While many medications treat ankylosing spondylitis by targeting pain and inflammation due to the disease, some people find that massage is a good addition to their overall ankylosing spondylitis management plan. The gentle kneading of a massage session can help relax muscles that have become tight in response to pain caused by the condition — a compensatory reaction by your body to help protect the spine but one that can lead to even more stiffness and soreness over time. “Muscles work by taking joints through a range of motion,” says Jeffrey Goldstein, MD, an orthopedic surgeon and chief of the spine service at NYU Langone Orthopedic Hospital in New York City. When spinal vertebrae are inflamed or fused because of AS, “there’s no longer motion there, so the muscles get tight and can be a source of pain. If you can relieve that stiffness, that’s good,” Dr. Goldstein says. “When someone is in a pain cycle, something calming and soothing can be very effective,” says Sara Daly, a physical therapist and massage therapist who owns Waterfalls Day Spa in Middlebury, Vermont.
Evidence and Precautions for Massage With Ankylosing Spondylitis
While many people with ankylosing spondylitis and other spinal and inflammatory conditions find massage to be beneficial, there isn’t a lot of scientific evidence to support massage as a treatment for AS. The Spondylitis Association of America (SAA) states that massage, when done carefully and gently, “may provide temporary relief of pain or stiffness and, in some cases, improve flexibility because of increased blood circulation” in people with AS. But it’s important, the group says, that your massage therapist knows about your condition and any physical limitations you have, and refrains from heavily manipulating any areas where your range of motion may be limited. What’s more, the SAA says that some people with AS don’t tolerate massage well and may experience increased pain after having a massage. While this may not be the most common experience for people with AS, it’s important to be aware of this risk. In a research review published in July 2018 in the journal Current Opinion in Rheumatology, the authors concluded that for people with AS, deep tissue massage has been found to be useful for symptom relief in small studies. But one of the article’s authors is skeptical when it comes to making recommendations to his patients. “I don’t send any patients to massage,” says Atul Deodhar, MD, a professor of medicine and medical director of rheumatology clinics at Oregon Health and Science University in Portland. “The effect size of massage is less than the effect size of ibuprofen,” when it comes to measurable disease markers like inflammation, Dr. Deodhar says. Still, Deodhar says that the biggest risk when it comes to massage for people with AS is that you may be wasting your money, as it’s unlikely to be harmful unless you have advanced disease.
Types of Massage for Ankylosing Spondylitis Pain Relief
If you decide to try massage therapy for ankylosing spondylitis pain or stiffness, you’ll find that there are many forms available. Here are a few that you may want to try: Swedish Massage This is the most popular type of massage, and it can be a good option for people with AS. It uses long strokes, circular movements, and kneading to loosen tight muscles. Pressure can range from very light to deep, depending on the client’s preference. “You’re really trying to get blood circulation going in the muscles,” says Rachel Simon-Falk, a physical therapist and massage therapist based in Silver Spring, Maryland. Deep Tissue Massage This form of massage focuses on manipulating both the top layer and deeper layers of muscle and other tissues, and often requires intense pressure. While deep tissue massage is meant to address severe tension and pain, it may cause soreness for a while afterward and may not be appropriate for some people for this reason, according to the Arthritis Foundation. Shiatsu In this form of massage, the therapist applies pressure to specific spots on the body to promote energy flow and relieve stress. Therapists may also lightly stretch your limbs. Proponents of shiatsu say that it helps balance the flow of qi, the life force present in all living things according to traditional Chinese medicine. Lymphatic Massage Also known as lymphatic drainage massage or a detox massage, this form of massage uses light, patterned strokes to help excess lymphatic fluid drain into the bloodstream. Lymphatic massage “is very good for people with arthritis, because they sometimes have a lot of excess fluid from the inflammatory process that’s been occurring,” Daly says. Petrissage If you opt for this massage technique, your therapist will gently lift your skin and knead or roll it. This can help lengthen the tissues that connect to your muscles, enabling them to relax a little. “Different muscle groups work in conjunction together and attach to the skin layer,” Simon explains. “Adding a little stretch and pliability can cause greater relief from discomfort.” Customized Massage Another option is to request a customized massage. Many day spas and massage studios have menus of massage choices, but you can also ask your therapist for a treatment that’s designed especially for your aches and pains. If your therapist isn’t familiar with ankylosing spondylitis, explain your symptoms and say that you’re interested in a massage designed to help reduce inflammation. Remember that your massage therapist works for you. Don’t hesitate to look for a different person if someone doesn’t seem eager to talk about your needs and wishes. “If you ask for a personalized massage, I’m going to have a long conversation with you and make sure you get what you are looking for,” Daly says. Additional reporting by Jennifer Acosta Scott.
