Ankylosing Spondylitis: Physiotherapy for Spinal Stiffness
Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine. It causes inflammation where ligaments and tendons attach to bone, leading to pain, stiffness, and — in advanced cases — fusion of the spinal vertebrae. While medication controls the inflammation, physiotherapy is essential for maintaining spinal mobility and posture.
AS typically begins in early adulthood (between twenty and thirty years of age) and affects men more frequently than women. The hallmark symptom is inflammatory back pain — pain that is worse in the morning, improves with exercise (not rest), and is associated with significant morning stiffness. Other symptoms may include fatigue, reduced chest expansion (due to rib involvement), and inflammation in other joints, eyes, or organs.
Without treatment, AS can lead to progressive spinal fusion — the vertebrae grow together, creating a rigid "bamboo spine." This fusion causes a characteristic forward-flexed posture, reduces mobility, and increases the risk of spinal fracture. The primary goal of physiotherapy is to prevent or minimise this progression.
Exercise is the most effective non-pharmacological treatment for AS. The programme should include: spinal mobility exercises (rotations, flexion and extension, lateral flexion — all performed daily to maintain range of motion), postural exercises (strengthening the back extensors and stretching the chest and hip flexors to maintain an upright posture), breathing exercises (to maintain chest expansion and rib mobility), and general fitness exercise (swimming is particularly beneficial as it works the spine in all directions).
The principles of AS exercise are: daily practice is essential (stiffness returns quickly if exercise stops), exercises should be performed when stiffness is worst (typically morning), and the programme should be maintained indefinitely. Group exercise classes specifically for AS patients are available through NASS (the National Ankylosing Spondylitis Society).
During flare-ups, reduce intensity but maintain gentle movement. Never force through severe pain.
Our back pain physiotherapy service provides spinal rehabilitation that can incorporate AS-specific exercises. Our home visit physiotherapy service provides ongoing support, while coordination with your rheumatology team ensures that physiotherapy complements your medical treatment.