Ankylosing spondylitis (AS) is an inflammatory arthritis that usually affects the back. Regular exercise, stretching, and other home remedies can play an important role in the treatment of back pain associated with ankylosing spondylitis.
According to the Global Healthy Living Foundation (GHLF), the most common symptoms of AS are stiffness and pain in the waist. This discomfort will worsen after waking up or after a period of inactivity. However, back pain caused by AS can also wake people from sleep.
Patients with AS may describe persistent dull pain that originates from the lower back or buttocks.
Exercise can play an important role in helping to improve the symptoms of AS. The American Spondylitis Association (SAA) recommends that patients with AS regularly perform four different types of exercise:
- Cardiovascular or aerobic
- Strength Training
This article explains how to perform specific exercises and stretching exercises that may help relieve AS-related back pain.
Posture exercises are a form of strength training. They usually involve the use of core muscles located around the center of the body.
Good posture can help prevent a person from being listless forward, which can reduce pressure on their back.
A person can try the following exercises to help strengthen the muscles responsible for posture.
Back against the wall
In this exercise, a person will stand with his back against the wall of his home or gym.
They can follow the steps below to practice:
- Stand with your back against the wall, with your heels and hips against the wall.
- Squeeze the shoulder blades together.
- Hold this position for about 5 seconds, then release.
- Repeat several times.
One may wish to perform this exercise on a mat. It includes the following steps:
- Lie on your back and turn your head to the side.
- If possible, stretch your arms towards your feet.
- Move your arms forward and slowly support your body with your elbows.
- Continue to raise your body until your chest is off the ground, then turn your head to the front.
- Hold for 10-20 seconds, and then return to the starting position.
Other posture tips
According to Versus Arthritis, a person should ensure that they maintain a good posture by keeping their shoulders back and relaxed and lifting their chin.
When sitting, they can also minimize posture-related symptoms by:
- Avoid leaning on the elbow
- Use a straight chair with a solid backrest
- Position the hips so that they touch the back of the chair
- Use a cushion behind their lower back
- When sitting at the desk, put everything they need within reach
- Make sure the seat is at the correct height
- Keep your knees at a right angle and use a footrest if necessary
- Avoid sitting in one position for too long without moving your back
The charity also recommends lying on the floor at some time during the day to help stretch the front of the hips.
One can try the following exercises:
As the name suggests, this exercise is based on Superman’s flying posture.
To perform this exercise, one needs:
- Lie on a soft mat or floor.
- Extend your arms above your head, then stretch your legs straight back.
- Lift your arms, chest, head, and legs off the floor.
- Maintain this position for about 5-10 seconds.
- Repeat 5-10 times.
If raising both arms and legs is too difficult, Versus Arthritis recommends putting one arm aside while looking forward, and then lift the outstretched arm and the other foot off the floor.
Maintaining this position helps stabilize the core.
It is simple to implement, although one may initially find it difficult to hold for a long time:
- Lie on your stomach with your forearms on the floor and your elbows directly under your shoulders.
- Tighten your abdominal muscles and lift your hips off the ground to form a straight line with your body.
- Maintain this position for 10-20 seconds.
Stretching plays an important role in flexibility and strength.
According to GHLF, flexibility and stretching exercises can help:
- Increase joint range of motion
- Prevent spine and joint stiffness
- Keep your back flexible
Here are some stretching exercises that AS patients can try.
Supine quadriceps stretch
A person should stretch the front of the thigh according to the following steps:
- Lie on his stomach.
- Wrap a fitness band, rope, belt, or other object around the top of one foot.
- Pull the shoulder straps over the shoulders until the thighs are stretched.
- Maintain this position and repeat the stretch on the other side.
Seated Figure Four
This kind of extension can help improve a person’s hip joint range of motion.
A person can follow the steps below:
- Sit on a chair with your feet flat on the floor.
- Lift your right leg and place your right foot directly above your left knee on your left thigh.
- Point your right knee to the side.
- Keep your spine straight and slowly bend forward.
- Hold for 10-20 seconds, then repeat on the other side.
Yoga is a physical and mental exercise that may benefit patients with AS.
Certain postures may be particularly useful. These include:
Cat and cow
For this action, a person alternates between two positions gently:
- Start with hands and knees and place on a yoga mat or other soft surface.
- Align your wrists with your shoulders, and your knees with your hips.
- When you inhale, look up to the ground and let your abdomen down.
- When you exhale, put your head down, tuck your chin into your chest, pull your belly button toward your spine, and arch your back toward the ceiling.
- Alternate slowly between the two positions a few times.
Extend the child’s posture
Infant pose is a resting posture that helps relax the body and stretch the back.
A person can follow the steps below:
- Starting on all fours, bring your legs together.
- Move the hand forward until the arm is fully extended.
- Sink your body backwards until your hips sit on your heels
- The forehead touches the ground lightly.
- Maintain the position for a few slow breaths.
According to the Arthritis Foundation, a brace or neck brace is not a practical solution to prevent flexion or forward bending.
Instead, the organization recommends:
- Use flexibility exercises to break the posture of standing or sitting in the front row for a long time
- Practice good posture when standing or sitting
- Exercise regularly
- Sleep on a pillow without a pillow or a very flat pillow
One should discuss with the doctor the pros and cons of using a back brace to help treat AS.
Physical therapy is an important part of the AS treatment plan. It can help improve muscle strength and maintain spine mobility.
Types of physical therapy include:
- Group exercise program
- Personal exercise plan
- Hydrotherapy, which is a water-based treatment in which a person exercises in a shallow swimming pool or spa bath
People can also benefit from swimming.
Complementary treatment may include:
A person can also take medication to help relieve back pain.
According to SAA, the first-line treatment for pain is non-steroidal anti-inflammatory drugs (NSAIDs). These drugs, including ibuprofen (Advil) and naproxen (Aleve), have the advantages of over-the-counter and prescription drugs.
Other drugs include biological agents, such as anti-tumor necrosis factor and anti-interleukin-17 drugs. If anti-inflammatory drugs and exercise do not help or the disease progresses, doctors will recommend these drugs.
Biological agents are the most recent AS treatment option.
Unless other treatments are ineffective or AS has developed to a level that severely restricts a person’s daily activities, doctors may not recommend surgery.
When possible, doctors should use minimally invasive surgery to correct the condition.
AS can cause back pain. Although doctors may recommend multiple medical options, regular strength and stretching exercises can help prevent the pain and other complications of AS.
One should discuss with the doctor the treatment plan that is best for them.