Physical Therapy Exercises for Ankylosing Spondylitis to Improve Joint Stiffness

• Ankylosing Spondylitis is a chronic inflammatory disease that affects the spine and other joints in the body.
• Exercise is an essential part of managing Ankylosing Spondylitis, as it can help improve flexibility, mobility, and overall quality of life.
• There are several types of exercises that can be beneficial for people with Ankylosing Spondylitis, including stretching, strengthening, and low-impact aerobic activities.
• It is important to work with a healthcare professional to develop an individualized exercise plan that takes into account your specific needs and limitations.
• With the right approach and guidance, exercise can be a safe and effective way to manage the symptoms of Ankylosing Spondylitis and improve overall health and well-being.

Ankylosing spondylitis sufferers typically develop pain and stiffness of the spine, including axial joints such as the shoulder and hip joints. While medications are essential for managing pain, inflammation exercises for ankylosing spondylitis are crucial in managing joint stiffness and pain. This article will teach the practices and a few home tips to prevent joint stiffness and deformity associated with Ankylosing Spondylitis.

11 Easy ankylosing spondylitis exercises

Individuals with ankylosing spondylitis (AS) experience pain and stiffness, mainly affecting the axial skeleton (spine, hips, and shoulders). Since the condition is inflammatory arthritis, fatigue can also be a prominent symptom¹. Ankylosing spondylitis typically affects the spine; it starts with low back pain that slowly affects the whole spine. 

The primary pathology of ankylosing spondylitis includes enthesitis, or inflammation of the anatomical region of the bony attachment of tendons, ligaments or joint capsules. Typically, this occurs in the spine; if unchecked, new bone formation may result in ankylosis or spinal fusion¹.

So, the exercises we will learn aim to prevent joint stiffness and tightness of the muscles. It is achieved through mobility exercises and, secondly, stretching exercises. Let’s start with mobility exercises.

Mobility exercises for stiff spine and axial joints

As I just mentioned, these are the group of exercises that are aimed to improve and maintain the mobility of affected joints. Stiffness of the spine is the major problem in Ankylosing Spondylitis, so taking care of it should be our priority.

We will discuss exercises that specifically mobilise the lower back’s spine rather than activities to mobilise the cervical and upper back. We will also learn movements that mobilise the spine as a whole.

#1 Raising chest in supine

The first exercise in the list of 11 exercises for ankylosing spondylitis is called raising the chest in supine. This exercise is designed to mobilize the spine as a whole, from the neck to the lower back. It is a simple exercise that can be performed easily at home.

1. To do this exercise, you need to lie down on your tummy with both your hands placed beside your shoulders.
2. Slowly raise your chest to the point where you feel a little uncomfortable.
3. Hold this position for a few seconds and then lower it down.
4. Repeat the process a minimum of 10 times in a single session. This exercise helps to improve your posture, increase flexibility, and reduce stiffness in the spine. It is recommended that you perform this exercise regularly to achieve maximum benefits.

#2 Lower back mobility exercise

Lower back mobility exercise helps to mobilize the lower back and stretch the muscles in the hips, glutes, and thighs. It also helps to release tension in the lower back and relieve pain. It is important to perform this exercise slowly and gently, without forcing the movement beyond your range of motion.

1. To perform the supine lying knee twist, start by lying on your back with your knees bent and your feet flat on the floor.
2. Keep your arms by your sides with your palms facing down.
3. Take a deep breath in and as you exhale, slowly lower both your knees to one side of your body while keeping your shoulders flat on the floor.
4. At the same time, turn your head to the opposite side of your knees.
5. Hold this position for a few seconds, then inhale and return to the starting position. Repeat this movement on the other side.

When performing the supine lying knee twist, it is important to keep the following tips in mind:

#3 Neck mobility exercise for ankylosing spondylitis

The starting position for this exercise is the sitting position.

1. First, sit comfortably with your back straight.
2. Then, slowly bend your neck to the left side and hold for a few seconds before bringing it back to the center.
3. Next, bend your neck to the right side and hold for a few seconds before bringing it back to the center again. This exercise is known as the neck bending exercise.

Apart from the neck bending exercise, there is also a neck rotation exercise that you can perform.

1. To do this, simply rotate your neck to the left side and hold for a few seconds before bringing it back to the center.
2. Then, rotate your neck to the right side and hold for a few seconds before bringing it back to the center again.

It is important to alternate between both exercises, repeating each 10 to 15 times in a single session. Begin with the neck bending exercise and repeat it 10 to 15 times before moving on to the neck rotation exercise. This exercise routine can help alleviate the symptoms of ankylosing spondylitis and improve your overall neck flexibility.

#4 Shoulder mobility exercises

There is a range of shoulder mobility exercises that you can learn by just looking at these figures.

Stretching exercises for ankylosing spondylitis

Stretching exercises are a very important component of ankylosing spondylitis exercises. When there is less motion at the joint due to the stiffness, the development of muscle tightness is obviously secondary to this joint stiffness. Stretching exercise is equally important to keep these muscles flexible and mobile.

