Some people with ankylosing spondylitis (AS) choose to have chiropractic adjustments to help manage their condition.

A person with AS has a type of arthritis resulting in inflammation of the spinal joints, sacroiliac joints, which link the pelvis and spine, and ligaments, which can cause pain and stiffness over time.

AS may cause only mild, temporary flare-ups in many people. Those with more severe AS can develop fused vertebrae, which is when bones of the spine join together. The spine can then become rigid and inflexible.

Chiropractic adjustments, also known as spinal manipulations, involve a chiropractor applying a controlled thrusting force to a joint using their hands or a device.

In people with acute and chronic low back pain, spinal manipulations may result in small improvements to how a person’s low back pain affects different aspects of everyday life — for instance, walking, standing, sleeping, and doing household chores, according to the National Center for Complementary and Integrative Health (NCCIH).

This article explains how chiropractic adjustments may help those with AS and whether doctors recommend the therapy. It will also detail the benefits and risks of chiropractic care for AS.

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The Spondylitis Association of America (SAA) says that doctors do not recommend chiropractic treatment for AS.

Similarly, the Arthritis Foundation urges caution in using chiropractic care in the management of inflammatory conditions, including AS.

The Arthritis Foundation suggests that a person should avoid chiropractic care if they are experiencing active inflammation and swelling due to a flare-up or if they have a fused spine. Adjustments in these circumstances could be dangerous.

A 2017 research review also urged chiropractors to take note of situations in which a high velocity, low amplitude spinal manipulation technique may not be the best approach. This technique involves the rapid use of force across a short duration, distance, or rotational area within the joint’s range of motion to release restriction in the joint.

The situations where this might not be safe include the inflammatory phase of conditions such as AS. However, the review noted that a low-velocity, low-amplitude technique, or soft-tissue work, may be safe in some cases.

Learn more about AS here.

A case series from 2017 described the condition of three people with inactive AS. All three had inflammatory low back pain and gradually worsening stiffness lasting more than 3 months.

While a person cannot generalize findings from a case series to apply to every person with a particular condition, case series can provide useful clues.

The three cases in this series had some similarities and some differences in clinical, laboratory, and imaging tests. The researchers concluded that chiropractic manipulation and rehabilitation appeared to reduce symptoms and improve musculoskeletal function in all three people.

Besides spinal manipulation, chiropractors can offer other therapies that may help, including:

  • Ultrasound: These are sound waves producing a massaging effect on soft tissue and joints, which can help to reduce swelling, pain, and stiffness.
  • Electrotherapy: This is painless, tiny electric pulses treating soft tissue injuries by stimulating nerves and muscles.
  • Low-level laser or “cold laser”: This is a non-heat-producing laser or light penetrating deep into the tissue, which may help to reduce inflammation.
  • Infrared sauna: This is a controlled level of heat warming up the joints from the inside, relieving pain and increasing circulation.

People with AS who undergo chiropractic adjustments may have more of a risk of fracturing the vertebrae, which are the spine bones, hip, or radius, which is one of the forearm bones. This is due to typically having lower bone density and strength than people without AS.

Chiropractic treatments have also resulted in neurological complications in some people. People with bone fusion due to AS are at an increased risk of these complications.

People should also avoid chiropractic care of the neck, even if there is no active inflammation. This is because there is a high risk of spine injuries resulting in paralysis.

An AS cure is currently not available, but treatment can help manage symptoms, support posture, and slow the worsening of the condition.

Most people receive medication and physical therapy. Medications a doctor may prescribe include over-the-counter anti-inflammatory medications or injected corticosteroids.

If the body does not respond to other treatments, a person may receive biological medications, which target specific immune messages and interrupt the signal for the body to produce inflammation. Alternatively, Janus kinase (JAK) inhibitors send messages to target cells to block inflammation from inside the cell.

Surgery is rarely recommended for AS, as there may be complications that occur, such as tissue turning to bone outside of the area. This is known as ectopic bone.

Learn more about treatments for AS here.

The SAA suggests that some people with the condition may benefit from the following alternative and complementary therapies:

  • acupuncture
  • yoga therapy
  • massage
  • TENS, which stands for “transcutaneous electrical nerve stimulation,” involves applying electrical pulses through the skin using electrodes to control pain

Exercise may help lessen the impact of AS to help a person maintain greater mobility and flexibility.

An ideal exercise program for AS should include:

  • range of motion or stretching, such as moving the muscles and joints through their full range of motion to improve flexibility and reduce stiffness, swelling, pain, and risk of fusion
  • aerobic or cardiovascular, which includes sustained periods of increasing blood flow through the heart to improve breathing, endurance, and mood, and reduce disease, pain, and fatigue
  • strengthening, which includes exercises to improve the function of muscles that support efficient and safe movement and good posture, especially the core muscles around the abdomen
  • balance, which includes exercises to improve stability and reduce the risk of falls and fractures, especially in people with lowered bone density
  • activities in water, such as swimming, which place less strain on joints and less risk of a joint or ligament injury

AS causes inflammation in the spine, ligaments, and joints. It is a type of arthritis that causes pain and stiffness and can lead to spinal rigidity.

The SAA says that doctors do not recommend chiropractic treatments for people with spondylitis. However, the Arthritis Foundation says that a person should avoid chiropractic care if they are having a flare-up or have a fused spine. Avoiding manipulation of the neck is also important, even if there is no active inflammation, as there is a high risk of spine injuries resulting in paralysis.

Chiropractic treatment could potentially help reduce symptoms and improve musculoskeletal function in people who are not experiencing active inflammation. Risks associated with this treatment include fractures and neurological complications.

Conventional treatments include medications, physical therapy, and surgery, while alternative therapies include acupuncture, massage, and TENS.