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A Spotlight On Ankylosing Spondylitis – An Elusive Pain In The Back!

By March 13, 2020July 20th, 2020Physiotherapy, Pilates, Spinal Physiotherapy

Ankylosing spondylitis (AS) is an autoimmune inflammatory arthritis affecting primarily the spine and other large joints. This chronic progressive disease currently affects ~1% of Australians and 3 times more common in males (than females) with a common onset during early adulthood (15-45 years old).

It occurs when the immune system attacks its own healthy tissues (the joints in the spine) leading to inflammation and causing pain and stiffness. Over time, new bone growth can develop which leads to fused joints in the spine that are susceptible to fracture due to restricted movements. In severe cases, this bony growth may compromise surrounding nerve roots around the spine.

The causes for AS remain unclear, however, genetic and environmental factors are commonly considered. The HLA-B27 gene appears in almost 90% of AS sufferers, however, is also common in 8% of the general population.

Symptoms tend to be intermittent due to flares and remissions of the disease.  They can include:

  • Stiffness particularly in the morning or after prolonged periods of rest
  • Pain in the lower back or buttock region (sacrum) initially but can be throughout the spine
  • Pain in other joints, tendons and ligaments (commonly in the ribs, back of heel and underneath the foot)
  • Fatigue

AS is commonly missed during early stages due to its elusive nature but usually accurately diagnosed from reported symptoms, a physical examination and supported by blood tests (of inflammatory markers and the HLA-B27 gene) and radiography (usually x-rays) by a rheumatologist.

AS requires medical and physiotherapy management. Medical management typically includes but is not limited to: analgesics for pain relief, non-steroidal anti-inflammatory drugs and/or disease modifying anti-rheumatic drugs (as necessary) by the direction of a rheumatologist. In severe cases, surgery may be necessary. This can include joint replacements to replace hip or knee joints damaged by the disease or a laminectomy to remove parts of the bone in your vertebrae to relieve compression on the nerve if it’s compromised.

Physiotherapy management aims to reduce pain and stiffness, improve flexibility, delay spinal deformity and maximise quality of life. A review on physiotherapy interventions for AS reveal that individual home or supervised exercise programs are beneficial for outcomes that include pain, stiffness, mobility and physical function. It can typically include:

  • Education and goal setting
  • Posture education
  • Advice on activity modification and pacing
  • Hydrotherapy
  • Exercise therapy – mobility, strength and cardiovascular exercises

Although the prognosis for AS is hard to predict, earlier treatment is thought to result in better management of the disease and its associated diseases but there is no cure. Associated diseases can include but are not limited to: uveitis; psoriasis; inflammatory bowel disease; increased cardiovascular disease risk; aortitis; upper lung fibrosis; depression; and spinal fractures.

So if you have AS or suspect you do, come visit our Physiotherapists at Bend + Mend in Sydney’s CBD to get assessed, start a Physiotherapy management plan and monitor your progress.


Arthritis Australia. (2020). Ankylosing spondylitis — Arthritis Australia. Retrieved from
Brown, M., & Bradbury, L. (2017). New approaches in ankylosing spondylitis. Medical Journal Of Australia, 206(5), 192-194. doi: 10.5694/mja16.01111
Dagfinrud, H., Hagen, K., & Kvien, T. (2008). Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd002822.pub3
Pradeep, D., Keat, A., & Gaffney, K. (2008). Predicting outcome in ankylosing spondylitis. Rheumatology, 47(7), 942-945. doi: 10.1093/rheumatology/ken195
Zão, A., & Cantista, P. (2017). The role of land and aquatic exercise in ankylosing spondylitis: a systematic review. Rheumatology International, 37(12), 1979-1990. doi: 10.1007/s00296-017-3829-8

Bend + Mend

Bend + Mend has been providing Sydney’s CBD with Physiotherapy and Pilates services since 2003. We have 4 great locations in Martin Place, Barangaroo, Darling Park and Circular Quay, all with private rooms and specialised one-on-one care. We also have Sydney CBD’s best-loved Physios who have helped over 10,000 people recover from pain and injury.

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