What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is a type of inflammatory, autoimmune arthritis that primarily affects the spine. It is characterised by intermittent pain and progressive stiffness due to the inflammation and eventual hardening of the ligaments that surround the spine. The classic early symptoms of AS are pain and stiffness of the sacroiliac joints, the joints connecting the pelvic bones to the sacrum in the lower back. In the more severe, final stages of the disease, the entire spine can become fused and rigid, often in a flexed, forward posture.
As this is an inflammatory disorder, many other systems and joints can also affected. A significant number of people with AS also suffer from irritable bowel syndrome and inflammation of the eye.
What causes it?
The cause of Ankylosing Spondylitis is not clear, however there are markers and predisposing factors that may contribute to the development of the condition. Genetics, chronic stress and frequent gastrointestinal infections are among the predisposing factors. Men are affected more often than women and symptoms usually begin between the ages of 17 and 45 years.
What are the signs and symptoms?
Intermittent back pain and progressive stiffness are the two most common symptoms of Ankylosing Spondylitis. Other tendons and ligaments may be affected, including those in the hands, feet and ribs. Symptoms tend to be worse following periods of rest, particularly first thing in the morning and improve following periods of activity. It is common for people to experience “flare-ups” and “remissions” of symptoms.
Some people with AS may experience mild discomfort in the spine from time to time, while others may experience severe and debilitating symptoms at frequent intervals with minimal time in remission. Long term issues with AS include breathing difficulties due to thoracic and rib cage stiffness and severe spinal pain and immobility. Medical treatment focuses on reducing inflammation and slowing the disease process.
How can physiotherapy help?
Physiotherapy treatment aims to manage pain during flare-ups and maintain optimal posture as the disease progresses. Your physiotherapist will assess your spinal movement and posture as well as strength. If your hands, feet, hips or shoulders are affected, they will also provide you with specific exercises to help maintain mobility and strength in those joints. Many studies have proven the positive benefits of exercise for those with Ankylosing Spondylitis, such as improved rib cage expansion when breathing, and improved posture of the upper back and neck.
While pain and stiffness often go together, joint stiffness can occur on its own. Joint stiffness can limit your ability to perform usual tasks, such as turning your head to check behind you while driving. Stiffness can also be a warning sign that a part of the body is vulnerable to future injury. There are many different causes of stiffness and below are some of the reasons why you might not be feeling as flexible as normal.
1. Disuse and lack of movement
Our bodies are designed to move. When we're not regularly moving our joints through their full range, they can begin to feel ‘tight’. This can be caused by a combination of the capsule that surrounds the joint tightening up and the muscles around the joint shortening and losing flexibility. Stiff and tight muscles can cause you to feel as though your joints are stiff, even if it is only the muscle length that is restricting the movement. Joint mobilizations, manipulation and muscle stretches or massage can have a significant effect in improving the symptoms.
The most effective way to maintain full movement is to regularly move joints through their full range, which also helps to keep muscles and joints healthy. Your physiotherapist can advise you on how to best approach this with a targeted set of exercises.
2. Osteoarthritis (OA)
OA is a degenerative disease, characterized by a breakdown of the joint surface cartilage and the growth of bony osteophytes around areas of stress. While OA is increasingly common as we age, it is thought that the primary cause is abnormal load and stress to joint surfaces and not simply aging itself. As the space between two joint surfaces become uneven, joints affected by OA can feel stiff or even ‘blocked’.
A person with OA will often feel stiff for around 15-20 minutes after being still. Physiotherapy programs to strengthen the muscles surrounding the joints, to help absorb weight-bearing forces, has been shown to have positive results with OA symptoms.
3. Inflammatory Related Stiffness
The inflammatory process is characterized by swelling and pain around a specific area. Usually this is a response to damage by the body. As an area swells, this will allow less space for movement and a sensation of stiffness, as anyone who has had sprained an ankle can attest to. Acute inflammation will cause swelling that increases over 24-48 hours and subsides gradually. Autoimmune disorders can cause the body to mistakenly have an inflammatory reaction where there has been no injury, with resulting pain and stiffness. Rheumatoid arthritis and ankylosing spondylitis are two examples of such disorders.
Stiffness caused by inflammatory disorders is characterized by a feeling of stiffness after rest, particularly in the morning, that can take longer than 30 minutes to subside. Inflammatory disorders unrelated to injuries are complex in cause and require collaboration with medical teams for best treatment outcomes. Acute injuries are best managed by following RICE protocols (Rest, Ice, Compression, Elevation).