Ankylosing spondylitis is a type of arthritis, and its main tell-tale characteristic affects the spine. Patients usually suffer from chronic jointal and ligamental inflammation within their back and neck bones and joints.

Over time, this will lead to chronic (another name for long term) pain, stiffness and even posture.

For moderate to severe types of ankylosing spondylitis, the affected bones and joints may fuse together (fusing means to irreversibly join together, and this is called ankylosis)…leading to a spine that’s inflexible and rigid.

That’s why patients with these type of conditions tend to develop abnormal posture that worsens over time.

Other joints that are not as commonly affected includes the joints of:

• shoulder
• neck
• hip
• knee
• ankles

In some cases, it can also affect the organs.

Causes and symptoms of ankylosing spondylitis

It’s unfortunate but so far the research and scientific community isn’t exactly clear what causes or aggravates ankylosing spondylitis; but tha tbeing said there is an agreement that it’s possibly due to a specific gene HLA-B27 (which points to the idea that this condition is likely genetically inherited).

Okay, here’s another thing to note:

even if 90% of patients who suffer from ankylosing spondylitis has the HLA-B27 gene, yet not all people with HLA-B27 gene has the disease.

So this disease usually starts at the lower part of the spine, which is the tail end at the sacro-iliac joints, the moving upwards to the lower back and slowly works its way up. In the early stages, patients typically experience consistent pain, stiffness and swelling in the hip joints and lower back.

The most common thing that they say is that if they rest or sit a while, when they try to stand up and walk, they have to wait for a while first because of the the pain and stiffness in their backs and hip.

Then…over time, the symptoms become worse, and starts to travel and move upwards, towards their neck.

It’d start to affect the lower back (lumbar), then middle back which is the thoracic bones and ribs. Sometimes the bones in the chest and ribs may fused together and this will impair the ability to breathe property (as the chest bones expand and contract with every breath).

How to diagnose ankylosing spondylitis

Your physician will first diagnose ankylosing spondylitis based on symptoms first such as

1. presence of pain and stiffness and at which locations (specificly if it begins in the hips and lower back first)
2. physical assessment e.g. testing for presence of pain and range of motion at the affected area
3. finding for abnormalities on X-Rays
4. finding for abnormalities on blood tests on presence of the HLA-B27 gene
5. identifying the disease progression if it has migrated / worsened

One important thing to note about ankylosing spondylitis is that its symptoms can be mixed/similar to other conditions such as lower back pain, hip bursitis, sprains, osteoarthritis etc; so the doctor need to be able to do differential diagnosis to tell them apart accurately.

Ankylosing spondylitis physiotherapy

There is a lot to do for patients with ankylosing spondylitis, but the overall 3 goals are:

1. Pain relief: decreasing the amount of pain
2. Managing inflammation and stiffness
3. Function: how to go back to life, work and responsibilities with minimal pains or inflammation

Some of the approaches that will be done by physiotherapists:

• spinal manipulation and mobilization techniques
• soft tissue stretch and management
• prevent compensation by strengthening weakened groups
• prevent/slow down deformity by postural correction
• muscle strengthening
• radio-frequency tech physiotherapy for pain management
• stability training
• gait and mobility training

Regular and ongoing consistent physiotherapy will be crucial part of the management of ankylosing spondylitis, combined with regular management by your primary physician (arthritis doctor).

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