Exercise and posture control are two of the most important aspects of treatment for people with ankylosing spondylitis.
Ankylosing spondylitis (AS) is a type of inflammatory arthritis that is painful and progressive. It mainly affects the spine, but it can also affect the joints, tendons, ligaments, eyes, and bowel. The condition is unpredictable, and it affects people in a variety of ways.
Two symptoms that most people with AS experience are stiffness and pain, so staying fit and flexible helps manage the condition.
The benefits of following an exercise program include developing and maintaining a good posture, improving flexibility, and reducing pain.
The Spondylitis Association of America (SAA) recommend four types of exercise, saying that an ideal exercise program will include them all:
- Stretching: These exercises improve flexibility and reduce muscle stiffness, swelling, and pain. They also minimize the risk of fusion of the joints.
- Cardiovascular: Exercises that increase the heart rate for an extended time, such as swimming or walking, improve lung and heart function, as well as boosting the mood. They also reduce pain and fatigue.
- Muscle strengthening: Strong core and back muscles help support the spine, improving movement and posture and also reducing pain.
- Balance: Balance exercises improve stability when still and moving, and they reduce the likelihood of falling. They are especially useful for people with lower bone density.
The following exercises can help relieve the symptoms of AS:
This exercise strengthens the core muscles and glutes.
- Lying on the back, bend the knees and place the feet flat on the floor.
- Lift the pelvis and the lower back off the floor.
- Hold for 5 seconds, then lower down slowly.
2. Hip and pelvis rotation
This exercise helps stretch out the lower back.
- Lie on the back with the hands above the head.
- Bend the knees and roll them slowly to one side.
- Hold for 5 seconds and then return the knees.
- Repeat 5 times on each side.
This exercise will help strengthen the upper and lower back and hips, which will help with posture. Be careful to avoid twisting the body or overstretching the neck.
- Kneel on the floor on all fours.
- Lift the right arm and left leg until they are parallel to the floor.
- Stretch and hold for 5 seconds.
- Lower and repeat with the other arm and leg.
- Repeat 5 times on each side.
4. Breathing exercises
These exercises move the ribs, which helps with breathing.
- Lie on the back with the knees bent and the feet flat on the floor.
- Place the hands on the sides of the body, against the ribs.
- Take five deep breaths in through the nose and out through the mouth. Push the ribs out against the hands with each breath.
- Then, place the hands on the upper front chest and take five deep breaths, as before.
The SAA recommend performing aerobic exercise between three and five times a week, for a total of 75–150 minutes per week.
Cardiovascular exercises may include:
- yoga or tai chi
Swimming is one of the best forms of exercise for AS because it engages all of the muscles and joints without jarring them.
It is best to speak to a healthcare professional before deciding on a cardiovascular exercise because some types, such as running, can place excess pressure on the joints.
6. Other exercises
The SAA also recommend the following exercises for spondyloarthritis, and they provide images in their online flyer:
- hamstring, quadricep, and hip flexion training
- other back stretches
- bending side stretches
- body rotations
- neck rotations and stretches
When to exercise
The easiest way to fit exercise into a busy life is to do it at the same time every day. Some people may prefer to do certain exercises, such as stretching, in the morning, to overcome stiffness. However, later in the day or the evening will suit others better.
Back pain from AS can lead people to change their posture to try to ease the pain. Over time, changes in posture can lead to stiffness, weakness, and pain in the muscles and joints.
Exercises that strengthen the core — meaning the back and abdominal muscles — can ease back pain and improve posture.
People can achieve and maintain good posture by:
- exercising regularly
- adding specific core strengthening exercises to their routine and doing these two to four times a week
- being aware of and trying to straighten their posture during daily activities, including sitting at a desk, walking, and watching TV
- trying posture training exercises
Certain exercises can help with posture when someone has AS, including the two below.
Posture exercise 1
- Stand against the wall with the back, heels, bottom, and shoulders touching it as much as possible.
- Push, but do not tilt, the head back into the wall.
- Hold for 5 seconds.
- Repeat 10 times.
Posture exercise 2
- Lie on the belly, looking straight ahead.
- Place the hands at the sides of the body.
- Lift one leg off the ground, keeping the knee straight. Lift the opposite arm out in front if it helps.
Exercise can be an important way of relieving the symptoms of AS and maintaining strength and flexibility. The SAA state that exercise is an “integral part” of treatment.
Exercise can act against some of the effects that AS can have on the body.
It can help people maintain more mobility and flexibility over time, and it can help prevent spinal fusion. People also typically find that exercise is effective for controlling pain.
In addition, the SAA say that exercise can help with AS by:
- improving posture
- enhancing strength, balance, and flexibility
- improving cardiovascular health
- improving breathing capacity
- reducing high blood pressure
- maximizing bone density
- aiding weight management
- improving a person’s response to medications
Exercise is an important part of treatment for AS. However, it is important to work with a healthcare professional when deciding on an exercise program.
Some sports, including high impact activities, such as jogging, can cause problems. Contact sports may harm people with advanced AS because these activities can increase the risk of joint or spinal injury.
Low impact but competitive sports, such as volleyball and badminton, may be good options. Pilates, yoga, and tai chi are also good choices for people with AS.
Ask a doctor: Anyone thinking about starting an AS exercise program should consult a doctor or physical therapist first. These experts can advise what exercises are suitable and how a person should carry them out. A person with AS can also get help with designing an individual exercise program.
Warm up first: As with all exercise, it is necessary to warm up first. People can start with stretches to loosen the joints and muscles before doing strength exercises or cardio. Doing this reduces the risk of injury.
Exercise on a comfortable surface: It is best to perform exercises in a comfortable area, such as on a carpeted floor or exercise mat. People who have problems getting up and down from the floor can exercise on a bed that has a firm mattress.
Build up slowly: When starting an exercise program, people are likely to experience some discomfort, so it is important not to overdo it. Starting slowly and building up gradually is a better approach.
Exercise has a wide range of benefits for people with AS. It helps improve flexibility, strength, posture, and cardiovascular health. Regular exercise can also help improve mobility and reduce the risk of fusion.
Official organizations recommend that people use four main types of exercise: stretches, strength training, cardio, and balance exercises.
People can speak to a healthcare professional to work out a personalized plan that suits their preferences, lifestyle, and needs.