Ankylosing spondylitis physical therapy


 * Associate Editors-In-Chief: Abhishek Singh, B.P.T [mailto:abhiksin7556@yahoo.co.in]

Overview
Ankylosing Spondylitis (AS, from Greek ankylos, stiff; spondylos, vertebrae), previously known as Bekhterev's disease, Bekhterev syndrome, and Marie-Strümpell disease is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures. AS is a form of spondyloarthritis, a chronic, inflammatory arthritis and autoimmune disease. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine. It is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as "bamboo spine".

Aims Of Physiotherapy Management
To minimise deformity & disability & to improve well-being,by maintaining normal function & improving person's quality of life.The aims can be achieved by:


 * Postural awareness/correction & ergonomics advice.


 * Pain Reduction.


 * Improving & maintaining cardiovascular fitness.


 * Regular assessment & monitoring of posture & mobility.


 * Designing a suitable home program of specific exercises & regularly monitoring all exercises.


 * Giving knowledge about disease & its management.


 * Maintaining & improving posture,mobility & function by increasing mobility of costovertebral,spinal & peripheral joints,stretching of tight muscle groups/bulk & strengthening of anti gravity muscles.

Ergonomic considerations & Postural Correction
Ergonomic advice AS person's how to maintain good posture during work,home or leisure activities.

Longer the patient maintain a flexed posture,it is more likely that spine attains a flexed posture if vertebrae fuse.So,it is advisable that patient's with job that requires stooped posture would move around at regular intervals & pay attention towards his posture.

Posture can be checked in a mirror or by patient standing as straight as possible against a wall with tucking chin in & should maintain this posture after walking away from the wall.

The ideal chair for an AS patient should support the whole spine including the neck,hips & knees should be at right angles & feet should be supported.Forearms should be supported on arm rest.

Exercise In Ankylosing spondylitis
Regular exercise program must start as soon as possible after AS diagnosis & performed for life.Physiotherapist role in providing patient with ongoing education,stimulus & inspiration so that exercise becomes part of his daily routine.

Joint Mobility Exercises

Exercises program should be designed to improve movements like flexion,extension,rotation & lateral flexion of lumbar,cervical& thoracic spines which is limited due to bony changes (formation of syndesmophytes),fibrosis & calcification of ligaments & muscle tension.

Full range of motion exercises should be done on a daily basis with a variety of equipments like gym ball to make exercise more interesting & fun.

Strengthening Exercises
Due to postural deformity & inactivity as a result of pain leads to muscle weakness which is a common feature of AS.So,strengthening of anti gravity muscle group i.e. extensor muscle & abdominal muscles are very important to maintain activities of daily living.Examples of extensor muscle groups are cervical,thoracic,lumbar spine extensors & glutei. Strengthening of all these muscle group can be effectively done in hydrotherapy pool & resistance should be raised as needed by the patient. All the exercises are held for 15-30 seconds & repeated at least five times.