What is Ankylosing Spondylitis?

It is a common inflammatory rheumatic disease affecting the head, ribcage and spine causing inflammatory back pain leading to structural and functional impairments that decrease overall quality of life for those individuals with this disease. The affected joints show irregular erosion and sclerosis. Tissue is gradually replaced by fibrocartilage and then becomes ossified. When these lesions occur in the spine, the junction of the annulus fibrosus of the disc cartilage and the margin of the vertebral bone undergo irreversible damage. The outer annular fibres are replaced by bone and the vertebrae become fused. In advanced stages of the disease the fusion typically ascends the spine, forming a long bony column referred to as “bamboo spine.”

Causes:

The causes are unknown and can be due to genetics and inflammatory back pain caused by sacroiliitis (inflamed sacroiliac joint), and inflammation at other locations of the axial skeleton (head, rib cage, spine).

Symptoms:

• Spinal stiffness, and loss of spinal mobility which is explained by spinal inflammation, structural damage, or both. The initial symptom is typically a dull pain that is insidious in onset. The pain is generally felt deep in the buttock and/or in the lower lumbar regions and is accompanied by morning stiffness in the same area that lasts for a few hours, improves with activity, and returns with inactivity. The pain becomes persistent and bilateral within a few months and is usually worse at night.

Complications

• In very severe cases when bone is damaged the body’s response is to form new bone as a healing mechanism.
  • This new bone that has been formed will bridge a gap between the vertebrae essentially fusing the vertebrae together. Causing stiffness and inflexibility.
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  • Fusion of the rib cage can restrict lung capacity and function

Physiotherapy Management in Curezone Physiotherapy Clinic, Mississauga

The best treatment for this disease is a combination of non-pharmacological and pharmacological treatments that include education and physical therapy.  The main therapy techniques to remedy the pain would include regular exercise and a visit to the physiotherapist.  The physiotherapist can administer different modalities like release techniques and manual therapies to help reduce the severity of the pain.  Patients with this disease can manage some of the chronic pain with anti-inflammatories and antirheumatic drugs that can be prescribed by your Medical Doctor or taken over the counter.

Assessments done by the Registered Physiotherapist   

The Physiotherapist will complete certain tests, to determine if the patient has Ankylosing Spondylitis which include the following.

• Schober test: The physiotherapist will assess the lumbar spines forward flexion while the patient is trying to touch their toes. Progressive loss of spinal motion is correlated with x-ray findings.
• Gaenslen Test: Sacroiliac (SI) pain is one of the common symptoms of AS and physiotherapists will test the SI joint by doing the Gaenslen maneuver if there is increased pain it could mean a possible joint disease.
• Chin-Brow Measurement: This test measures the spines curvature specifically in the neck. Patients with AS have necks that flex forward this is due to spinal stiffness.  The physician will measure the angle of your neck and after initial visit and follow up visits to see if the angle is progressively getting worse or improving.
• Chest Expansion: When AS affects the mid back region chest expansion can be difficult to complete. This can be measured by having the patient complete full inspiration from a deep expiration of breath.
• ROM Techniques: The therapist will test your joints range of motion (ROM) to see how far you can successfully move the joint through a full pain free movement the movements that will be tested are flexion, extension, lateral bending, and spinal rotation.

Physiotherapy Treatment Techniques 

Physiotherapy Treatment consist of MANUAL THERAPY such as mobilizations, soft tissue release , active and passive stretch techniques with home exercise program based on your condition. The physiotherapist might do some modalities such as Laser therapy, Ultrasound therapy, Mckenzie treatment techniques to alleviates the pain and reduce swelling and inflammation.  

Some exercises that the physiotherapist will prescribe (that are not limited to) to patients with AS include the following, these exercises are meant to build core strength and produce improvements in flexibility.

• Planks
• Bird Dogs
• Prone Straight Leg Raise
• Deep Neck Flexion
• Shoulder Rolls
• Back Extension
• Shoulder Shrugs
• Neck Rotation

Make sure you book your appointment today and get assessed by our physiotherapist now at 905 997 4333

Sheena John

Registered Physiotherapist