Ankylosing spondylitis, or AS, is a chronic inflammatory arthritis that primarily affects the spine. It causes pain, stiffness and eventually fusion of your vertebrae. One of the hallmark signs of this disease is called “bamboo spine” because the vertebrae look like bamboo shoots when they fuse together.
Ankylosing spondylitis can start during the teenage years or early adulthood. Symptoms include low back and hip pain that improve with activity and worsen at rest. Those in later stages of disease progression can experience pain and stiffness along their spine as well as severe limitations in flexibility and mobility.
Chalk stick fracture of ankylosing spondylitis at the level of L1 vertebrae. (Image by Hellerhoff via Wiki Commons, CC BY-SA 4.0)
Ankylosing spondylitis is strongly linked to the HLA-B27 gene, but having the gene does not mean you will get the condition. Ankylosing spondylitis is rare, affecting only 0.2% to 0.5% of the general population. It affects men twice as much as women.
However, the cause of ankylosing spondylitis is unknown. Genetics and environmental factors, such as infections, may play a role. Early diagnosis and treatment can be helpful in preserving quality of life. Treatment typically involves physical therapy, medication, and lifestyle modifications to manage symptoms and maintain mobility.
Massage therapy can also be an effective treatment in the management of ankylosing spondylitis due to its effect on overall quality of life. Not only can massage offer pain relief, it can help with flexibility, stress reduction, muscle spasms, and circulation.
Does massage work for ankylosing spondylitis?
A 2017 study compared pain and symptoms in 27 men with ankylosing spondylitis and found massage was effective in reducing pain levels and scores on the Bath Ankylosing Spondylitis Disease Activity Index (BASDI). The BASDI includes information on severity of fatigue, pain in peripheral and spinal joints, local tenderness, and stiffness upon waking.
Pain relief: Using massage to decrease muscle tension can help alleviate pain in the back, neck, and shoulders, which are the areas most commonly affected by ankylosing spondylitis.
Think of pain as having a volume knob. Increased tissue damage can turn the volume up while interventions like cryotherapy, exercise, and massage can turn the volume down using a system called descending modulation.
In ankylosing spondylitis, the painful joints send signals to your brain as a sort of alarm system. In descending modulation, your brain sends signals back to the peripheral nerves that signal your body to turn down the pain sensation.
Massage can help with this by sending “feel-good” signals to your brain. Your brain responds by releasing natural painkillers called endorphins, which are like your body’s own pain medicine.
These endorphins help block some of the pain signals and, in turn, help you feel better and move better.
Improved flexibility: Massage can improve range of motion by reducing pain, relaxing tight muscles and improving joint mobility in areas where stiffness is present.
Muscle spasms: When joints are stiff, tight, or painful the muscles around them become stiff and tight. Using massage to help relieve muscle spasms can be an effective way to get moving with less pain.
Stress: The chronic pain of ankylosing spondylitis can cause stress or anxiety. Use of massage to promote general relaxation can decrease stress, improve sleep, and improve overall well-being.
Circulation: Improved blood flow from massage can help bring oxygen, nutrition, and hydration to tissues and remove metabolic waste products. Increased local circulation to muscles can also reduce tension because when muscles have more oxygen and nutrients, they relax.
What precautions should massage therapists take?
At the initial visit, massage therapists should discuss the patient’s entire health history to determine if any related complications are present. Patients with ankylosing spondylitis can have cardiovascular issues, inflammation of the eye, and/or difficulty breathing as the joints fuse. It may be important to consult with the patient’s healthcare team to ensure massage fits with the overall plan of care.
Samantha Ream, a licensed massage therapist at ReQuest Physical Therapy in Gainesville, Florida, cautions that it may be uncomfortable for a patient to lay prone on the table.
“The therapist may need to experiment with pillows and/or padding to keep the patient as comfortable as possible,” Ream said. “Some suggestions would be to place pillows or padding under the sternum in prone, under the knees in supine, and between the knees in sidelying.”
Once it is determined that massage will be beneficial, the massage therapist should take caution to avoid fused areas of the spine. It’s also important to be gentle during flare-ups because the joints and tissues may be inflamed. And so, gentle techniques may be better than deeper strokes. During non-flare times, there’s some evidence that suggests deeper techniques may be beneficial.
Patients with ankylosing spondylitis may also have postural adaptations that require modified positioning. Depending on disease progression, these patients may need extra pillows to support their head when lying supine due to increased kyphosis. Ankylosing spondylitis can also cause hip pain that may make it difficult for the patient to lie sideways. As always, communication with the patients to ensure they are comfortable is key.
Finding a qualified massage therapist
When choosing a massage therapist, look for someone experienced in treating arthritis or chronic inflammatory conditions. The therapist should be experienced with Swedish massage and myofascial release and be able to customize your sessions to your specific needs.
The massage therapist should be knowledgeable about how to work through flare-ups and when to avoid inflamed or even fused areas. Patient comfort should always be the priority.
