ANKYLOSING SPONDYLITIS (AS) EXERCISES, CAUSES, SYMPTOMS AND TREATMENT

ANKYLOSING SPONDYLITIS (AS)

• Also known as MARIE-STRUMPELL DISEASE or MORBUS BECHTEREW DISEASE

• ANKYLOSING SPONDYLITIS (AS) is a chronic systemic a progressive inflammatory disease affecting the sacroiliac joints, the axial skeleton and ligaments.

• It manifest back pain and progressive stiffness of the spine (your back) and ligament

• As it is a systemic disease so it not only affects the spine and sacroiliac joints but also causes aortitis (inflammation of the blood vessels) and aortic insufficiency (leaking of the aortic valve of the heart) as the disease progresses in about 5–10% of patients, it also causes pulmonary disease and iridocyclitis (inflammation of the iris i.e., the colored part of the eye) or uveitis (a form of eye inflammation).

• Initially, there is inflammation of the joints which is then followed by synovitis, arthritis, and cartilage destruction, fibrous and later bony ankylosis (stiffening and immobility of a joint due to fusion of the bones abnormally.).

• Usually, after bony fusion occurs, the pain may subside and leave the spine stiff permanently (burnt-out disease).

• Firstly, there is the involvement of the SI joint, then lower back and upwards, the hip, knee, and manubrio-sternum later as the disease progresses.

• Mostly seen in young adults and more in males than in females.

CAUSES OF ANKYLOSING SPONDYLITIS(AS)

• The exact causes are unknown.

• 85% of the people who are affected has a strong genetic association with a gene HLA-B27

LATERAL VIEW OF LOWER BACK

SYMPTOMS OF ANKYLOSING SPONDYLITIS

(AS)

• Mostly early morning stiffness and insidious onset of lower back pain.

• At first, the stiffness is felt after a period of rest, and improves with activity

• Stiffness and calcification or fusion of spine (the bamboo spine) and SI joint pain and tenderness

• Pain seems to be worst at night or early morning when the patient is awakened from sleep. Pain resolves only after he walks about or does some exercises or activity, unlike the other lower back pain

• Rarely there is the involvement of peripheral joints such as the shoulders, hips, and knees, smaller joints, and presence of chronic inflammatory bowel disease.

Note that in common lower back pain the symptoms reduces as you rest and increases with activity but in ANKYLOSING SPONDYLITIS (AS) the symptoms aggravate with rest and reduce with activity.

• Marked Postural Deformities: Neck bend forward (flexion deformity), forward bending and rounded upper back (kyphosis), hip and knee flexion deformity

TREATMENT OF ANKYLOSING SPONDYLITIS

(AS)

• Main aim is controlling the pain and maintaining maximum degree of joint mobility.

• This can only be achieved by a structured exercise program lifelong.

• In some cases, surgical intervention is required which includes spinal osteotomy and joint replacement.

Conservative (non-surgical) method:

• NSAIDs (indomethacin) for pain relief

• Physiotherapy

• Radiotherapy in some resistant cases

PHYSIOTHERAPY

• Thermotherapy to reduce pain

• Postural correction

• Exercises to maintain mobility

EXERCISES FOR ANKYLOSING SPONDYLITIS

 (AS)

• PASSIVE CHIN TUCK EXERCISE

• ACTIVE CHIN TUCK EXERCISE

• BACK FLEXION EXERCISES

• BACK EXTENSION EXERCISES

• BACK ROTATION EXERCISE

• SIDE-LYING LEG RAISE

• HIP-HITCHER EXERCISE

• ISOMETRIC ADDUCTOR SQUEEZE EXERCISE

• ADDUCTOR LIFT EXERCISE 

• SACRAL CIRCLE

Once pain resolves and good mobility and strength are achieved, HIGH-INTENSITY EXERCISES AND SWISS BALL EXERCISES can be started.

Things To Be Taken Care Of:

• GETTING IN AND OUT OF BED

• TURNING IN BED

TRY TO REPEAT PRONE POSITION (SLEEPING ON YOUR TUMMY) TO PREVENT KYPHOSIS AND HIP MUSCLES TIGHTNESS

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