Ankylosing Spondylitis: Causes, Signs & Treatment Options

Written by Leah Bell-Steele
Physiotherapist, University of Queensland
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on March 17, 2022
Contributed by Jamie Page
Physiotherapist, Salford University

Man out amongst trees standing and holding his back in pain

According to the Australian Family Physician, approximately 1 in 200 people will be diagnosed with ankylosing spondylitis.[1] Additionally, 5% of chronic (long-term) lower back pain is due to this condition. On average, patients are most commonly diagnosed at 50 years of age.[2]

Another major symptom seen in ankylosing spondylitis is difficulty breathing. This is due to the difficulty of the lungs expanding from the stiffness of the spine and overall inflammation. As a result, both heart and lung health should be monitored in those diagnosed with this condition.

Read on to understand what you should know about ankylosing spondylitis; the risk factors, treatment options and expected recovery time.

What is Ankylosing Spondylitis?

Ankylosing spondylitis, also known as Bechterew’s, is an inflammatory condition of the spine. Persistent inflammatory changes of the spine can cause each segment of the spine (vertebrae) to fuse. Over time, this can lead to issues, such as developing a hunched back posture, lower back pain and spinal stiffness.

According to the Australian Family Physician, ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae (bones) in the spine to fuse over time.[3]

What are the symptoms of ankylosing spondylitis?

The primary symptom of ankylosing spondylitis is pain and reduced flexibility in the spine. People also experience pain in the ankles, hips, neck and shoulders, and sometimes, the eyes as a result of inflammation.

Common symptoms of ankylosing spondylitis

  • Lower back pain

  • Lack of mobility

  • Stiffness

  • Arthritis or inflammation of the joints

  • Chest pain

  • Fatigue

  • Painful flare-ups

What causes ankylosing spondylitis?

The cause of ankylosing spondylitis is not known, however, genetic factors seem to be involved. The primary gene that increases the risk of ankylosing spondylitis is called HLA-B27.[3] Not everyone with this gene will develop the condition.

Common causes of ankylosing spondylitis

  • Symptoms of ankylosing spondylitis often start to be seen in teen and young adulthood.

  • Men are more likely to have ankylosing spondylitis than women. Men also tend to have a more severe form of ankylosing spondylitis.

Sports that increase the risk of ankylosing spondylitis

Although exercise and staying active is beneficial for people who have ankylosing spondylitis, high impact activities that require a high amount of twisting of the spine place too much stress on the back can cause pain and other complications.

  • Tennis

  • Squash

  • Racquetball

  • Running

  • Basketball

How is ankylosing spondylitis diagnosed?

Ankylosing spondylitis can cause a lot of pain and affect the quality of your life. It can limit you from doing the things that you love to do.

There are several options available when it comes to diagnosing your back pain as ankylosing spondylitis. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are rehabilitation experts that deal with spinal problems and joint pain. They can diagnose spinal conditions and effectively provide treatment for your pain and help you manage other symptoms to keep you healthy and active.

An assessment from a physiotherapist is simple and comprehensive. Similar to visiting a GP, your physiotherapist will ask vital questions regarding your health and lifestyle. This would help in diagnosing your condition and determining your treatment goals.

After establishing the background of your condition, your physiotherapist will then perform a detailed assessment of your spine and other joints to determine factors that contribute to your pain and other disability due to ankylosing spondylitis.

Your physiotherapist will then create a diagnosis and treatment plan based on your assessment. This whole process will take about 30 to 60 minutes. You will also be given the details of your program.

This will include:

  • Treatment frequency that will be required

  • List of exercises you need to do at home

  • Strategies to manage the pain and prevent complications

  • Timeline of your treatment and rehabilitation

How is ankylosing spondylitis treated?

Although ankylosing spondylitis is a permanent condition, there are many things that can be done to help you stay healthy and manage your symptoms, ultimately reducing your pain.

There are several options when it comes to treating ankylosing spondylitis. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.

Treatment of ankylosing spondylitis can improve patient’s overall quality of life. In some patients, treatment can prevent or delay the fusion of your spine and improve overall stiffness and mobility.

Ankylosing spondylitis is a condition that physiotherapists come across regularly, and the process for treating it is straightforward.

Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.

Your treatment will focus on reducing your pain, treating inflammation and improving your mobility. Your physiotherapy program will involve a lot of treatment for postural correction and increasing your functional capacity.

The key to treating ankylosing spondylitis is to reduce inflammation. The four key drivers of inflammation that we can control are:

  • Nutrition

  • Sleep

  • Stress management

  • Exercise

By eating well, getting adequate sleep, minimising stress where possible and exercising, we can reduce overall inflammation and improve symptoms.

Discuss with your physiotherapist the best strategies for you to reduce inflammation to achieve the best outcome.

Depending on the severity of your ankylosing spondylitis, a physiotherapist may also provide you with a combination of the following types of treatments:

  • Advice and Education - Probably the most important part of treating ankylosing spondylitis. You need the right advice as to what will work best for you.

  • Therapeutic Exercises - Exercise techniques to improve your overall function and decrease pain.

