Ankylosing spondylitis is a chronic disease that cannot be cured but it can be treated. Exercise, changing daily routines, and taking medication can decrease pain and the risk of future complications.
Most doctors use a “treat to target” approach, treating a patient’s symptoms with a specific goal in mind. For example, a doctor may set a target for:
- A CRP level below 10, indicating low or no inflammation.
- A BASDAI score of 4 or lower. BASDAI stands for Bath Ankylosing Spondylitis Disease Activity Index, and it is a 6-questions survey filled out by patients. A survey score to a 4 or lower indicates ankylosing spondylitis disease activity is mild or inactive.
Unlike people with other forms of arthritis, people with ankylosing spondylitis sometimes report their symptoms lessen or even disappear as they age. While young people can hope for this change, it does not happen in all or even most cases, so doctors recommend all patients follow a treatment plan.
Exercise can be difficult for ankylosing spondylitis patients when they are dealing with pain and changes to their posture; however, exercise is essential to reducing pain.
Why? Ankylosing spondylitis pain is typically caused by joints that are inflexible and under stress. Physical activity and light stretching will help a person maintain posture, range of motion, and a healthy weight—ensuring joints stay flexible and are not subjected to unnecessary stress.
People with ankylosing spondylitis are advised to exercise whether their ankylosing spondylitis is active or stable. Slow motion or non-weight bearing exercises are often recommended, including:
- Tai Chi
- Pool therapy, also known as water therapy
- Weight training
- Biking or stationary bicycling
People who are recently diagnosed with ankylosing spondylitis and who already participate in high impact exercise, such as running, are advised to talk to their doctor about possibly switching to a lower impact exercise, such as Pilates or swimming.
Regular exercise really can help. One study found that people with ankylosing spondylitis who participated in water exercise classes 5 times a week for 4 weeks had improved range of motion in their spines, reduced disease activity, reduced disability, reduced pain, and better quality of life.1
A physical therapist can demonstrate how to maintain good posture, achieve flexibility through stretching, and support the spine with strengthening exercises. They may also teach patients deep-breathing exercises to increase lung capacity.
Ankylosing spondylitis lasts a lifetime, and it is not realistic to constantly attend physical therapy appointments. Instead, physical therapy is useful for people who are recently diagnosed and people who are experiencing new symptoms or joint changes.
Making certain changes to one’s day-to-day activities can make a significant difference in how severely ankylosing spondylitis affects a patient's life. For example, people are advised to:
- Quit smoking, which is associated with lung and cardiac diseases.
- Eat a healthy, anti-inflammatory diet.
- Avoid picking up heavy items that strain the back or other affected joints.
- Make adjustments to the work environment. People who normally spend a lot of time at a desk may want to get an adjustable height desk that allows users to stand or sit. Change positions often and take regular breaks. People who do manual labor may need to limit work hours or change jobs.
- Use special support devices, such as lumbar support pillows, back braces, support mattresses and zero-gravity chairs.
Patients can talk with their health care providers to discuss activities that could be modified and identify useful support devises.
Patients can make a lot of gains using exercise, physical therapy, changing daily habits and using support devices. But some patients must also take medications to control symptoms.