Massage therapy · Kitchener–WaterlooAnkylosing Spondylitis (AS)

The name comes from ankylosis, meaning fusing, spondyl- meaning spine, and -itis meaning inflammation.

AS, like most types of arthritis, causes inflammation and pain in the affected joints and tissues. The sacroiliac joints (where the base of the spine meets the pelvis) are mainly affected. AS usually first starts to develop between 18 and 40 years of age (NHS, 2023b). The cause is unknown, although there is thought to be a link with a particular gene variant called HLA-B27 (NHS, 2023a).

AS is an inflammatory condition. Over time, the inflammation can affect the facet joints (the joints between each vertebra) and the places where ligaments attach to the spine. In some people the bones of the spine gradually join up (fuse), which can make the back stiff and fix the posture in one position. Most people with AS remain fully independent or only minimally disabled in the long term, but some eventually become severely disabled (NHS, 2023a; NHS, 2023e).

AS can also be linked with problems in other parts of the body, such as inflammation in the eye (iritis), inflammatory bowel disease, the skin condition psoriasis, weakened bones (osteoporosis) and heart and blood vessel disease (NHS, 2023b; NHS, 2023e). Like many conditions, AS can affect a person mildly or severely and any range in between.

(NHS, 2023b)

If you suspect you have AS, first discuss this with me or your family doctor or nurse practitioner. If your family doctor or nurse practitioner thinks you may have AS, they should refer you to a rheumatologist (a specialist in conditions affecting the muscles and joints), who will investigate and diagnose your condition (NHS, 2023a).

There is no single definitive test for AS. Diagnosis is based on your symptoms, blood tests to look for inflammation, and imaging tests such as X-rays or an MRI scan. AS can usually be confirmed when an X-ray shows inflammation of the sacroiliac joints (sacroiliitis) together with typical symptoms; if an X-ray cannot confirm it, an MRI scan is usually offered (NHS, 2023c).

A genetic blood test for the HLA-B27 gene variant (HLA stands for human leukocyte antigen) may also be done. This gene variant is found in most people with AS and can contribute towards a diagnosis, but it is not entirely reliable: not everyone with AS has it, and some people have it without ever developing AS (NHS, 2023c).

The NHS describes physical methods such as massage being used to improve comfort and spinal flexibility (NHS, 2023a). Working alongside your medical team and physiotherapist, I can help with hands-on treatment and exercises for your posture and spinal movement. See the My Approach tab for how I work.

• Physiotherapy: physiotherapy is a key part of treating AS. A physiotherapist can set up a suitable exercise programme with the most effective exercises for you, either on your own or in a group, and hydrotherapy (exercise in a warm pool) is also recommended (NHS, 2023d; NICE, 2017).
• Keeping active: keeping active is key. It can improve your posture and the range of movement in your spine, and help stop your spine becoming stiff and painful (NHS, 2023d). Swimming or playing sport can help you stay flexible, alongside some daily stretching and exercise. If in doubt, speak to your physiotherapist or rheumatologist before taking up a new sport or form of exercise (NHS, 2023d).

Options outside my scope

• Anti-inflammatory painkillers (NSAIDs): these are usually the first medicines prescribed for AS to ease pain and inflammation, and your family doctor, nurse practitioner or rheumatologist will find the one and the dose that suit you (NHS, 2023d).
• Other painkillers: if NSAIDs are unsuitable or you need extra pain relief, your doctor may recommend another painkiller, such as paracetamol, or prescribe a stronger one, such as codeine (NHS, 2023d).
• Biological medicines: anti-TNF medicines, given by injection, may be recommended if symptoms are not controlled with NSAIDs and exercise; other biological medicines (monoclonal antibodies) and tablets called JAK inhibitors are further options (NHS, 2023d).
• Steroid injections: corticosteroids can be injected into a particular joint that is inflamed (NHS, 2023d).
• DMARDs (disease-modifying anti-rheumatic drugs): these may be used for inflamed joints in parts of the body other than the spine (NHS, 2023d).
• Bone-strengthening medicines: if AS leads to osteoporosis (weak bones), medicines to strengthen the bones may be needed (NHS, 2023e).
• Surgery: most people with AS do not need surgery. A joint replacement, such as a hip replacement, may be recommended if a joint becomes badly damaged, and in rare cases surgery is needed to correct a badly bent spine (NHS, 2023d).

How I can help (see the My Approach tab)

• Hands-on treatment for stiffness and muscle tension, adapted with extra care during flares
• Exercises for posture, spinal movement and breathing
• Support after a joint replacement, once your surgeon has cleared you

If you've had a joint replacement, I need your surgeon's okay before hands-on treatment; then I can help with scar work, stiffness and building strength back up. New or worsening symptoms go to your doctor first (see When to Get Urgent Help).