  • Postural Training - Specific exercises to improve your posture and mobility.

  • Strengthening Exercises - Exercise techniques designed to support your core and improve spinal stability.

  • Stretching - Techniques to increase your range of motion and decrease joint stiffness.

  • Manual Therapy - Hands-on physiotherapy techniques to improve overall joint mobility and decrease pain.

Physiotherapy treatment can last for about 30 to 60 minutes. Most patients can feel improvements in pain in just a single session.

Next step - Creating a treatment plan made for you

After your initial visit, your therapist will create a detailed step by step program to help with your recovery and improve your overall health status.

Self-care for ankylosing spondylitis

If you have ankylosing spondylitis, here are the best things you can do and avoid.

Things to do:

  • Exercise

Exercise is the best pain remedy for ankylosing spondylitis. Staying active can delay the progression of ankylosing spondylitis. Use exercise to alleviate pain and enjoy life to its fullest.

  • Hot packs / cold packs

If you are experiencing pain and swelling of your joints, apply cold packs for at least 10 to 15 minutes to control the swelling and decrease pain. Hot packs can also relieve stiffness and allow you to move better. Apply it for at least 15 to 20 minutes.

  • Gentle stretching

Stretch your muscles regularly to help relieve tightness and stiffness of your joints, especially on the spine. Incorporate stretching exercises in your daily routine.

  • Massage

Light massage can help you relax and feel more flexible when you do exercises. It can reduce pain and improve blood circulation in your spinal areas.

Things to avoid:

  • Smoking

Smoking should be avoided because it increases the risk for more significant spinal damage and circulatory problems.

  • Sleeping too late

Give your body enough time to rest. Having complete sleep will allow your body to heal itself better and can prevent the worsening of the symptoms.

  • Stress

Avoid stressful situations. Stress signals the release of various stress hormones and chemical processes in the brain that can aggravate your pain and worsen ankylosing spondylitis.

Do I need a specialist or surgery?

It is rare that ankylosing spondylitis will require surgical intervention. In the process of diagnosis, medical imaging may be suggested, such as an X-Ray or MRI, to assess the spine and any changes that have occurred.

Blood tests will also be done to determine the presence of the HLA-B27 antigen or other inflammatory substances that may be linked to ankylosing spondylitis.

There are some cases where bony spurs or growths may put pressure on the nerves from the spine. In these cases, if there is sufficient pain, a laminectomy or osteotomy may be performed for the benefit of pain reduction. This will not change the diagnosis of ankylosing spondylitis or cure the condition, but it can help with symptoms.

What is the recovery time / prognosis for ankylosing spondylitis?

Ankylosing spondylitis is a permanent condition. However, intense periods of pain and stiffness can be prevented and managed accordingly to help you lead a healthy and active life.

People who undergo physiotherapy rehabilitation can delay the progression of ankylosing spondylitis and reduce the risk of needing spinal surgery.

Can ankylosing spondylitis progression be prevented?

Guaranteeing prevention can be impossible; however, you can improve the outcome by being proactive upon diagnosis.

  • Active exercise - Exercise can increase your bone health and improve your muscle strength which gives more stability to your joints, thus reducing the risk of damage.

  • Maintain a healthy weight - Maintaining a healthy weight will allow you to move better and decrease the stress in your joints and spine.

  • Avoid overuse of your joints - Although staying active is beneficial, you still have to pace your activities and prevent overuse of your joints, especially your hips and back.

  • Be mindful of your posture - Do postural exercises and stretching regularly to help your body maintain an optimal posture. Avoid slouching and improper sitting as much as possible. Improper sitting can increase the pressure in your pelvis and may worsen your symptoms.

  • Sports - Doing leisure sports is good to help you stay active. Swimming is one of the best physical activities for people with ankylosing spondylitis.

Outlook and the main takeaways

Ankylosing spondylitis is a rare painful condition that affects the spinal joints and other areas of the body. Although there is no cure for ankylosing spondylitis, there are many things that can be done to help patients deal with pain and manage their symptoms.

Physiotherapy can help people with ankylosing spondylitis achieve their most optimal function and stay active as much as possible.

Book a consultation with your nearest physiotherapist today and live a healthier life.

Anatomy of the spine

Your spine is made of a series of bones (vertebrae) stacked on top of each other. It extends from your lower back up to your neck.

The spine is divided into spinal segments:

  • Cervical - 7 vertebrae

  • Thoracic - 12 vertebrae

  • Lumbar - 5 vertebrae

  • Sacral - 5 fused vertebrae

  • Coccyx (tailbone)

Ankylosing spondylitis causes inflammation in the spinal areas and other parts of the body. The pain usually starts at the lower back or buttocks (sacroiliac joints) and gradually affects other hip and spine areas.

Because of the constant pain during movement, the body starts to react by forming new bones around the spine area to prevent movement. This results in gradual fusing of the spinal bones, which restricts movement.

Written by Leah Bell-Steele
Physiotherapist, University of Queensland
Published on March 17, 2022
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on March 17, 2022
Contributed by Jamie Page
Physiotherapist, Salford University
Sources
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Last medically reviewed on March 17, 2022
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