Physiotherapy for ankylosing spondylitis: can it help?

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Physical therapy can help improve several symptoms of ankylosing spondylitis. Specifically, it can help reduce joint pain and stiffness, and improve strength, range of motion, and flexibility.

Ankylosing spondylitis is a form of inflammatory arthritis that primarily affects the spine and can limit mobility. Exercise plays an important role in the treatment of ankylosing spondylitis, so it should be a priority for people with this condition.

Physiotherapy provides a clinical way for people with ankylosing spondylitis to stay active and learn different exercise techniques. A large part of physical therapy involves learning how to apply exercises at home.

A physiotherapist will work directly with a person to develop routines and exercises that will help improve their mobility and strength.

This article explores some of the potential benefits that a physical therapist can offer to someone living with ankylosing spondylitis.

A physiotherapist can show a person with ankylosing spondylitis how to make exercise part of their daily life.

According to a 2016 study, some of the potential benefits of regular exercise for people with ankylosing spondylitis include:

  • improved mobility and posture
  • less pain and stiffness
  • increase in strength
  • improved physical function

During a physical therapy session, a person often engages in several exercises that can help relieve their ankylosing spondylitis symptoms. As part of the sessions, the physiotherapist will also teach the person how to do exercises to help solve problems and how to perform exercises at home.

While every situation is different, and although a physiotherapist tailors their program to the individual, some common exercises that a physiotherapist may recommend include:

  • functional training to help a person continue or increase their daily activities
  • exercises to help the spine
  • cardiovascular exercise to improve symptoms and overall health
  • stretching routines
  • strengthening exercises

Posture training

A person with ankylosing spondylitis may change their posture to compensate for the pain associated with the condition. Over time, poor posture can lead to increased back pain and stiffness. It can also put increased pressure on the spine.

A physical therapist may recommend several posture training exercises for someone with ankylosing spondylitis. These can include lying down and standing with your back against a wall. These exercises strengthen the extensor muscles – such as the lower back, shoulder blades, and buttocks – to help improve spinal extension.

To do a lying down exercise for posture:

  1. Lie on your stomach on a firm surface.
  2. Place a pillow or towel under the chest or forehead for extra comfort.
  3. Straighten your arms out to the sides.
  4. Work until you hold this position for up to 20 minutes.

To do a back to wall exercise for posture:

  1. Stand against a wall so that your heels, buttocks, and shoulders are touching the wall.
  2. Bring your head back to the wall.
  3. Hold the position before you relax and repeat.

Strengthening exercises

According to the Spondylitis Association of America, strengthening the abdominal muscles can help a person with ankylosing spondylitis reduce stress on the spine and minimize back pain. Core muscles are the abdominal muscles and other muscles that support the spine.

Planking is an exercise that can help strengthen core muscles. A person performs a plank by getting on top of a push-up position and holding the position.

For starters, a physiotherapist can show a person how to perform a plank while standing against a wall. As the person builds their strength, they can perform the plank on their knees and work up to a full plank. To relieve their hands, they can balance on their forearms instead of their hands.

Flexibility or stretching exercises

Flexibility exercises such as stretching can help a person with ankylosing spondylitis maintain mobility and reduce the risk of joint fusion.

Some areas that a person with ankylosing spondylitis should stretch include:

  • hips
  • thighs
  • Chest
  • the back

A physiotherapist can recommend stretching exercises that are appropriate for the person. People can also try yoga stretches such as Cat-Cow, Downward Dog, and Forward Fold to help stay mobile and reduce back pain.

Deep breathing exercises

Living with ankylosing spondylitis can cause a person to have difficulty breathing deeply and breathing in general. A person’s physiotherapist can work with them on deep breathing exercises that help expand their chest and increase their lung capacity.

Diaphragmatic breathing, or belly breathing, is a deep breathing exercise that helps strengthen the diaphragm and increase lung efficiency.

To perform diaphragmatic breathing:

  1. Sit or lie down in a comfortable position.
  2. Place one hand on the chest and the other on the stomach.
  3. Inhale through your nose so that the stomach pushes against the hand, but keep the chest as still as possible.
  4. Exhale through pursed lips as the stomach muscles contract.

Pain management techniques

In a 2019 review of studies, researchers note that people who exercised experienced as much 21% reduction in pain compared to those who did not exercise.

While exercise can benefit many people with ankylosing spondylitis, not all programs work for everyone. Some people may need gentle, low impact exercise or one focused on reducing stress or pain.

These can include activities such as yoga, deep breathing, or other low impact exercises that benefit the individual without harming their body.

Individual activities

Individual activities include different types of exercise which often focus on low impact aerobics. These are activities that can help improve a person’s overall cardiovascular and mental health and reduce pain and disease activity.

Individual activities can include a number of low impact exercises, such as:

  • cycling
  • do tai chi
  • using an elliptical machine
  • walking
  • to swim
  • to do yoga

A person should speak with a physiotherapist about the exercises they want to try. They should also work with their physiotherapist to determine the best group classes for their needs.

Surgery is not the first-line treatment for ankylosing spondylitis. In other words, a doctor will probably only recommend surgery for a person with ankylosing spondylitis if their daily life is severely affected and no other treatment has worked.

A person’s doctor will likely recommend physical therapy after surgery. A physiotherapist will work with the person in the same way as before, teaching and guiding them through strength, flexibility and other exercises.

The main difference is that the goals of physiotherapy after surgery will focus on supporting a person’s full and safe recovery.

The exact cause of ankylosing spondylitis is still not known. However, the researchers note that a combination of genetic and environmental factors may play a role in its development. As a result, people cannot prevent ankylosing spondylitis from occurring.

That said, treatment can help prevent ankylosing spondylitis from getting worse. The goals of almost all treatment options are to slow or stop the progression of the disease and to improve symptoms and quality of life.

The amount of physical therapy a person needs when living with ankylosing spondylitis can vary depending on their needs and a doctor’s recommendation.

Sessions tend to last between 30 minutes and 1 hour, depending on the facility. How often a person goes to physiotherapy each week depends largely on their needs.

A person should check with their insurance provider to determine the costs associated with physical therapy. It may also only cover a certain number of physiotherapy sessions per month or per year.

Physiotherapy can play an important role in the treatment of ankylosing spondylitis. A person may notice increased flexibility and mobility as well as a general decrease in pain when following the recommendations of their physiotherapist.

Exercise recommendations vary, but a person can expect to learn about various types of exercise including strength, flexibility, cardio, and others. A physical therapist will create a personalized routine designed to help the person living with ankylosing spondylitis make the most improvements.


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