Ankylosing Spondylitis: Treatment and Rehabilitation Options

Ankylosing spondylitis

Upon waking up in the morning, I often experience stiffness and soreness in my cervical and lumbar spine.
However, after doing some stretching exercises, I feel slightly better.
This condition has persisted for about 3 to 4 years, but I started feeling lower back pain approximately 6 to 7 years ago (during high school).
As a soldier, I recently received a diagnosis at a military hospital and found out that I have ankylosing spondylitis.
After learning that I could apply for a medical discharge, I realized the severity of my condition.
I would like to know what treatments and rehabilitation I should pursue to alleviate my symptoms.
Additionally, if the condition worsens, what could be the potential consequences? Thank you!

Xin Bing, 20~29 year old female. Ask Date: 2001/02/04

Dr. Lin Junliang reply Orthopedics

Patients with ankylosing spondylitis should engage in long-term rehabilitation exercises (detailed information can be found on various medical websites) to prevent spinal deformity, stiffness, and joint rigidity.
During painful episodes, medication can be used as an adjunct treatment.
In the later stages of the disease, which may lead to spinal and joint fusion and inflammation, surgical intervention may be considered.

Reply Date: 2001/02/04

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It is part of a group of diseases known as spondyloarthritis. The symptoms you describe, such as morning stiffness in the neck and lower back that improves with movement, are characteristic of AS. This condition can significantly impact your quality of life, especially as a military personnel where physical fitness is crucial.

Treatment Options
1. Medications: The first line of treatment for AS typically includes nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, which can help reduce inflammation and alleviate pain. If NSAIDs are insufficient, disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine may be prescribed, particularly if peripheral joints are involved. In more severe cases, biologic agents targeting tumor necrosis factor (TNF) or interleukin-17 (IL-17) can be effective in controlling inflammation and slowing disease progression.

2. Physical Therapy: Rehabilitation plays a crucial role in managing AS. A physical therapist can design a personalized exercise program focusing on improving flexibility, posture, and strength. Regular stretching and strengthening exercises can help maintain spinal mobility and reduce stiffness. Exercises such as pelvic tilts, spinal extension exercises, and aerobic activities like swimming or cycling can be beneficial.

3. Exercise: Engaging in regular physical activity is essential. Low-impact aerobic exercises, stretching, and strengthening exercises can help maintain mobility and reduce pain. Activities like yoga or Pilates can also improve flexibility and posture. It’s important to find a routine that you enjoy and can stick with, as consistency is key in managing AS.

4. Posture Training: Since AS can lead to a forward stooped posture, working on posture correction is vital. This may include exercises that strengthen the back muscles and improve overall body alignment.

5. Heat and Cold Therapy: Applying heat can help relax tense muscles and alleviate pain, while cold therapy can reduce inflammation and numb acute pain. You may find alternating between heat and cold beneficial.

6. Lifestyle Modifications: Maintaining a healthy weight can reduce stress on your joints. Additionally, avoiding smoking and limiting alcohol consumption can help improve overall health and reduce the risk of complications associated with AS.

Potential Complications
If left untreated or inadequately managed, AS can lead to significant complications. These may include:
- Spinal Fusion: Chronic inflammation can lead to the fusion of vertebrae, resulting in a rigid spine and loss of mobility.

- Postural Changes: The forward bending posture can lead to difficulties in daily activities and may affect lung capacity.

- Eye Inflammation: AS is associated with a higher risk of uveitis, an inflammatory condition of the eye that can lead to vision problems if not treated promptly.

- Cardiovascular Issues: There is an increased risk of cardiovascular diseases in individuals with AS, necessitating regular cardiovascular health monitoring.

Conclusion
In summary, managing Ankylosing Spondylitis involves a multifaceted approach that includes medication, physical therapy, exercise, and lifestyle modifications. It is crucial to work closely with your healthcare team to develop a comprehensive treatment plan tailored to your specific needs. Regular follow-ups and monitoring are essential to adjust your treatment as necessary and to prevent complications. Engaging in a supportive community, whether through online forums or local support groups, can also provide encouragement and shared experiences that may help you cope with the challenges of living with AS.

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