Physical therapy, also called physiotherapy, can help improve several ankylosing spondylitis symptoms. For instance, it can help reduce joint pain and improve strength, range of motion, and flexibility.

Ankylosing spondylitis is an inflammatory form of arthritis that primarily affects the spine and can limit mobility. Exercise plays an important role in the treatment of ankylosing spondylitis and is a high priority for people with this condition.

Physical therapy offers a clinical way for people with ankylosing spondylitis to both stay active and learn about different exercise techniques. A large part of attending physical therapy is learning how to apply exercises at home.

A physical therapist will work directly with a person to develop routines and exercises that will help improve their mobility and strength.

This article explores some of the potential benefits a physical therapist has to offer to someone living with ankylosing spondylitis.

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A physical therapist can show a person living with ankylosing spondylitis how to incorporate exercise into their daily life.

According to 2016 recommendations, some of the potential benefits of regular exercise for people with ankylosing spondylitis include:

  • improved mobility and posture
  • less pain and stiffness
  • increased strength
  • improved physical function

While at a physical therapy session, an individual will often engage in several exercises that can help relieve their ankylosing spondylitis symptoms. As part of the sessions, the physical therapist will also teach the person how to do exercises to help address areas of concern and how to perform exercises at home.

Although every situation is different, and a physical therapist will tailor their program to the individual, some common exercises that a physical therapist may recommend include:

  • functional training to help a person continue or increase daily activities
  • exercises geared to helping the spine
  • cardiovascular exercises to improve symptoms and overall health
  • stretching routines
  • strengthening exercises

Posture training

A person with ankylosing spondylitis may change their posture to compensate for pain related to the condition. Over time, inadequate posture can lead to increased back pain and stiffness. It can also place increased strain on the spine.

A physical therapist may recommend several posture training exercises for people with ankylosing spondylitis. These may include prone lying and standing with their back against a wall. These exercises strengthen the extensor muscles in the lower back, upper back, and hips to help improve spinal extension.

To perform a prone lying exercise for posture:

  1. Lie flat on the stomach on a firm surface.
  2. Place a pillow or towel under the abdomen or forehead for comfort.
  3. Straighten the arms by the sides.
  4. While looking directly at the ground, lift the head and chest a few inches off the ground while gently squeezing the shoulder blades together.
  5. Hold this position for as long as you comfortably can without losing proper form.
  6. Repeat three times.

To perform a back-against-the-wall exercise for posture:

  1. Stand against a wall so that the heels, butt, and shoulders touch the wall.
  2. Bring the head back to the wall.
  3. Hold the position for around 20–30 seconds before relaxing and repeating.
  4. Repeat 10 times.

Strengthening exercises

According to the Spondylitis Association of America, strengthening the core muscles can help people with ankylosing spondylitis reduce stress on the spine and minimize back pain. Core muscles are the abdominal muscles and other muscles that support the spine.

The plank is one exercise that can help strengthen core muscles. A person performs a plank by getting into the top of a pushup position and holding the position.

To start, a physical therapist may show an individual how to perform a standing plank against a wall. As the person builds strength, they can perform the plank on their knees and work up to doing a full plank. To take pressure off their hands, they can balance on their forearms instead of their hands.

Flexibility or stretching exercises

Flexibility exercises such as stretching can help people with ankylosing spondylitis maintain mobility and reduce the risk of joint fusion.

Some areas that a person with ankylosing spondylitis should stretch include:

  • the hips
  • the thighs
  • the chest
  • the back

A physical therapist can recommend stretching exercises specific to the individual. People can also try some yoga stretches to help stay mobile and reduce back pain.

Deep breathing exercises

Living with ankylosing spondylitis can cause a person to develop difficulty taking a deep breath and breathing in general. A physical therapist may work with them on deep breathing exercises that help expand the chest and increase their lung capacity.

Diaphragmatic breathing, or belly breathing, is a deep breathing exercise that helps strengthen the diaphragm and increase lung efficiency.

To perform diaphragmatic breathing:

  1. Sit or lie down in a comfortable position.
  2. Place one hand on the chest and the other hand on the stomach.
  3. Breathe in through the nose so the stomach rises and pushes against the hand, but keep the chest as still as possible.
  4. Exhale through pursed lips while the stomach drops.

Pain management techniques

In a 2019 review of studies, researchers noted that people who exercised experienced as much as a 21% reduction in pain compared with those who did not exercise.

Although exercise can benefit many people living with ankylosing spondylitis, not all programs work for everyone. Some people may need gentle, low impact exercises or ones that focus on reducing stress or pain.

These can include activities such as yoga, deep breathing, or other low impact exercises that provide benefit to the individual without hurting their body.

Individual activities

Individual activities include different types of exercise that often focus on low impact aerobics. These are activities that can help improve a person’s overall cardiovascular and mental health and help decrease pain and disease activity.

Individual activities can include any number of low impact exercises, such as:

  • cycling
  • practicing tai chi
  • using an elliptical machine
  • walking
  • swimming
  • practicing yoga

A person can talk with a physical therapist about exercises they are interested in trying. They can also work with their physical therapist to determine the best group classes for their needs.

Learn more about exercise and posture for ankylosing spondylitis.

Surgery is not a first-line treatment for ankylosing spondylitis. In other words, a doctor will likely only recommend surgery for someone living with ankylosing spondylitis if their daily life is severely affected and no other treatments have been successful.

A person’s doctor will likely recommend physical therapy following a surgical procedure. A physical therapist will work with the individual in much the same way as before by teaching them and guiding them through strength, flexibility, and other exercises.

The main difference is that the goals of physical therapy following surgery will focus on helping a person fully and safely recover.

The amount of physical therapy a person needs when living with ankylosing spondylitis can vary based on their needs and a doctor’s recommendations.

Sessions tend to be between 30 minutes and 1 hour, depending on the facility. How often someone attends physical therapy each week depends largely on need.

A person should check with their insurance provider to determine what costs are associated with physical therapy. It also may only cover a certain number of physical therapy sessions per month or year.

According to a 2016 article, most types of exercises are safe for people with ankylosing spondylitis. However, a person may need to avoid high impact exercises, such as contact sports and martial arts.

A physical therapist can provide more information about what types of exercise or movements an individual may need to avoid.

The exact cause of ankylosing spondylitis is still not known. However, researchers note that a combination of genetic and environmental factors may play a role in its development. As a result, people cannot prevent ankylosing spondylitis from occurring.

That said, treatment can help prevent ankylosing spondylitis from worsening. The goals of nearly every treatment option are to slow or stop progression of the condition and improve symptoms and quality of life.

Learn about managing an ankylosing spondylitis flare-up.

Physical therapy can play an important role in the treatment of ankylosing spondylitis. A person may notice increased flexibility and mobility as well as a general decrease in pain when following the recommendations of their physical therapist.

Exercise recommendations will vary, but individuals can expect to learn about various types of exercise, including strength, flexibility, cardio, and others. A physical therapist will create a custom routine to help the person living with ankylosing spondylitis make the most improvements.