Massage therapy · Kitchener–WaterlooSpondyloarthropathy

Spondyloarthropathy is not the same as facet joint osteoarthritis, the "wear and tear" arthritis of the small joints at the back of the spine (Perolat et al., 2018). They are different conditions and are treated differently, so it is important to get the right diagnosis.

These conditions are linked by a gene called HLA-B27 and by inflammation at the places where tendons and ligaments attach to bone (called enthesitis) (Kataria and Brent, 2004). Ankylosing spondylitis is a type of axial spondyloarthritis (NHS, 2023a).

The bones join together to form a canal that protects the spinal cord. The spinal column has three main sections, which create its natural curves: the neck (cervical), the chest area (thoracic) and the lower back (lumbar). Below the five lumbar vertebrae, vertebrae that are fused together make up the lowest part of the spine (the sacrum and coccyx), and the sacrum connects the spine to the pelvis.

The spinal cord works like an electrical cable, carrying messages between the brain and the rest of the body. Nerves branch out from the spinal cord through openings between the vertebrae. Ligaments and muscles give the spine and upper body stability and support, and strong ligaments join the vertebrae and keep the spinal column in position.

In the spondyloarthropathies, inflammation often affects the sacroiliac joints, where the base of the spine (the sacrum) joins the pelvis, as well as the spine itself and the places where tendons and ligaments attach to bone (Kataria and Brent, 2004).

• Back pain and stiffness that get better with exercise, but do not improve or get worse with rest
• Pain and stiffness that are worse in the morning and at night, sometimes waking you up
• Pain around the buttocks
• Pain and swelling in other joints, such as the hips and knees
• Pain where tendons attach to bone, for example behind or under the heel
• Extreme tiredness (fatigue)

1. Exercise and Physical Therapy

Keeping active can improve your posture and the range of movement in your spine, and help stop it becoming stiff and painful (NHS, 2023c). A physiotherapist can draw up an exercise programme that suits you. This may be an individual or a group exercise programme, or hydrotherapy (exercise in a warm pool) (NHS, 2023c). Physiotherapy can include hands-on methods such as massage to improve comfort and spinal flexibility (NHS, 2023a). Some daily stretching and exercise is important (NHS, 2023c). I can coach you through stretches and exercises to do at home.

2. See Your Family Doctor or Nurse Practitioner

If you have persistent symptoms, see your family doctor or nurse practitioner. If they think you may have the condition, they should refer you to a rheumatologist for further tests and treatment (NHS, 2023a).

Options outside my scope

• Anti-inflammatory painkillers (NSAIDs): these are usually the first medicines prescribed, to ease pain and swelling; your family doctor, nurse practitioner or rheumatologist will look for the one that suits you (NHS, 2023c).
• Biological medicines: if NSAIDs and exercise do not control your symptoms, a specialist may recommend medicines such as anti-TNF treatment, which are given by injection and reduce inflammation (NHS, 2023c).
• Steroid injections: a corticosteroid (steroid) medicine can be injected into a particularly inflamed joint (NHS, 2023c).
• Disease-modifying medicines (DMARDs): these are sometimes used to treat inflamed joints in parts of the body other than the spine (NHS, 2023c).
• Surgery: most people will not need surgery, but a joint replacement may be recommended if a joint such as the hip becomes badly damaged (NHS, 2023c).

How I can help (see the My Approach tab)

• Hands-on work to ease stiffness and muscle tension in your back, hips and chest
• Stretching, breathing and exercise to keep your spine and ribs moving
• Gentler, shorter sessions during a flare

Chest wall work needs your informed consent and a written consent form. If one eye becomes red and painful, or you get leg weakness or bladder or bowel changes, get help straight away (see When to Get Help Quickly).