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Exercise & Movement

A key component to managing spondyloarthritis conditions like ankylosing spondylitis (AS) is regular exercise or physical therapy. The other mainstay of treating AS are medications like non-steroidal anti-inflammatory drugs (NSAIDs) and biologics (tumor necrosis factor (TNF) inhibitors and interleukin-17A (IL-17A) inhibitors).1

How ankylosing spondylitis affects the body

AS causes chronic inflammation, pain and stiffness in the affected joints. Most often, AS is focused on the joints in the spine and the SI joints, although other joints in the body may also be inflamed, such as the hips, shoulders, ribs, knees, hands, or feet. There is much variability in AS, with no two people with the condition having the same experience. In addition to the differences in which joints or parts of the body are affected, there are differences in the progression of the disease. Some people may have rapid progression while others have a mild or slower progression. While the disease is chronic and may progress and cause joint damage and disability, some with AS may never experience significant joint damage, and early and effective treatment may help prevent or slow joint damage.2,3

In the affected joints, AS causes chronic inflammation, which can lead to bone loss, and as the body rebuilds this bone tissue, new bony tissue can grow where the ligaments attach to the joint (syndesmophytes) and/or fuse the joint. The joint damage is permanent and can impact a person’s mobility, flexibility, and quality of life.2

How exercise and movement can help ankylosing spondylitis

The pain and stiffness that are characteristic of AS are worse in the morning after sleep or after periods of inactivity, and they improve with movement and activity or a warm shower.4 Although exercise and physical therapy have not been shown to prevent the progression of AS, getting regular movement in the joints can help manage the symptoms of the disease and help people living with AS maintain their flexibility and mobility.5

Recently, exercise recommendations for people with AS were developed by a team of Australian physical therapists and a rheumatologist. These guidelines were created after a thorough review of existing research and clinical data and include suggestions that regular physical activity involves a variety of approaches to encompass stretching, strengthening, cardiopulmonary, and functional fitness. The exercise recommendations also encourage an exercise plan be customized to meet the individual’s preferences, goals, and lifestyle.6

Physical Therapy

Physical therapy can also be beneficial for people living with AS. Physical therapy is a healthcare discipline that helps people reduce pain and improve or restore mobility. Physical therapists are licensed healthcare professionals that can help people with AS manage their condition by using treatment techniques to promote the ability to move and maintain range-of-motion in joints.7 Physical therapists will create a combination of exercises and techniques to help the individual with AS achieve or maintain strength, flexibility, good posture, and joint mobility. The individual is also responsible for doing the exercises on their own in between appointments.8

Written by: Emily Downward | Last reviewed: March 2019
  1. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2015;68(2):282-98.
  2. D. J. Pradeep, A. Keat, K. Gaffney; Predicting outcome in ankylosing spondylitis, Rheumatology, Volume 47, Issue 7, 1 July 2008, Pages 942-945, https://doi.org/10.1093/rheumatology/ken195
  3. Swift D. Ankylosing spondylitis: disease progression varies widely. Medpage Today. Available at
  4. https://www.medpagetoday.com/rheumatology/arthritis/49096. Accessed 2/14/19.
  5. Most common symptoms. Spondylitis Association of America. Available at https://www.spondylitis.org/Ankylosing-Spondylitis/Symptoms. Accessed 1/21/19.
  6. Ankylosing spondylitis. University of Washington Orthopaedics and Sports Medicine. Available at http://www.orthop.washington.edu/patient-care/articles/arthritis/ankylosing-spondylitis.html. Accessed 2/12/19.
  7. Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum. 2016
  8. Feb;45(4):411-27. doi: 10.1016/j.semarthrit.2015.08.003. Epub 2015 Aug 18.
  9. Who are physical therapists? American Physical Therapy Association. Available at http://www.apta.org/AboutPTs/. Accessed 2/12/19.
  10. Physical therapists' guide to ankylosing spondylitis. Move Forward, American Physical Therapy Association. Available at https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=ecf13e37-b094-48bf-af52-8da048f8bdab. Accessed 2/12/19.