Understanding Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the sacroiliac (SI) joints and the axial skeleton often having a strong genetic predisposition. Ankylosing spondylitis is a disease characterized by pain and progressive stiffness. It is part of a group of rheumatic diseases medically known as spondyloarthropathies which actually involves the vertebral joints and shares the human antigen HLA-B27.

Ankylosing spondylitis is considered to be hereditary, even though environmental factors have been suggested. Most people with the HLA-B27 antigen do not develop AS. It is known to affect white males about four times as often as females. Onset typically occurs between the ages of 15 and 45.

In the early stages of the disease, the sacroiliac joints, where the spine articulates with the back of the pelvis, become inflamed and painful. As the disease progresses, ossification is triggered by the Immune system’s defense mechanism. Ossification causes new bone to grow between vertebrae eventually merging them together increasing the risk for fracture. Eventually, ossification affects the spinal ligaments leading to the stenosis or narrowing of the spinal canal which can cause neurologic deficits.

Signs & Symptoms of Spondylolisthesis

  • Dull low back pain and localized stiffness involving the gluteal and lumbo-sacral areas.
  • Insidious or gradual onset of symptoms experienced by people younger than 40 years.
  • As the disease progresses, pain and limitation of movement becomes more persistent and experienced on both sides of the spine as the symptoms progress up the spine.
  • Stiffness and discomfort of the hips, shoulder and ankle joints arise.
  • Symptoms tend to worsen in the morning and following inactivity.
  • Alleviation of low back pain with exercise or activity.
  • Patients may complain of difficulty in breathing or chest tightness.
  • Cauda Equina Syndrome (specific nerve compression) may develop causing bilateral lower extremity numbness, weakness, and incontinence.

Professional Treatment for Ankylosing Spondylitis

  • Treatment for Ankylosing spondylitis (AS) is aimed at relieving the patient’s symptoms and preventing spinal deformity which mainly includes physician prescribed non-steroidal anti-inflammatory medicine.
  • Adhere to a physical therapy program that will strengthen back muscles, improve posture, increase flexibility and range of motion, and techniques to enhance breathing.
  • Consistently participate in activities that help alleviate stiffness. Warm baths, stretching activities performed in bed prior to rising and aquatics activities such as swimming and pool running are strongly advised.
  • Management may also include the use of drugs that block cell growth (cytotoxic drugs) in people who do not respond well to corticosteroids.
  • Non-surgical treatment such as traction and/or bracing are used to manage spinal fractures resulting from AS.
  • Corticosteroid therapy and TNF-alpha inhibitors have been FDA-approved for the treatment of Ankylosing Spondylitis and can lead to stunning improvement in the inflammatory and systemic nature of AS.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What is a Schober test?
  2. How early should Ankylosing Spondylitis be treated with a Tumor Necrosis Factor-blocker?
  3. What associated symptoms can I expect with this disorder?
  4. My blood workup tested positive for HLA-BA27 antigen, what are my chances of contracting AS?
  5. What does the Gaenslen’s maneuver measure?
  6. What is a “Bamboo Spine” and how do I prevent it?
  7. Can you elaborate more on the use of a halo brace or a TLSO device and how will they help me?

Elite Sports Medicine Tips from Mike Ryan

  • IMPROVE YOUR RANGE.  Regular daily exercise is an effective method to deal with symptoms of AS. Complete body flexibility exercises are needed to maintain joint motion from head to toe.
  • WATCH YOUR WEIGHT. Maintain your optimum weight and embracing a healthy diet will minimize the stress on your spine.
  • STAY HOT. Use a heat pack and warm baths help to increase the blood flow to the spine and surrounding tissue to help reduce pain and stiffness.
  • AIM TO BE ACTIVE. It is very important to understand that excessive rest is not the best solution to decreasing your stiffness. Maintain an active lifestyle.
  • ALWAYS WATCH YOUR STEP. Sports carrying a higher risk of falls such as skiing as horseback are best avoided to minimize the risk for spinal fractures.
  •  GAIN BY REDUCING THE PAIN.  Deep tissue massage, ultrasound, passive stretching, heat/ice and acupuncture may all have a positive role to play in reducing pain and maintaining mobility.
  • SUSTAIN THE FLOW BUT KEEP IT SLOW. Swimming, dancing and exercises to improve muscle tone, strength and flexibility are ideal while rapid twisting movements should be avoided.