Ankylosing spondylitis physical therapy: Difference between revisions

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{{CMG}}; '''Associate Editors-In-Chief:''' [[Abhishek Singh|Abhishek Singh, B.P.T]] [mailto:abhiksin7556@yahoo.co.in]
{{CMG}}; '''Associate Editors-In-Chief:''' [[Abhishek Singh|Abhishek Singh, B.P.T]] [mailto:abhiksin7556@yahoo.co.in]
==Overview==
==Overview==
'''Ankylosing Spondylitis''' Ankylosing spondylitis (AS, from Greek ankylos, stiff; spondylos, vertebrae), previously known as Bekhterev's disease, Bekhterev syndrome, and Marie-Strümpell disease is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures. AS is a form of spondyloarthritis, a chronic, inflammatory arthritis and autoimmune disease.
'''Ankylosing Spondylitis''' (AS, from Greek ankylos, stiff; spondylos, vertebrae), previously known as Bekhterev's disease, Bekhterev syndrome, and Marie-Strümpell disease is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures. AS is a form of spondyloarthritis, a chronic, inflammatory arthritis and autoimmune disease. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine. It is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as "bamboo spine".


It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine.
It is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as "bamboo spine".
==Physical therapy==
==Physical therapy==
'''Aims Of Physiotherapy Management'''
===Aims Of Physiotherapy Management===
To minimise deformity & disability & to improve well-being,by maintaining normal function & improving person's quality of life.The aims can be achieved by:
To minimise deformity & disability & to improve well-being,by maintaining normal function & improving person's quality of life.The aims can be achieved by:


i-Postural awareness/correction & ergonomics advice.
* Postural awareness/correction & ergonomics advice.


ii-Pain Reduction.
* Pain Reduction.


iii-Improving & maintaining cardiovascular fitness.
* Improving & maintaining cardiovascular fitness.


iv-Regular assessment & monitoring of posture & mobility.
* Regular assessment & monitoring of posture & mobility.


v-Designing a suitable home program of specific exercises & regularly monitoring all exercises.
* Designing a suitable home program of specific exercises & regularly monitoring all exercises.


vi-Giving knowledge about disease & its management.
* Giving knowledge about disease & its management.
 
vii-Maintaining & improving posture,mobility & function by increasing mobility of costovertebral,spinal & peripheral joints,stretching of tight muscle groups/bulk & strengthening of anti gravity muscles.


* Maintaining & improving posture,mobility & function by increasing mobility of costovertebral,spinal & peripheral joints,stretching of tight muscle groups/bulk & strengthening of anti gravity muscles.


== Posture ==
== Posture ==


[[Image:AS.jpg|centre|500px|]]
[[Image:AS.jpg|centre|500px|]]
== Ergonomic considerations & Postural Correction ==
Ergonomic advice AS person's how to maintain good posture during work,home or leisure activities.
Longer the patient maintain a flexed posture,it is more likely that spine attains a flexed posture if vertebrae fuse.So,it is advisable that patient's with job that requires stooped posture would move around at regular intervals & pay attention towards his posture.
Posture can be checked in a mirror or by patient standing as straight as possible against a wall with tucking chin in & should maintain this posture after walking away from the wall.
The ideal chair for an AS patient should support the whole spine including the neck,hips & knees should be at right angles & feet should be supported.Forearms should be supported on arm rest.
== Exercise In Ankylosing spondylitis ==
Regular exercise program must start as soon as possible after AS diagnosis & performed for life.Physiotherapist role in providing patient with ongoing education,stimulus & inspiration so that exercise becomes part of his daily routine.
'''Joint Mobility Exercises'''
Exercises program should be designed to improve movements like flexion,extension,rotation & lateral flexion of lumbar,cervical& thoracic spines which is limited due to bony changes
(formation of syndesmophytes),fibrosis & calcification of ligaments & muscle tension.
Full range of motion exercises should be done on a daily basis with a variety of equipments like gym ball to make exercise more interesting & fun.
== Strengthening Exercises ==
Due to postural deformity & inactivity as a result of pain leads to muscle weakness which is a common feature of AS.So,strengthening of anti gravity muscle group i.e. extensor muscle & abdominal muscles are very important to maintain activities of daily living.Examples of extensor muscle groups are cervical,thoracic,lumbar spine extensors & glutei.
Strengthening of all these muscle group can be effectively done in hydrotherapy pool & resistance should be raised as needed by the patient. All the exercises are held for 15-30 seconds & repeated at least five times.
== References ==
1-Tidy's Physiotherapy Edited by Stuart Porter(Thirteenth edition)

Latest revision as of 14:56, 3 March 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Abhishek Singh, B.P.T [2]

Overview

Ankylosing Spondylitis (AS, from Greek ankylos, stiff; spondylos, vertebrae), previously known as Bekhterev's disease, Bekhterev syndrome, and Marie-Strümpell disease is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures. AS is a form of spondyloarthritis, a chronic, inflammatory arthritis and autoimmune disease. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine. It is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as "bamboo spine".

Physical therapy

Aims Of Physiotherapy Management

To minimise deformity & disability & to improve well-being,by maintaining normal function & improving person's quality of life.The aims can be achieved by:

  • Postural awareness/correction & ergonomics advice.
  • Pain Reduction.
  • Improving & maintaining cardiovascular fitness.
  • Regular assessment & monitoring of posture & mobility.
  • Designing a suitable home program of specific exercises & regularly monitoring all exercises.
  • Giving knowledge about disease & its management.
  • Maintaining & improving posture,mobility & function by increasing mobility of costovertebral,spinal & peripheral joints,stretching of tight muscle groups/bulk & strengthening of anti gravity muscles.

Posture


Ergonomic considerations & Postural Correction

Ergonomic advice AS person's how to maintain good posture during work,home or leisure activities.

Longer the patient maintain a flexed posture,it is more likely that spine attains a flexed posture if vertebrae fuse.So,it is advisable that patient's with job that requires stooped posture would move around at regular intervals & pay attention towards his posture.

Posture can be checked in a mirror or by patient standing as straight as possible against a wall with tucking chin in & should maintain this posture after walking away from the wall.

The ideal chair for an AS patient should support the whole spine including the neck,hips & knees should be at right angles & feet should be supported.Forearms should be supported on arm rest.


Exercise In Ankylosing spondylitis

Regular exercise program must start as soon as possible after AS diagnosis & performed for life.Physiotherapist role in providing patient with ongoing education,stimulus & inspiration so that exercise becomes part of his daily routine.

Joint Mobility Exercises

Exercises program should be designed to improve movements like flexion,extension,rotation & lateral flexion of lumbar,cervical& thoracic spines which is limited due to bony changes (formation of syndesmophytes),fibrosis & calcification of ligaments & muscle tension.

Full range of motion exercises should be done on a daily basis with a variety of equipments like gym ball to make exercise more interesting & fun.


Strengthening Exercises

Due to postural deformity & inactivity as a result of pain leads to muscle weakness which is a common feature of AS.So,strengthening of anti gravity muscle group i.e. extensor muscle & abdominal muscles are very important to maintain activities of daily living.Examples of extensor muscle groups are cervical,thoracic,lumbar spine extensors & glutei. Strengthening of all these muscle group can be effectively done in hydrotherapy pool & resistance should be raised as needed by the patient. All the exercises are held for 15-30 seconds & repeated at least five times.



References

1-Tidy's Physiotherapy Edited by Stuart Porter(Thirteenth edition)