Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that predominantly affects the sacroiliac joints and spine, and may also involve other joints. This condition leads to structural damage and functional impairments, resulting in a decreased quality of life.
The estimated prevalence of AS per 10,000 people varies by region:
- Europe: 23.8
- Asia: 16.7
- North America: 31.9
- Latin America: 10.2
- Africa: 7.4
Role of Physiotherapy and Rehabilitation in Ankylosing Spondylitis
Rehabilitation is an essential component of medical therapy for AS and plays a fundamental role in maintaining tissue and musculoskeletal health. It is important at every stage of the disease.
The most affected aspects of lifestyle and quality of life for people with AS are physical strength, general health, and pain.
Surveys indicate that the most prevalent concerns include
stiffness (90.2%)
pain (83.1%)
fatigue (62.4%)
poor sleep (54.1%)
concerns about appearance (50.6%)
worry about the future (50.3%)
medication side effects (41%)
Initial or Acute Phase
Postural and Gestural Re-education
Rehabilitation that focuses on posture and movement is effective in addressing secondary damage. Exercise programs that target muscle chains have shown greater improvements compared to conventional exercise routines. Exercises designed to improve spinal mobility and muscle strength, along with stretching of tight muscles and respiratory exercises, can counteract muscle hypotonia. This comprehensive approach helps improve overall health and enables patients to better manage pain, both physically and psychologically.
Postural and gestural re-education is valuable for recovery and for restoring correct movement patterns whenever possible.
Active physiotherapy is generally preferable to passive physiotherapy, as it encourages greater patient participation and collaboration, leading to better pain control. For this reason, home exercises are considered an essential part of the physiotherapy program.
Chronic Phase
In the chronic phase, widespread ankylosis may develop, leading to significant rigidity of the spine and a stooped posture. The formation of joint deformities can result in serious functional limitations, potentially causing loss of mobility.
Physiotherapists should educate and empower patients to actively participate in their therapeutic process, helping them understand the benefits of physiotherapy and the importance of performing exercises daily at home or in small groups to achieve their goals.
Home Exercise Program
Patient education, active involvement, and motivation are crucial for successful treatment outcomes in individuals with AS.
Research shows that home exercise programs improve symptoms, mobility, functional skills, and overall quality of life. One study comparing daily home exercises for three months with drug therapy alone found that both groups experienced significant improvements in quality of life, fatigue, depression, disease activity, and mobility. However, the group performing home exercises achieved greater improvements.
Home exercise programs that include aerobic, stretching, and pulmonary exercises, alongside routine medical management, lead to better outcomes in spinal mobility, work capacity, and chest expansion.
According to the Spondylitis Association of America (SAA), an ideal exercise program for AS should include the following four types of exercise:
- Stretching: Improves flexibility, reduces muscle stiffness, swelling, and pain, and minimizes the risk of joint fusion.
- Cardiovascular Exercise: Activities such as swimming or walking improve lung and heart function, boost mood, and reduce pain and fatigue.
- Muscle Strengthening: Strengthening core and back muscles supports the spine, improves movement and posture, and reduces pain.
- Balance Training: Improves stability and reduces the likelihood of falling, which is especially important for individuals with lower bone density.
Benefits of Exercise
Exercise is a key strategy for relieving AS symptoms and maintaining strength and flexibility. Regular exercise can help by:
- Improving posture
- Enhancing strength, balance, and flexibility
- Improving cardiovascular health
- Increasing breathing capacity
- Reducing high blood pressure
- Maximizing bone density
- Aiding weight management
- Improving response to medications
Frequently Asked Questions about Ankylosing Spondylitis (AS)
1. What is Ankylosing Spondylitis and how does it affect the body?
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that primarily affects the sacroiliac joints and spine, though it can also involve other joints. Over time, AS can cause structural damage, joint stiffness, and reduced mobility, leading to significant functional impairments and a decreased quality of life.
2. Why is physiotherapy important in the management of AS?
Physiotherapy is a cornerstone of AS management because it helps maintain tissue and musculoskeletal health, improves mobility, and reduces pain. Rehabilitation is important at every stage of the disease, helping to address stiffness, improve posture, and prevent or delay joint deformities. Active participation in physiotherapy, especially through home exercise programs, has been shown to improve symptoms and overall quality of life.
3. What types of exercises are recommended for people with AS?
An effective exercise program for AS should include:
- Stretching to improve flexibility and reduce stiffness.
- Cardiovascular exercises like swimming or walking to boost heart and lung health and reduce fatigue.
- Muscle strengthening to support the spine and improve posture.
- Balance training to enhance stability and prevent falls.
These exercises, when done regularly, can help manage symptoms and maintain function.
4. How does exercise benefit people with AS beyond symptom relief?
Regular exercise offers several benefits for people with AS, including:
- Improved posture and spinal mobility
- Enhanced strength, balance, and flexibility
- Better cardiovascular and respiratory health
- Reduced blood pressure
- Maximized bone density
- Assistance with weight management
- Improved response to medications
Overall, exercise helps maintain independence and a higher quality of life.
5. Can home exercise programs be as effective as supervised physiotherapy?
Yes, studies have shown that home exercise programs, when performed regularly and correctly, can be as effective as supervised physiotherapy in improving symptoms, mobility, and quality of life for people with AS. Patient education, motivation, and consistency are key factors in achieving the best outcomes from home-based exercise routines.
