Ankylosing spondylitis physical therapy

The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.

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)