Let us first start with stretching the muscles around the hip for ankylosing spondylitis exercises.

#5 Piriformis muscle

Tightness in the hip muscles is a common problem, and one of the most common muscles to get tight are the piriformis muscles. These muscles are located on either side of the buttocks and are often stiff.

1. To stretch these muscles, begin by lying flat on your back.
2. Next, try one piriformis muscle at a time by pulling the knee towards the chest slightly obliquely.
3. If you’re stretching your right piriformis muscle, bend your right knee and hold it with both hands cupped together.
4. Pull your knee towards the chest in the direction of your left shoulder until you feel a comfortable stretch on the outer side of your right buttock.
5. Hold the stretched position for one minute, and then release it slowly.
6. Repeat the same process on the left side to pull the left piriformis muscle. In a single session, repeat this exercise two to three times.

#6 Hip flexors stretching

The hip flexors are a group of muscles located at the front of the thigh that are responsible for flexing the hip joint. Tightness in the hip flexor muscles is common in the advanced stages of Ankylosing Spondylitis, and therefore, it is crucial to stretch them properly. When the hip flexors are tight, it can be difficult to maintain a fully straight position, and one may compensate by bending the knee joint.

1. To stretch these muscles, start by lying flat on your back.
2. Move to the edge of the bed, making sure you maintain your balance.
3. Let one of your legs hang off the bed, allowing the weight of your leg to stretch the hip flexors.
4. Hold this position for a minute, then switch sides and repeat the process.
5. You can do this exercise 2 to 3 times on each side during a single session.

#7 Neck stretching exercises for ankylosing spondylitis

The tightness of the neck muscles becomes visible with time as Ankylosing Spondylitis disease progresses and the neck comes to a bad posture known as forward head posture. That’s why the stretching of neck muscles is equally very very important. We need to stretch both the right side muscle and the left side muscles of the neck.

1. To begin with, find a comfortable and straight sitting position or you can stand to do this exercise.
2. In order to stretch the muscles on the left side of your neck, place your right hand on the right temple area, just above your ear, and pull your head towards the left side.
3. Stretch until you feel comfortable on the right side of your neck and hold this position for at least 1 minute or 60 seconds, then slowly release it.
4. Repeat the same stretch for the left side of your neck. Since this is a stretching exercise, it is recommended to repeat it two to three times during a single session, twice daily.

#8 Chin tuck exercises for ankylosing spondylitis

This is also a kind of neck stretching exercise in which we are actually stretching the sternocleidomastoid muscle muscles. I will not go to do into the deeper anatomy of the sternocleidomastoid muscle just visit this link to learn more about this muscle.

1. To perform the exercise, start by sitting or standing up straight with your shoulders relaxed.
2. Next, gently tuck your chin in towards your chest, as though you are trying to make a double chin.
3. Hold this position for a 10 seconds, then slowly release and repeat. It’s important to make sure that you are not tilting your head forward or backward, but rather keeping it in line with your spine.

#9 Stretching of shoulder muscles

It is important to take care of the shoulder muscles when correcting bad forward head posture, as tightness in these muscles can reinforce the problem. The anterior capsule and the muscles on the front of the shoulder are commonly affected and need to be stretched. My favorite exercise for stretching these structures is very easy to perform.

1. For this exercise, simply find a corner in your house and stand at a distance of one hand facing the corner.
2. Raise both shoulders and place your forearm flat on the wall, keeping the shoulder and elbow at a 90-degree angle.
3. Place both hands on the adjacent walls and then lean your body and chest towards the corner. You should feel a nice stretch in the anterior part of your shoulder joint.
4. Hold this position for at least one minute and then return to the normal position.
5. Repeat this exercise two to three times in a single session.

Other home tips

An active lifestyle is a must

In addition to these exercises, I would strongly recommend an Ankylosing Spondylitis sufferer adopt an active lifestyle. Do not remain in your bed, engage yourself in the daily chores of your house this will help the movement of your joints and it will prevent any developing stiffness of the joints and muscles together. 

Morning jogging has an important role

I would also insist on morning jogging as a part of ankylosing spondylitis exercises. Jogging not only improves the health of your muscles and joints, but it is also a very good way for breathing exercises. When we are running, we are jogging we have to take a deep breath which increases the chest expansion and compression during respiration and expiration.

This is a kind of a very good breathing exercise that will prevent any future respiratory complications

Managing ankylosing winter pain effectively

Joint pain and muscle pain become very severe during the winter for these kinds of sufferers, so managing this kind of pain is very important without taking analgesics. One of my favourite ways that I often recommend to my patient is the use of an infrared lamp. 

Infrared lamps are very easy to use and very handy, just plugin and switch on the device and the warm red light emitting from the lamp will ease your pain almost instantly. You can apply over your painful region, the most common painful areas are the upper back and the lower back.

Apply it gently over your upper back and lower back area for 5 to 10 minutes and you would feel instant relief in your pain. 

Keep Reading: Biologics for Ankylosing Spondylitis: Everything you should know

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.