Ankylosing Spondylitis and Physiotherapy

Ankylosing spondylitis is part of the arthritis group, with the number one characteristics being long term jointal and ligamental inflammatory response within our back bone (spine), causing pain and decreasing the movement and mobility within the joint. In severe cases, bones that are affected may join together (termed ankylosis fusion) causing a spine that is very stiff.

If that happens, the patient with the problem may develop a stiffness-related posture. Other joints that can be also affected but not so common includes the joints of the neck, hips, knees, shoulder and ankle; and may even affect the human organs.

At this point in time scientists and doctors are still not exactly sure the cause of this condition, but what they’re sure of at this point in time is that 90% of the cases, patients has a DNA gene HLA-B27, which seems to suggest that the likelihood of ankylosing spondylitis is possibly more due to genetics. Note that even if 90% of people who has this disease has this particular HLA-B27 gene, but note that all people who has this gene has the disease.

Inflammation often begins at the lower back bone and at the sacrum-iliac joint. Often patients will complain of persistent and chronic pain and rigidity in the joints of the lower back and hip. Usually a patient will have the above symptoms especially after a bout of rest or non-movement.

Slowly, symptoms then move upwards along the spine, and may also affect the rib cage. If it affects the rib cage, what may happen is that the bones of the rib cage and sternum may join together – and if this happens, breathing will be difficult as the lungs will not be able to expand to take air in.

What physiotherapists does is to assess and diagnose if it is ankylosing spondylitis or not, and this is done via symptomatic assessments of this disease:

• Is there presence of pain and stiffness?

• If yes, where is the pain and stiffness located/which joints are favoured?

• Physical assessments which tests for presence of pain and range of motion of the said affected joints

• Poring over X Rays to look for postural anomalies

• Blood test results for the presence of the HLA-B27 gene

• Identifying if the disease had started to progress

The challenge with ankylosing spondylitis is that often early symptoms goes unnoticed and undiagnosed as the early symptoms resemble other conditions such as osteoarthritis of the back and knee or sprain back, which are rather common conditions.

Once the diagnosis has been made and confirmed, the focus of physiotherapy will be to provide as much pain relief as possible, decrease inflammation and inflammatory response, stretch out and prevent stiffness and increase range of motion, strength and stamina.

This is done through a matrix of

• joint and soft tissue mobilization and manipulation,

• soft tissue management,

• strengthening of weakened and unaffected muscle groups,

• prevention of deformity via postural correction (habitual and strength-wise)

• improve function and mobility

Regular physiotherapy and exercise therapy are crucial to the management of ankylosing spondylitis, as well as medication from your doctor.