Back pain is the main symptom of ankylosing spondylitis (AS), a form of arthritis that affects the spine. The pain typically affects the lower back or hips, where the spine and pelvis join up. It may get worse after periods of inactivity, such as after sleeping.

AS is an autoimmune disease. When someone has AS, their immune system attacks healthy joints in the spine. This causes swelling, or inflammation, which can lead to stiffness and pain. Some people may find it hard to move around.

In severe cases, the inflammation can make the bones that make up the spine, the vertebrae, fuse together. This may make the spine rigid and inflexible.

This article will explain what AS back pain feels like, the available treatments, tips for sleeping, and things to avoid.

A CT scan of a person's spine and hips.Share on Pinterest
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According to the patient advocacy group Creaky Joints, AS can cause pain in the lower back, where the spine meets the pelvis, or in the area just above the buttocks. When the pain appears above the buttocks, it may move from side to side.

AS back pain can get worse after periods of inactivity, such as after sleeping or sitting for some time. It may come and go, or it may be constant.

It can also cause inflammation and pain in other areas of the body, including the shoulders, knees, or feet. When it affects the ribs, people may find it hurts to breathe in.

Other AS symptoms include:

  • fatigue
  • eye pain and vision changes
  • loss of appetite
  • skin rashes
  • stomach pain
  • loose bowel movements

There is no cure for AS. However, there are things people can do to manage the condition. In most cases, doctors will recommend a combination of medication and physical therapy.


Doctors may recommend one or more of the following medications to help people manage the pain:

  • over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
  • biological medications or Janus kinase inhibitors, which may be able to reduce or stop the inflammation that causes the pain
  • corticosteroid injections, which can help decrease inflammation and ease the pain

Physical therapy

Staying active is one of the most important aspects of managing AS. It can ease back pain and help people stay flexible and mobile.

The best approach is different for each person. It is a good idea to speak with a doctor before starting a new exercise regime. This is particularly true for people who have fusions in their spine.

A doctor or physical therapist may recommend:

  • posture training to reduce strain on the spine
  • stretching and flexibility exercises, such as yoga, to keep the spine mobile and flexible
  • strengthening the back and core muscles so they are better able to support the bones and joints
  • balance exercises to help people maintain healthy posture and decrease the likelihood of falling
  • water-based exercise to ease joint pain and improve mobility

To exercise safely, the United Kingdom’s National Axial Spondyloarthritis Society recommends:

  • talking with a doctor before taking part in contact sports or high-impact exercise
  • taking time to explain AS and its effects to exercise instructors
  • avoiding over-exercising or trying to do too much
  • maintaining good posture while exercising


If a person has severe AS, doctors may recommend surgery to repair or replace joints. In rare cases, doctors may suggest an operation to straighten the spine or repair breaks in the vertebrae.

Learn more about surgery for AS here.

Some people say that using complementary therapies can help with AS back pain, but researchers are not sure if they work.

According to the Spondylitis Association of America (SAA), different complementary therapies have different levels of evidence to back them up. It recommends that people speak with their doctor before trying one.


Acupuncture involves inserting thin needles into the skin at various points on the body. The SAA says the treatment can help with the pain in some people.


Gentle massage from a therapist with knowledge of AS may provide temporary pain relief in some people. However, for others, it can be a pain trigger.

Chiropractic treatment

Doctors do not recommend this for AS. Chiropractic treatment involves the practitioner manipulating the person’s back or neck. Sometimes, it can lead to spinal breaks, especially in people with spinal fusion.

AS pain and discomfort can make it difficult to sleep. The SAA offers the following tips for getting a good night’s sleep with AS. It says a person should:

  • select a comfortable, supportive mattress that evenly distributes the weight and does not cause the spine to contort
  • find a spine-friendly sleeping position, such as flat on the back with a thin or no pillow
  • practice sleep hygiene by avoiding caffeine later in the day, following a relaxing bedtime routine, and keeping a regular sleep-wake schedule
  • use heat, such as from a heat pad, shower, or bath, to ease pain before sleep
  • avoid sleeping on the stomach

AS back pain tends to be worse after sitting for a long time, so it is important to stay mobile.

Most people with AS will have times where the symptoms get worse. Doctors call these flares, but they do not know what causes them. Factors that may contribute include over-exercising or being excessively active, illness, or emotional stress.

To avoid symptoms getting worse, people can try:

  • following the treatment plan set out by their doctor
  • staying active, but avoiding over-exercising
  • using a supportive mattress at night
  • reducing or managing their stress levels
  • keeping good posture at all times, including when sitting down

Anyone who suspects they may have AS should speak with a doctor as soon as possible, even if the pain is only mild. It is especially important to do this if a person has a family history of AS or they have symptoms affecting other parts of the body.

A doctor can diagnose AS and help a person slow the progression of the disease.

Back pain from AS typically affects the lower back or top of the buttocks, where the spine joins the pelvis. The pain may be mild or severe. It can come and go, or it may be more constant.

AS back pain tends to be worse after periods of inactivity, such as sleeping or sitting, or during a flare-up. Treatments include medications, physical therapy, or surgery. Complementary therapies, such as acupuncture or massage, may also help some people.