Condition guide
A rheumatic disease that usually starts before the age of 40 and causes inflammatory pain and stiffness in the lower and upper back. Its most typical feature is pain that gets worse with rest and better with movement. Alongside medication, regular exercise is an essential part of treatment.
Ankylosing spondylitis is an inflammatory rheumatic disease that affects the spine and the sacroiliac joints, where the spine joins the pelvis. Today it is considered part of a broader group called axial spondyloarthritis. If the inflammation is not brought under control for a long time, new bone can form in the spine and movement can become permanently restricted.
Because the symptoms come on gradually and are mistaken for ordinary back pain, diagnosis is often delayed for years. Early diagnosis and treatment are important for keeping you mobile.
According to the recommendations of the Assessment of SpondyloArthritis international Society (ASAS) and EULAR, updated in 2022, the cornerstones of treatment are information about the condition, regular exercise, stopping smoking and, when needed, physiotherapy. The first step in medication is anti-inflammatory painkillers (NSAIDs). If the disease stays active, a rheumatologist plans advanced treatments such as biologic medicines or JAK inhibitors. Long-term cortisone treatment is not recommended when the spine is affected.
In a 2019 Cochrane review covering 14 studies and 1,579 patients, exercise programmes lasting 12 weeks on average, mostly added to medication, slightly improved day-to-day function and slightly reduced disease activity as rated by patients, compared with no exercise. Pain could also ease: pain scored at 6.2 out of 10 was about 2 points lower in those who exercised. In people already receiving physiotherapy or regular treatment, exercise gave a smaller additional benefit.
Smoking is linked to more active disease and faster new bone formation in the spine; stopping smoking is part of treatment.
Exercises at home
The programmes in the studies mostly consisted of strengthening, flexibility, stretching and breathing exercises. Do these exercises every day, ideally after a warm shower to ease morning stiffness. Move through your full range, slowly and without holding your breath.
Stand with your back against a wall, with your heels, buttocks and shoulder blades touching it. Gently tuck your chin in and bring the back of your head towards the wall; hold for 5 seconds. Checking from time to time how close your head gets to the wall helps you keep track of your posture.
10 reps, every daySit or stand up straight, looking straight ahead. Without tilting your head, draw your chin straight back and feel the back of your neck lengthen. Hold for 5 seconds, then release.
10 reps, twice a daySit on a chair with a low back and clasp your hands behind your neck. Lifting your chest towards the ceiling, gently arch your upper back backwards over the top edge of the chair. Take a deep breath as you do this.
10 reps, every dayGet on your hands and knees. As you breathe out, round your back up towards the ceiling; as you breathe in, let your lower back sink and lift your head. Move slowly, using your whole spine.
10 reps, every dayLie on your front. Bring your elbows under your shoulders and slowly lift your chest off the floor, keeping your hips on the floor. Hold for a few seconds, then slowly lower yourself down. It is a good exercise to counter a stooped posture.
10 reps, every dayGet on your hands and knees with your back flat. Reach one arm forwards and the opposite leg backwards, without letting your lower back sag. Hold for 5 seconds, then switch sides.
8–10 reps on each sideGenetic predisposition is important: most patients carry a tissue type called HLA-B27. However, most people who carry HLA-B27 never develop the disease, and this test alone cannot confirm the diagnosis.
Inflammatory back pain eases with movement and gets worse with rest. Regular exercise reduces stiffness and helps maintain your range of movement and your posture. During painful flare-ups, reduce the intensity, but keep moving.
Swimming, exercising in water, walking, cycling, Pilates and yoga are all suitable options. People whose spine has become severely stiff should avoid sports with a risk of falls and knocks, because a stiffened spine can fracture even after a minor knock.
Yes. Medication controls the inflammation, while exercise keeps you mobile and maintains your posture and muscle strength. Guidelines recommend using both together.
See a doctor without delay if you have any of the following:
Sources
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İhsan Eren