Conditions & Treatments - Ankylosing Spondylitis                                            


Ankylosing spondylitis (AS) is a form of progressive arthritis due to chronic inflammation of the joints in the spine (1). This inflammation can lead to the formation of new bone on the spine which can cause the spine to fuse in an immobile position and at times resulting in a kyphotic posture (1). AS classically affects the sacroiliac joints, but in some individuals, the cervical spine, shoulder, lumbar spine, hips, knees, and tarsals may also be affected (2). Patients may complain of stiffness and soreness that worsens with rest and improves with activity and movement (2). Night pain may be present, and the patient may state that he or she awakes during the second half of the night (2). Patients may complain of severe early morning stiffness that lasts more than 30 to 60 minutes (2). A review of systems may reveal uveitis, fatigue, weight loss, fever, malaise, cardiac complications, and pulmonary complications (2).

The age of onset of AS symptoms often occurs between the teen years and the third decade of life, with onset after 40 years old being rare (2). Men are affected two to three times more than women, and ankylosing spondylitis is often found in the family history (2).

Rudwaleit et al. developed a screening tool for AS (2). If at minimum three of the following four criteria are present, the specificity is 97.3% (95% CI, 92.4-99.1): morning stiffness greater than 30 minutes, back pain decreases with exercises and does not decrease with rest, night pain only in the second half of the night, and alternating buttock pain (2).

Radiologic tests, including plain films and MRIs, may be used to confirm a diagnosis of AS (1). Additionally, a blood test will be taken to look for the HLA-B27 gene, which is present in the majority of Caucasians with AS (NIAMS) (1). Once diagnosed by a rheumatologist, the patient may seek care from a variety of health care practitioners, including an ophthalmologist, a gastroenterologist, a physiatrist, and a physical therapist (1)

Physical Therapist Management
Early after onset, spinal mobility may be normal (3). To track spinal mobility throughout the disease process, physical therapists may measure lumbar flexion using the modified Schober's test (3). Lumbar side bending, rotation, and extension may also be tracked through observed active range of motion. Physical therapists may also measure chest expansion at the fourth intercostal space and measure occiput-to-wall distance (3).

To track pain, physical therapists should use the visual analogue scale (VAS) (3). To measure function, physical therapists should use the Bath Ankylosing Spondylitis Functional Index (BASFI) (3). To measure fatigue, physical therapists should use the fatigue question Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (3).

A 2008 Cochrane Review concludes "that an individual home-based exercise or supervised exercise program is better than no intervention; that supervised group physiotherapy is better than home exercises; and that combined inpatient spa-exercise therapy followed by group physiotherapy is better than group physiotherapy alone (4)." Exercise programs analyzed in the review lasted between two and ten months and included strengthening, aerobic exercises, hydrotherapy, sport activities, and stretching (4). In the studies analyzed, no patient reported harm from the physical therapy interventions (4). Overall, authors concluded that "physiotherapy or exercises are helpful to people with ankylosing spondylitis (4)."

Last revised: January 20, 2014
by Michelle Kornder, SPT


1) National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers about Ankylosing Spondylitis. Available at: Accessibility verified: January 7, 2014.
2) Boissonnault, WG. Primary Care for the Physical Therapist. 2nd edition. St. Louis, Missouri: Saunders; 2011.
3) Golder V, Schachna L. Ankylosing Spondylitis: An update. Australian Family Physician. 2013; 42(11):780-784. Available from UW Madison, Madison, WI. Accessed January 7, 2014.
4) Dagfinrud H, Hagen KB, Kvien TK. Physiotherapy Interventions for Ankylosing Spondylitis (Review). The Cochrane Library. 2008, Issue 1. Available from UW Madison, Madison, WI. Accessed January 7, 2014.
5) Ozgocmen S, Akgul O, Altay Z, Altindag O, Baysal O, Calis M, Capkin E, Cevik R, Durmis B, Gur A, Kamanli A, Karkucak M, Madenci E, Melikoglu M, Nas K, Senel K, Ugur M. Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. International Journal of Rheumatic Diseases. 2012; 15:229-238. Available from UW Madison, Madison, WI. Accessed January 7, 2014.

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