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Exercise therapy is considered to be an important overall component in the management of patients with ankylosing spondylitis (AS) and is typically coordinated by a physical therapist. The primary goals of exercise therapy in ankylosing spondylitis include:

• Maintaining or improving mobility of the spinal column and peripheral joints and increasing spinal flexibility.
• Stretching the hip joint to prevent stiffness because stiffness in the hip joint may result in a forward bending position leading to postural problems.
• Stretching muscles which may have become shortened
• Strengthening the muscle groups of the back, legs, and trunk
• Improving posture
• Maintaining chest expansion
• Reducing pain and stiffness

In general, range-of-motion and other types of exercises that help to strengthen muscle groups, reduce stiffness of the spine and peripheral joints, and improve posture are recommended. For example, swimming is considered an excellent form of exercise because it uses all major muscle groups and joints without exerting an excessive amount of stress or strain on the joints. Deep-breathing exercises are also helpful for patients with ankylosing spondylitis because they help maintain chest expansion.

It is advisable to consult with your doctor or a physical therapist and obtain their recommendations for an individualized exercise regimen that would fit with your health and lifestyle. Considerations of an individualized exercise program include a variety of factors including age, overall health, and certain risk factors.

Although several studies have been published during the past few decades that have reported the benefits of exercise therapy for the management of ankylosing spondylitis, a systematic Cochrane review of this subject published in 2001 concluded that the positive effects of physiotherapy for the management of ankylosing spondylitis was relatively short-term. The reviewers concluded that, based upon their review and analysis of the prior literature, that there was insufficient evidence available upon which to base a firm recommendation either for or against the use of physiotherapy for the treatment of ankylosing spondylitis.

In addition to exercise therapy, physical therapists may suggest alternative methods of pain relief, including muscle relaxation by means of:

• Massage therapy
• Transcutaneous electrical nerve stimulation (TENS)
• Heat packs for reducing pain and stiffness or cold packs for reducing swelling

• Spa therapy which consists of a wide range of therapeutic regimens including:

  • mineral water bathing (balneotherapy)
  • total body immersion in water (hydrotherapy)
  • relaxation therapies

Spa therapy has been used for many centuries by patients with a variety of rheumatic conditions, however, its role in the management of ankylosing spondylitis has not been fully established. The results of a single randomized, controlled, clinical trial conducted in Austria and the Netherlands involving 120 patients with AS suggested that a combination of spa therapy and physical exercise provided improvement in overall well-being and reduction of pain in some patients. The authors concluded that these benefits may last up to one-year after treatment. Additional studies are needed in this area before specific recommendations and guidelines can be established regarding the effectiveness of spa therapy in the management of patients with ankylosing spondylitis.