Exercise and posture control are two of the most important aspects of treatment for anyone with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that can last for life. It is painful and progressive. It mainly affects the spine, but it can also affect joints, tendons, ligaments, the eyes, and the bowel. The condition is unpredictable, and it affects people in a variety of ways and at different times.

Spondylitis support groups say that medication alone is not enough to treat AS. They believe that exercise is a vital part of treatment for the condition and should be a high priority.

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.

Exercise can be an important way of relieving symptoms of AS and maintaining strength and flexibility.

The U.K.'s National Ankylosing Spondylitis Society note that exercise:

  • increases flexibility, which makes it easier to do simple things, such as putting on shoes and socks
  • increases mobility, which makes it easier to do everyday tasks
  • improves posture, which builds confidence and reduces self-consciousness
  • is physically tiring, which improves sleep quality, ensuring you wake, feeling refreshed
  • reduces stiffness and pain, which results in less pain at night and improved sleep quality
  • improves joint movement, posture control, muscle length and strength, lung capacity, balance, and cardiovascular fitness

In some cases, good posture and mobility can be regained through a combination of exercise and medicine. The Spondylitis Association of America state that "most people with spondylitis say they feel much better after exercise."

It can be difficult to find time to exercise every day, but it should be done, even if it is only for 5-10 minutes.

Arthritis Research UK recommend the following breathing exercise to strengthen the diaphragm:

  1. Lie on your back and bend your knees, keeping the feet flat on the ground.
  2. Placing your hands on your ribs at the sides of your chest, take a deep breathe in through the nose and push your ribs out against your hands. Breathe out, as far as you can, through your mouth. Repeat the breathing exercise 10 times.
  3. Repeat the exercise, but this time place your hands on the upper part of the front of your chest. Remember to breathe in and out as deeply as you can. You can do this exercise at any time in a lying or sitting position.

This exercise works to strengthen the back:

  1. Lie on your front with your hands by your sides and look straight ahead, putting a pillow under your chest for comfort, if required.
  2. Stretch one arm out in front of you and raise the opposite leg off the ground without bending it. Repeat about 5 times for each leg.
  3. With your arms back by your sides, raise your head and shoulders off the ground 10 times.
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Stretching one arm and the opposite leg in this pose will develop strength in the back and core.

They also recommend the following exercises:

  • Place your heels and your bottom against a wall. Keeping your head straight (not tilted), push it back gently toward the wall. Hold this position for about 5 seconds, then relax. Do this 10 times, if possible.
  • Stand with your feet apart and your hands on your hips. Keeping your knees and feet facing forward, turn from the waist to look behind you. Do this 5 times for each side, holding each pose for about 5 seconds.
  • Kneel on all fours. Stretch one arm and the opposite leg out in line with the floor and hold for 10 seconds. Do the same with the other side and repeat 5 times.

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 morning exercises, such as stretching to overcome stiffness, while others will choose later in the day or the evening.

Anyone with AS will be used to experiencing pains and strains. Having good posture makes a person with the condition look and feel better.

However, when experiencing bad back pain, a person tends to bend forward, which ultimately puts more stress on the spine. This can often lead to a pattern of bad posture and pain.

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The tendency is to bend forward if experiencing back pain, but a person with AS should consciously maintain good posture.

To achieve and maintain good posture, people can follow these steps:

  • Do not slouch, but think yourself tall when standing or sitting.
  • Hold your head straight, directly above your body, with the chin centered, and in line with the floor.
  • Placing the heels about 4 inches from a wall, try to touch it with your shoulders and buttocks. Hold the pose for about 5 seconds and repeat.

Prone lying is an exercise for good posture and, as the name suggests, is done lying down. People can do it in the morning before they get up.

  • Lie face down and as flat as possible on the ground or a firm mattress.
  • Rest your head on your hands, facing the left or the right or alternating.

Lying prone can be a bit uncomfortable at first, so do it for a couple of minutes and build up slowly, until you can hold a prone position for about 20 minutes.

Exercise can be an important part of treatment for AS, and the most important therapy a person can do to help themselves. However, it is important to make the right choices.

Sports to avoid

The Spondylitis Association of America advise that contact sports are not a good idea for anyone who has advanced AS, because joints and the spine may be injured.

Low-impact but competitive sports, such as volleyball and badminton, are seen as good options. Pilates, yoga, and tai chi are also acceptable for people with AS.

However, swimming is considered to be one of the best forms of exercise because it involves all muscles and joints without jarring them.

Tips for getting started

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 they should be carried 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. Exercises should be done in a comfortable area 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 out on an exercise program, an individual is likely to experience some discomfort, so it is important not to overdo it. Start slowly and build up gradually.