This is because ankylosing spondylitis leads to abnormal bone growth that causes the joints around the spine, hip and pelvis to fuse together. It makes good posture difficult and can cause you to lean forward. You may have difficulty walking and fall more easily. People with ankylosing spondylitis sometimes have trouble breathing due to stiffness in the joints in the ribs and spine, limiting their ability to breathe deeply.
With physical therapy, the goal is to make sure that you are actively involved in the movement around your spine. Back and abdominal strengthening exercises do just that. The stronger it is, the less pressure is placed on your spine, which can relieve pain. Some of the best exercises to do involve the use of bridges and planks, but they can be challenging if you don’t have a great range of motion. Your physical therapist can adjust or change the exercises to make them as comfortable for you as possible. For example, if I have a client who is parenting a young child, I might show them how to get down safely on the floor on their stomach, propped up on their elbows. This type of activity allows them to play with an infant or toddler, and it also stretches the short back muscles that affect the pain. Other major moves are:
- Sits against a wall, strengthening your butt, back and hips
- Standing and raising the leg to help relieve tightness in the hips
- The chin is stretched to extend your neck
Since AS can also lead to “freezing” of the spine, posture 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 standing against a wall, or even yoga movements such as mountain pose or child’s pose. A combination of movement and stretching exercises, which can make you more flexible and reduce stiffness, swelling, and pain, is also key. These are particularly important because patients tend to restrict movement whenever they feel 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 muscles around it often tighten, causing more stiffness and pain.
Get physical outside of physical therapy
What you do outside of physical therapy is just as important. Try to do as much aerobic exercise as possible, preferably on most days of the week, for at least 30 minutes. People with ankylosing spondylitis have a higher risk of heart disease, so any of them
An activity that helps the heart is important. It also improves lung capacity, which may relieve chest tightness that often accompanies ankylosing spondylitis. Your physical therapist can help you figure out which exercises are best for you. If you like to ride a bike, for example, you’re better off riding a stationary bike where you stay upright instead of crouching. Swimming is another great activity, especially if you have a stroke on your breast or back. Both strengthen and stretch the muscles in your neck, shoulders, and back. But honestly, you can do any kind of exercise. I had a patient who loved ice hockey, so we set up a routine for him at the local ice rink. He skates with a hockey stick, passing a puck from side to side, to encourage trunk rotation.
Make time to relax
People often ask me if complementary therapies such as acupuncture or massage can help. They can’t hurt, but they probably don’t do much. These types of therapies are passive, which means that the therapist does most of the work. It may make you feel a little better, but it won’t actively build strength and flexibility, which is what you need to manage the pain associated with AS in the long term.
What helps, and what I encourage my clients to do, is meditative exercises such as deep breathing several times a day, as well as before physical therapy and exercise. 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 the spine and rib cage from tightening too much, which can affect breathing. I also recommend activities like yoga, pilates, or tai chi a few times a week. Although there are no specific studies of its effect in people with ankylosing spondylitis, studies of back pain have found that people who exercise regularly experience significantly less pain and disability than those who do not. These have the benefits of meditation and breathing as well.
It is important to remember that there is no cure for AS. But the right treatments — including physical therapy — can go a long way toward reducing the pain and stiffness associated with the disease.