As the disease progresses, the bones of your spine may fuse together, making it even more difficult to move and causing your condition to become more painful. Your doctor or rheumatologist may prescribe medication to reduce the inflammation. Your doctor is also likely to suggest that you work with a physical therapist for ankylosing spondylitis, according to the Spondylitis Association of America (SAA). Physical therapists can teach you exercises to manage your pain and stiffness, improve posture, and increase mobility, and provide you with information about ankylosing spondylitis. Here’s what physical therapists tell people to do to help manage the condition:
- Learn more about your condition. The more you know about ankylosing spondylitis, the better the decisions you can make about managing and treating it, says Mary Ann Wilmarth, PT, DPT, OCS, MTC, a retired physical therapist and patient advocate for people with arthritis-related conditions. A physical therapist is a good place to start because they are neuromusculoskeletal experts, she adds.
- Start with an evaluation. “A physical therapist can help you identify which muscle groups and joints to work on and develop an individualized plan that targets your specific body,” says Eric Robertson, PT, DPT, OCS, director of Kaiser Permanente Northern California Graduate Physical Therapy Education and associate professor of clinical physical therapy at the University of Southern California. “This is important given the somewhat variable nature of how ankylosing spondylitis presents.” Dr. Robertson is also a spokesperson for the American Physical Therapy Association (APTA).
- Maintain good posture. Posture is important for everyone, but for people with ankylosing spondylitis it can be even more important, according to the APTA. When you slump your head forward or round your shoulders, you limit your range of motion in your neck and back, Dr. Wilmarth says, “and you don’t want to be at any more of a disadvantage with your spinal range of motion than you already are.” A physical therapist can check your posture and help you develop an exercise and strengthening routine to maintain an upright position.
- Practice good ergonomics. Good ergonomics go with good posture, and they’re important to further support the body when you’re sitting or performing other daily activities, says Arthritis Research UK. Ideally, your chairs should have adequate lumbar support to keep your back and neck in a neutral position for minimal pressure and maximum mobility. Change your position throughout the day to alter the stress on your back and joints. “With both posture and ergonomics, the ultimate goal is to maintain as normal a posture as possible so that if any fusion does occur down the line, it will happen with the spine in the optimal position,” Wilmarth says.
- Get exercise. Work with your physical therapist to learn exercises that will strengthen your back and neck. Ask your physical therapist for deep-breathing exercises to help keep your chest and rib cage flexible. Your exercise routine should include both aerobic and strength-training activities. Aerobic exercise works well to improve circulation, breathing, flexibility, joint mobility, and overall health and well-being, Wilmarth says. Strength training is just as important, Robertson says, because it can help support all of your other activities and exercises. Be sure to include the core muscles and hips. “It’s important to maintain hip extension range of motion,” he adds. “Stretching your hip flexors can help you continue to walk comfortably.” On the days when you feel too stiff and sore to exercise, take a hot bath or shower to loosen up your muscles. Begin your exercises slowly. When you’re warmed up, it’s easier to perform aerobic exercises,” Wilmarth says. And if you schedule your exercises for the time of day when you’re least tired or tend to have the least pain, you’ll have more success.
- Sleep well. Getting quality sleep at night is important to your overall health, the SAA says. Look for a mattress that’s firm enough to offer support but sufficiently soft to provide comfort. Getting up and stretching at least once in the middle of the night can also help avoid morning stiffness, Robertson notes.
- Learn pain-management techniques. Heat or ice packs can help you manage pain and inflammation in your joints, according to the Arthritis Foundation. Your physical therapist may suggest you use a transcutaneous electrical nerve stimulation (TENS) unit, which provides electrical stimulation to alleviate pain, Wilmarth says. TENS units may also provide indirect benefits, including improved sleep, according to a study published in February 2019 in the Journal of Pain Research. Additional reporting by Brian Dunleavy
