Ankylosing spondylitis (AS) is a general term for forms of inflammatory arthritis. You may also see this called axial spondylarthritis (AxSpA).
It is a painful, progressive form of inflammatory arthritis and mainly affects the lower back, which tends to present with certain signs and symptoms as detailed below (3). You should seek medical advice if you also have a current, or history of, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), psoriasis or uveitis (red/painful eye). Uveitis has been shown to present in up to 30% of patients diagnosed with axial spondylitis (4).
Ankylosing spondylitis is a form of inflammatory arthritis. This happens when the body’s immune system (which is meant to keep us well by fighting infection) starts to cause inflammation in the joints and the area around them, causing damage. Why this happens is not fully understood, but research shows that it can run in families (3).
An immediate family history/first-degree relative with ankylosing spondylitis (including psoriatic arthritis or rheumatoid arthritis) raises the suspicion of having this condition. If you are unsure, your musculoskeletal physiotherapist or GP may get an understanding by asking questions about your symptoms (but do not worry if you cannot remember exactly).
This is not an exhaustive list. These factors could increase the likelihood of someone developing ankylosing spondylitis. It does not mean everyone with these risk factors will develop symptoms.
Each year, a GP may only see one person presenting with new-onset ankylosing spondylitis, making it a challenge to diagnose (3). Cases of ankylosing spondylitis are believed to range from 0.05% to 0.23% in the general population (1).
Before further investigations, your musculoskeletal physiotherapist will assess for many of the signs/symptoms associated with ankylosing spondylitis as outlined above.
If you are under 45 and have had back pain for more than 3 months, and have 4 or more of the above-mentioned signs/symptoms, your physiotherapist or GP may consider sending you to a rheumatologist. A rheumatologist is a specialist in conditions affecting muscles and joints; they will carry out further tests that may include X-ray or MRI, with or without blood tests.
The tests can help to differentiate between forms of ankylosing spondylitis, which include:
There is no cure for this condition however, treatment is available to relieve symptoms and help prevent its progression, as well as learning to self-manage. Your musculoskeletal physiotherapist will answer your queries regarding your condition, assess your posture and periodically measure your flexibility, especially of your back, neck, trunk and hips. They will also suggest useful strategies for managing your activity levels so that you are able to control your symptoms. Regular reassessment will ensure you are maintaining health, fitness and function, and will allow for changes to be made to your treatment programme.
Research is clear that remaining active within limitations will help manage your ankylosing spondylitis symptoms. Aerobic exercises such as walking, swimming and cycling will help improve/support your flexibility, strength, and overall fitness. Any exercise you decide to undertake needs to be regular, consistent and kept up over the long term. So, it is important to choose something you enjoy.
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at helping patients diagnosed with AS. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
This programme focuses on improving/maintaining the range of movement within the hips and spine. It is important not to further irritate your symptoms and to pace yourself. We suggest you carry these exercises out daily prior to progressing onto the next stage of rehabilitation when your pain and function allows. This should not exceed any more than 4/10 on your perceived pain scale.
This is the next progression. More focus is given to progressive loading of the lower back and hips. It remains important not to further irritate your symptoms and pace yourself as you progress into doing these exercises so always progress as able. This should not exceed any more than 4/10 on your perceived pain scale.
This programme is a further progression with challenging progressive loading of the lower back and hips. It remains important not to further irritate your symptoms and pace yourself as you progress into doing these exercises. This should not exceed any more than 4/10 on your perceived pain scale.
For patients wanting to achieve a high level of function or sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage your condition.
Medication – often you will be started with the lowest effective dosage of NSAIDs, such as ibuprofen or naproxen, to fight the inflammation, along with protective medication for your stomach. If your rheumatologist thinks that you have a form of severe active axial spondylitis then they may start you on medications known as disease-modifying anti-rheumatic drugs (DMARDS) to slow down the disease progression. However, please note that DMARDS is an umbrella term for several medications which come under this category (3).
Surgery – this is not recommended unless your symptoms are significantly affecting the quality of your life and worsening/progressing despite optimal conservative treatment as outlined above (3).
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
With PCN partnerships from Cornwall to Durham, Weston-Super-Mare to Southwold, our network of specialist physiotherapists operate face-to-face or remotely depending on your local needs.
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