Ankylosing Spondylitis (AS) is an inflammatory condition, which predominantly affects the joints of the spine, hip joints and sacroiliac joint (joints within the pelvis). There is a higher prevalence of AS in men, and symptoms normally start to show around the age of 20-30. Most patients diagnosed with AS have complained of back pain or pelvic pain for quite a few years before a definitive diagnosis is reached. Other symptoms include stiffness within the joints first thing in the morning which lasts more than an hour, reduced movement in the spine; particularly loss of extension, and side bending that worsens with time. Patients also note that exercise and movement helps symptoms and rest worsens symptoms.
How is AS Diagnosed?
Diagnosis depends on the number of the above-mentioned reported symptoms and then radiological assessment of the spine and sacroiliac joint condition. Evidence of joint fusion and inflammatory changes on imaging will confirm a diagnosis of AS but there are a range of joint conditions that exist in which the above symptoms can be reported but there are no signs of radiological change.
How is AS Treated?
Because of the joint fusion and stiffness that occurs with AS, the mainstay of physiotherapy treatment is education on the correct stretches and exercises to be performed to manage the condition. It is vital that a regular and sustained exercise programme is in place alongside medical management strategies, which may include different disease modifying drugs. The patient should be in contact with a rheumatologist who will work with the physiotherapist and advise on the medical management of the disease. This will allow the patient to best manage their condition. Hydrotherapy can also be very useful as an extra treatment to aid flexibility and maintain muscle strength.
Frequently patients with AS will complain of symptoms of tendinopathy or pain in their tendons. This is common with AS and should be looked out for. Pain in tendons such as the Achilles, outer elbow and shoulder should be monitored and treated early to avoid problems. Physiotherapy can be very helpful in the management of these symptoms. Advice on graded loading programmes, offloading tape and activity modification alongside manual therapy techniques can be utilised.