Physical Therapy for Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a form of spondyloarthritis that causes chronic pain and stiffness in the affected joints. While AS primarily affects the joints in the spine and the sacroiliac joints (between the base of the spine and the pelvis), it can also affect other joints in the body, such as the hips, shoulders, ribs, knees, hands, or feet. As the condition progresses, it can cause joints to become fused, which greatly impacts a person’s flexibility and range of motion.¹ AS is more common in men than women, although people of both genders can develop the condition. In men, the severity of the joint damage from AS is often greater, but women with AS have more pain and functional limitations.²

Physical therapy and regular exercise are key parts to managing AS, in combination with medications like non-steroidal anti-inflammatory drugs (NSAIDs) and biologics (tumor necrosis factor (TNF) inhibitors and interleukin-17A (IL-17A) inhibitors).³ In the United States, physical therapy ordered by a physician is generally covered by insurance though there may be co-payments for each visit.

How physical therapy can help people with AS

Physical therapy is a healthcare discipline that helps individuals 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.⁴

Although physical therapy has not been shown to prevent the progression of AS, it can help manage the symptoms of the disease and help people living with AS maintain their ability to move. Pain-free movement is critical to an individual’s quality of life and their ability to engage in work and other activities. Physical therapists tailor the treatment plan to the individual, creating a unique plan to meet the needs and any limitations of their patient.^5,6

Physical therapy assessment

An initial appointment with a physical therapist will include a thorough assessment. For a person with AS, the physical therapist will evaluate the individual’s posture and their range of motion in their spine, hips, knees, and shoulders. The person may be asked to bend forward and backward, squat, and walk. Because AS can also impact the chest, causing inflammation and stiffness in the joints between the ribs and the spine and/or the ribs and the breastbone, the physical therapist will also measure the chest expansion upon taking a deep breath.⁷

Physical therapy exercises for AS

There is much variability in the severity, number of joints affected, and progression of AS among different people with the disease, and each person has their own unique circumstances, such as the type of work they do and what sports or types of exercises they enjoy. A physical therapist tailors their treatment plan to the individual’s needs, and the plan is flexible over time to accommodate if the person gains strength or has additional limitations due to AS progression.

Physical therapy exercises and techniques for AS may include⁷:

• Strengthening exercises
• Flexibility exercises
• Stretching exercises
• Posture training
• Deep-breathing exercises
• Pain management techniques

Some people with AS who have severe joint damage to the hip joint may have surgery to replace the hip joint, called a total hip replacement or hip arthroplasty. Physical therapy can be helpful during recovery from a hip replacement to help the person improve walking and regain strength, balance, and range of motion.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.⁷