Another cause of Back Pain and stiffness: Ankylosing spondylitis

Ankylosing Spondylitis (AS) is a progressive chronic inflammatory disease that leads to gross stiffness and loss of range of movement of the spine.

In addition to Medical interventional physiotherapy intervention plays an integral role in the management of this condition.

AS is a systemic, rheumatic, progressive chronic inflammatory disease affecting the spine, more commonly affecting males than females (3:1).

The exact cause of AS remains unknown but genetic and environmental factors are believed to play a key role in its development.

Over 90% of patients affected by this condition will be HLA-B27 (Human Leucocyte Antigen) positive. The presence of this antigen evokes an autoimmune process where the body starts to attack healthy and “self” tissue leading to inflammation of the ligament and the capsules of the spine and pelvis. This ongoing inflammation combined with the body’s attempt to repair can eventually lead to ossification of the ligaments. Over time this process can cause the affected vertebra to fuse. This has been termed as bamboo spine.

Symptoms of Ankylosing Spondylitis

• The initial disease starts with intermittent low back pain and pain at the sacroiliac joints. Eventually, it may progress to affect the whole spine.
• Pain and stiffness tend to be worse at night, first thing in the morning, or after prolonged periods of inactivity. It may even disturb a person from their sleep.
• The pain typically gets better with activity or exercise.
• A loss of motion or mobility in the lower spine, thoracic spine and cervical neck. A person may also to struggle to fully expand their chest because the joints between the ribs may also be affected.
• Fatigue is also a common symptom.

Additional but less common symptoms include:

• Eye inflammation or uveitis
• Heel pain
• Hip pain and stiffness
• Joint pain and joint swelling in the shoulders, knees, and ankles
• Loss of appetite
• Slight fever
• Weight loss

The role of Physiotherapy in AS

• Education and Advice to patient.
• Patients should be advised to avoid prolonged immobilisation or bed rest.
• Relieve and minimise pain and discomfort.
• This can be done through heat/ ice therapy, hydrotherapy, exercise therapy, soft tissue release and mobilisation of the spine.
• Maintain and increase the mobility affected joints and enhance physical endurance.
• Individualised exercise prescribed by the physiotherapist will target the affected joints and muscles. Endurance exercises involve working the muscles against light resistance with high repetition.
• Prevent and correct the deformity.
• Rounded and stooped postures may develop if patients are not exercising and attending to their posture.
• Increase chest expansion and vital capacity.
• Breathing exercises should consist of apical breathing exercises, Diaphragmatic breathing exercises, Lateral costal breathing exercises and Ballooning exercise. These ought to be in addition to thoracic/ rib mobility exercises.
• Attention to posture. This includes work ergonomics and sleeping postures.