“As a patient, you need to remember that you are in complete control of your massage experience,” Ream said. “You can tell your therapist that you want them to start with light pressure, and then guide the gradual increase of pressure as your body responds.”
Ream also said that you should find a therapist who not only listens but asks about your symptoms every session and should be well versed in your co-morbidities and the progression of your ankylosing spondylitis.
A massage therapist who is willing to collaborate with your other providers is ideal; it may be worth asking your healthcare providers for recommendations as they can share the benefit of other patient’s experiences with you.
Online reviews and ankylosing spondylitis support groups can also be an excellent starting point when researching massage therapists who specialize in ankylosing spondylitis in your area. Ream echoed this suggestion in emphasizing “communication is key for a safe and successful massage therapy session.”
Other treatments for ankylosing spondylitis
Non-pharmacological or conservative treatments for ankylosing spondylitis should be used to reduce pain, improve mobility, and slow disease progression by addressing the physical and lifestyle factors contributing to the symptoms. These treatments include physical therapy, exercise and heat-cold therapy, which can be used alone or with medication.
Applying heat can relax stiff muscles and increase blood flow, while cold packs can reduce swelling and numb acute pain. These therapies are especially helpful during flare-ups or after exercise.
Physical therapy
Physical therapy can help you improve or maintain mobility, reduce pain, and slow disease progression.
Through targeted exercise and manual therapy techniques, physical therapy can address some of the common elements of ankylosing spondylitis- stiffness and poor posture. A physical therapist can teach you stretching routines to help with stiffness and flexibility as well as exercises to strengthen postural muscles and reduce stress on affected joints.
A savvy physical therapist will include exercises to slow the progression of kyphosis (forward curvature of the spine) and breathing exercises to promote chest expansion which can be problematic as the disease progresses.
Programs should be tailored to increase range of motion and mobility while making daily activities easier and more comfortable. By incorporating regular movement and safe exercises, physical therapy reduces pain, prevents complications like severe spinal fusion or joint damage, and empowers you to stay active.
Exercise
Physical activity also helps combat the stiffness and pain caused by inflammation in the spine and peripheral joints. Exercises that focus on flexibility, such as yoga and stretching routines, help maintain joint mobility and prevent the spine from becoming stiff.
Low-impact, aerobic activities like swimming and walking can improve cardiovascular health and overall fitness without negatively affecting the joints.
Exercise consistency is key, as regular movement prevents stiffness from worsening and promotes improved posture. It also strengthens the muscles that support the spine, which reduces strain. Beyond physical benefits, staying active improves mood and reduces stress.
Diet
Diet can also play a role in managing the symptoms of ankylosing spondylitis.
A study published in the Archives of Rheumatology examined the relationship between diet, oxidative stress, and inflammation in patients with ankylosing spondylitis.
A moderate positive correlation was found between antioxidant levels and dietary phytochemical index in the control group, suggesting that higher dietary intake of phytochemicals is associated with better antioxidant status.
The study suggests that patients with ankylosing spondylitis should pay more attention to their diet to increase serum antioxidant status, emphasizing the potential role of dietary choices in managing oxidative stress associated with the condition.
Patients with ankylosing spondylitis can easily increase their intake of phytochemicals by incorporating more plant-based foods. Phytochemicals are found in plants that have antioxidant and anti-inflammatory properties. Here’s how you can boost your intake:
- Eat a variety of fruits and vegetables: Aim for colorful produce like berries, citrus fruits, spinach, kale, tomatoes, carrots, and bell peppers.
- Include whole grains: Choose whole-grain options like oats, quinoa, brown rice, and whole wheat instead of refined grains.
- Snack on nuts and seeds: Almonds, walnuts, flaxseeds, and chia seeds are excellent sources of phytochemicals.
- Add legumes: Incorporate beans, lentils, and chickpeas into meals.
- Use herbs and spices: Season your food with turmeric, ginger, garlic, parsley, oregano, and cinnamon.
- Drink phytochemical-rich beverages: Opt for green tea, black tea, or herbal teas. Natural fruit or vegetable juices without added sugars are also good options.
- Choose plant-based oils: Use olive oil or flaxseed oil for cooking or salad dressings.
By building a diet full of these nutrient-rich foods, you can naturally boost your phytochemical intake, decrease inflammation, and support overall health as you navigate life with ankylosing spondylitis.
Penny Goldberg, DPT, ATC
Penny Goldberg, DPT, ATC earned her doctorate in Physical Therapy from the University of Saint Augustine and completed a credentialed sports residency at the University of Florida. She is a Board Certified Clinical Specialist in Sports Physical Therapy.
Penny holds a B.S. in Kinesiology and a M.A. in Physical Education from San Diego State University. She has served as an Athletic Trainer at USD, CSUN, and Butler University.
She has presented on Kinesiophobia and differential diagnosis in complicated cases. Penny has published on returning to sports after ACL reconstruction and fear of movement and re-injury.
Outside of the clinic, Penny enjoys traveling, good cooking with great wine, concerts, working out and playing with her dogs.
