What Your Physical Therapist Wants You to Know About AS Pain

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When you have ankylosing spondylitis (AS), one of the most notable issues is pain—either the sharp, stabbing type when you move certain ways, or an ongoing dull ache that comes from stiffness and inflammation. Some people have both. While stretching and movement may not eliminate your pain completely, they’re part of a larger strategy that could reduce pain levels overall. Here, physical therapists share their insights on what you can do to dial down the hurt, reduce early morning muscle stiffness, and feel more comfortable overall.

Consider Gentle Yoga and Pilates

Both yoga and Pilates are heavily focused on improving mobility in the trunk and mid back, which makes them ideal for those with AS, says Jordan Allison, D.P.T., at Colorado in Motion in Fort Collins, CO. “These practices, along with specifically prescribed exercises from your physical therapist, are the perfect place to start for addressing your pain,” he says. If there’s no studio near you, no problem: There’s a breadth of online fitness apps that have classes you can do in your home. Just be sure to start slow and opt for shorter sessions at first, Allison says.

Focus on Your Breathing

Whether you’re doing yoga, Pilates, or just gentle stretches, the best-kept secret to effectiveness is to pay attention to your breathing, Allison says. The type you’ll want to do is diaphragmatic breathing—also called “belly breathing”—that pulls the diaphragm down with each inhale. That helps the lungs fill more easily, creating subtle movement in the spine. “This helps mitigate the negative effects of AS related to spinal mobility,” says Allison. “Even if you’re not moving very much, taking these breaths can help you create more motion in your back, reducing pain.”

Do Back-Strengthening Exercises

General movement is helpful, but any kind of back-strengthening exercise can be particularly valuable for reducing AS pain, says Allison. That includes moves such as spine extension, spine rotation, cat-cow poses, and dumbbell rows. “Exercises that encourage the recruitment of the muscles between your shoulder blades is especially good for those with AS, and improves overall functional mobility,” he says. If you’re not sure which ones to do, he suggests talking with your physical therapist and putting together just a few moves you can do at home a couple times weekly.

Find an Activity You Truly Enjoy

While regular movement is essential for lowering AS pain, you’re much more likely to make it a habit if you really enjoy the activity, according to Kate Ayoub, D.P.T., a physical therapist and health coach in Washington D.C. “Especially when you’re just getting started and want to create a consistent exercise routine, think about what you like doing the most,” she says. “Then you can build on that as you make it a habit.” For example, if you love walking outside, you can incorporate stretches before and after a daily walk.

Set Meaningful Goals

Just reducing your AS pain may seem like enough of a goal, but if your pain level drops, you may stop exercising as a result and end up back where you started, Ayoub says. That’s why having realistic but meaningful goals can give you a sense of progress. For instance, maybe you want to go on a bike ride with your kids in a few months, or do a 5K walk for charity, or simply sleep better without pain waking you up. She suggests talking with your physical therapists and setting milestones along the way that can get you there.

Stretch Before Bed and When You Wake

Sleep is incredibly important for reducing inflammation, so it’s important that you employ strategies that get you the shuteye you need. One helpful tactic is to put gentle stretches into your bedtime routine, says Tammy Penhollow, D.O., owner of Phoenix, Arizona-based Precision Regenerative Medicine. “AS is an inflammatory condition, and as such, the pain is amplified when the body is inflamed,” she says. “Stretch before bed and upon awakening to lower the inflammation response.”

Add in Gentle Twists

Sometimes, people with AS pain try to avoid twisting because it can exacerbate their pain. While a sudden twist—especially one that extends beyond your range of motion—can cause a painful flare, doing gentle twists can be beneficial for improving mobility, says Allison. Rotation through the trunk can build strength and flexibility, as well as reduce the kind of stiffness that can increase pain. A practice like yoga tends to include twists, but you can also put them into your day anytime, he adds. And be sure to breathe deeply as you twist to help relax your muscles.

Do More Core Work

A few times per day, try a few minutes of gentle core work such as getting into plank pose, doing a side stretch on each side, trying dead bug pose, or balancing on one leg, which fires up the core muscles to stabilize you. These types of moves are crucial when you have AS, says Penhollow, because they help support the spine and build the muscles that wrap around your torso, alleviating the pressure on your back overall. What not to do: Avoid standard crunches and sit-ups since those can cause too much constriction in your spine.

Combine Movement With Stress Relief

One strategy that’s important for pain reduction is reducing tension throughout the day, since stress can exacerbate AS symptoms, including pain. Fortunately, you can tackle both stress and stiffness together, with practices like tai chi, walking, yoga, and deep breathing. It’s also helpful to bring in other stress-relief tactics like massage, mindfulness, getting out into nature, progressive muscle relaxation, and simply taking more breaks throughout the day. This can all help not only the physical aspects of AS, but also the emotional strain that might come with it.

Talk to Your Physical Therapist

Although strategies like the ones on this list are helpful, keep in mind that everyone is unique in terms of their needs and the extent of their AS. Physical therapists and occupational therapists can develop a tailored exercise plan that’s most appropriate for your needs, says Allison. Take advantage of that resource, and don’t forget to also do the exercises they suggest for home care. Movement is nutrition for your back, and a physical therapist can be essential for helping you understand what and how much you should be doing.

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