Physical therapy (PT) is one way you can stay active when you have ankylosing spondylitis (AS). PT can help reduce stiffness in your joints and improve your posture and flexibility, which can decrease your pain.

AS is a type of inflammatory arthritis that can cause severe pain and limit your mobility. If you have AS, you might not feel like moving or exercising because you’re in pain.

But not moving can actually do more harm than good. If you have AS, some type of exercise should be a part of your treatment plan. Exercise will improve your strength, flexibility, coordination, and balance.

PT safely guides you through exercises to manage your condition. A physical therapist will create an exercise plan that is specific to you. They may also teach you how to maintain proper posture when participating in daily activities.

Depending on insurance coverage, people may see physical therapists from three times per week to once per month, generally for an hour or less.

If you’d like to see a physical therapist, ask your doctor if they have a recommendation and check with your insurance provider about coverage.

Read on for information about how a physical therapist can help, along with exercise tips that can ease your symptoms.

At a PT session, a physical therapist will likely teach you about different exercises you can do at home that can help you manage your AS.

One study found that an effective exercise regimen for AS includes stretching, strengthening, cardiovascular exercise, spinal mobility exercise, and functional training to help with daily activities.

During a PT session, your physical therapist might ask you to try the following types of exercises:

Posture training

Improving your posture is key to managing your AS symptoms. Your physical therapist may suggest the following:

  • Prone lying. To do this, you’ll lie face down on a firm surface with a pillow or towel under your chest and forehead. Lie in this position for 1 to 2 minutes, working your way up to 20 minutes.
  • Standing against the wall. Stand against the wall with your heels four inches away and your butt and shoulders lightly touching the wall. Try to bring the back of your head to the wall and hold this pose for 10 seconds. Repeat five times.

They may also recommend that you stand, walk, and sit tall while doing all exercises to maintain proper posture.

Strengthening exercises

Yoga is one exercise that can increase your strength, along with the use of light hand weights. Tai chi is another option that increases strength and balance through slow movements based on martial arts.

The Spondylitis Association of America points out that core strengthening exercises are key to managing back pain in AS. Strengthening the abdominal and back muscles that make up your core can take stress off your back and reduce pain.

Flexibility and stretching exercises

Range of motion can be increased by performing flexibility exercises. These are exercises that you do without weights, focusing on joints that are stiff.

Flexibility exercises are especially important for people with AS to counter the natural tendency to avoid moving joints and areas that hurt. But immobility can lead to further stiffness and increased pain when you move.

Lack of movement can also lead to spinal fusion in people with AS. This is when the bones of the spine grow together, causing a rigid backbone, making it difficult to walk.

Your physical therapist will help you design a routine of the flexibility exercises you need. Consistency is key in your practice. Your therapist will make recommendations about how frequently to do the exercises. Some stretches can even be done in a chair if you find standing exercises too challenging.

One to try is the seated glute stretch:

  1. Sit in a chair with your back upright and your feet flat on the floor.
  2. Lift your right leg and put the outside of your right ankle on your left thigh above your knee, letting your right knee fall out to the side.
  3. Slant your upper body forward while keeping your spine straight. Hold for 10–20 seconds.
  4. Sit upright again and repeat on the other side.

Deep breathing exercises

If you have AS, you may sometimes find it difficult to take a deep breath. You may feel short of breath even during daily activities. This is because the chest cavity may be inflamed and stiff, and it does not expand as it should.

Deep breathing exercises can help keep the chest wall flexible, especially the joints where the ribs meet the vertebrae of the spine. Daily breathing exercises may gradually increase your capacity to take a deep breath.

You can try this simple exercise of alternating deep breaths with regular breaths to feel how deep breathing can help your chest expand:

  1. Start by sitting or lying down and inhale one slow, deep breath. Allow your abdomen and your chest cavity to expand fully.
  2. Breathe out slowly and feel your abdomen fall as you exhale.
  3. Alternate regular breaths with deep ones several times.

Pain management and exercise

One analysis of 14 trials in 9 countries found that those who exercised experienced a 21 percentTrusted Source reduction in pain over those who didn’t exercise.

Deep breathing and relaxation exercises can also help, as they reduce tension in your body, which in turn can help reduce your level of pain.

It is sometimes difficult to exercise when it hurts, even if you know it will help in the long run. Your physical therapist can help develop an individual exercise program for you that will be gentle enough, yet effective, too.

Individual activities

A physical therapist can help design a personalized exercise plan for you that accommodates the stage of your AS, your lifestyle, and your physical condition. Every person is different.

In addition to your individual exercise routine, your physical therapist may have you try cycling, swimming, or another low-impact aerobic exercise.

They may also recommend an exercise class, but you’ll need to choose carefully. Start with a beginner’s class, and make sure your instructor knows about your AS.

The National Axial Spondyloarthritis Society in the United Kingdom recommends people with AS choose gentle, low-impact activities that involve minimal body contact with others. Some of their choices include:

  • Pilates
  • tai chi
  • indoor cycling (on a static bike)
  • water aerobics
  • yoga

It’s important to remember that when you have AS, exercise will affect you differently at different times. Be ready to change up your exercise choices as needed.

Your physical therapist will be able to help you choose activities you enjoy that don’t run the risk of injury. They will help you modify your plan so you can keep it up over the long term.

During PT, you’ll learn about different exercises you can do on a daily basis to ease pain or stiffness caused by AS.

Research analyzing eight trial results showed that moderate exercise can improve body function, mobility, and disease activity in people with AS.

The research showed that for people with AS, exercise improved both disease symptoms and the ability to do daily activities by nearly 1 point on a scale of 1 to 10. The improvement occurred after 3 to 12 weeks of exercise.

Some other benefits of exercise for people with AS include:

  • More flexibility. You’ll find it easier to go about daily tasks when your spine is flexible.
  • Better posture. You’ll feel more comfortable when you can stand straight and tall.
  • Less stiffness and pain. Over time, performing a personalized exercise program will result in less pain.
  • Better sleep. Everything is easier when you get enough sleep. Exercise will tire you out, which can lead to better sleep.

Before you start PT, know that some slight pain or discomfort will likely occur when you begin exercising. But you shouldn’t push through severe pain.

Let your physical therapist know if you’re experiencing extreme discomfort during your session.

Some people will need more strengthening exercises, while others will need more stretching. A physical therapist will help you figure out your specific needs.

Seeing a physical therapist is a great first step to incorporate exercise into your daily routine. The last thing you want to do is injure yourself and cause more pain.

A physical therapist can teach you low-impact exercises that don’t put extra strain on your joints or spine.

You can find resources on group exercise at Arthritis Foundation and Spondylitis Association of America.

You can find a physical therapist in your area by searching the American Physical Therapy Association’s online database.

You can also ask your doctor for a recommendation. They may be able to recommend a physical therapist who specifically works with people living with conditions like AS.

You can also check with your insurance provider for a list of physical therapists in your area covered by your plan.

PT has many benefits for people living with AS. The targeted exercises can improve your strength, posture, and flexibility. Physical therapists can also help ensure you’re doing all the exercises correctly and safely.

Talk to your doctor to see if they recommend a physical therapist as part of your treatment plan, and consult your doctor before doing any exercise on your own.

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