Exercises and stretches to help relieve back pain associated with ankylosing spondylitis

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that typically affects the back. Regular exercise, stretching, and other home remedies can play an important role in treating ankylosing spondylitis-associated back pain.

SolStock/Getty Images

According to the Global Healthy Living Foundation (GHLF), the most common symptoms of AS are stiffness and pain in the lower back. This discomfort can worsen after waking up or following a period of inactivity. However, back pain due to AS can also wake people from their sleep.

People with AS may describe an ongoing and dull pain stemming from the lower back or buttocks.

Exercise can play an important role in helping improve AS symptoms. The Spondylitis Association of America (SAA) advises people living with AS to engage regularly in four different categories of exercise:

• cardiovascular, or aerobic
• strength training
• stretching
• balance

This article explains how to perform specific exercises and stretches that may help alleviate AS-associated back pain.

Posture exercises 

Posture exercises are a form of strength training. They often involve engaging the core muscles, which are located around the center of the body.

Good posture can help prevent a person from slouching forward, which can decrease the strain on their back.

A person can try some of the following exercises to help strengthen the muscles responsible for posture.

Back against the wall

In this exercise, a person will stand with their back to a wall in their home or a gym.

They can perform the exercise by following these steps:

1. Stand with the back straight up against a wall with the heels and buttocks resting against its surface.
2. Squeeze the shoulder blades together.
3. Hold the position for about 5 seconds and then release.
4. Repeat several times.

Prone lying

A person may wish to perform this exercise on a mat. It involves these steps:

1. Lie on the stomach with the head turned to one side.
2. Straighten the arms toward the feet if possible.
3. Move the arms forward and slowly prop the body up using the elbows.
4. Keep lifting the body until the chest is off the ground and turn the head to face forward.
5. Hold for 10–20 seconds and return to the starting position.

Other posture tips

According to Versus Arthritis, a person should ensure that they maintain good posture by keeping their shoulders back and relaxed and holding their chin up.

When sitting, they can also minimize posture-related symptoms by:

• avoiding leaning on their elbows
• using upright chairs with a solid back
• positioning the buttocks so that they touch the back of the chair
• using a cushion behind their lower back
• placing everything they need within easy reach when sitting at a desk
• ensuring that the seat is at the correct height
• keeping the knees at a right angle and using a footrest if necessary
• avoiding sitting in one position for too long without moving the back

The charity also suggests lying on the floor at some point during the day to help stretch the front of the hips.

Strength exercises

A person can try the following exercises:

Superman

As the name implies, this exercise is based on the flying position of Superman.

To perform this exercise, a person needs to:

1. Lie on the front on a soft mat or the floor.
2. Stretch the arms above the head and extend the legs out straight behind.
3. Lift the arms, chest, head, and legs off the floor.
4. Hold the position for about 5–10 seconds.
5. Repeat 5–10 times.

If lifting both arms and legs is too difficult, Versus Arthritis recommends leaving one arm at the side while looking forward and then lifting the outstretched arm and opposite foot off the floor.

Plank

Holding this position helps stabilize the core.

It is simple to perform, although a person may find it challenging to hold for long initially:

1. Lie on the stomach with the forearms on the floor and the elbows directly below the shoulders.
2. Tightening the stomach muscles, lift the hips off the floor to create a straight line with the body.
3. Hold the position for 10–20 seconds.

Stretches

Stretching plays an important role in mobility and strength.

According to the GHLF, flexibility and stretching exercises can help with:

• increasing joint mobility
• preventing stiffness in the spine and joints
• maintaining flexibility in the back

The following are some stretches that a person with AS can try.

Lying quadricep stretch

A person should follow the steps below to stretch the front of the thighs:

1. Lie on the stomach.
2. Loop an exercise band, rope, belt, or other object around the top of one foot.
3. Pull the strap over the shoulder until there is a stretch through the thigh.
4. Hold this position and then repeat the stretch on the other side.

Seated figure four

This stretch can help improve a person’s hip mobility.

A person can follow the steps below:

1. Sit in a chair with both feet flat on the floor.
2. Lift the right leg and place the right foot just above the left knee on the left thigh.
3. Point the right knee out to the side.
4. Keeping the spine straight, slowly bend forward.
5. Hold for 10–20 seconds and then repeat on the other side.

Yoga poses 

Yoga is a mind-and-body practice that may benefit a person living with AS.

Certain poses may be particularly useful. These include:

Cat and cow

For this move, a person gently alternates between two positions:

1. Start on the hands and knees on a yoga mat or another soft surface.
2. Align the wrists with the shoulders and the knees with the hips.
3. While inhaling, look up with the head and let the stomach lower toward the floor.
4. While exhaling, bring the head down, tucking the chin into the chest, and pull the navel toward the spine to let the back arch toward the ceiling.
5. Alternate slowly between the two positions several times.

Extended child’s pose

Child’s pose is a resting pose that helps relax the body and stretch the back.

A person can follow these steps:

1. Begin on all fours, placing the legs together.
2. Move the hands forward until the arms are fully extended.
3. Sink the body back until the buttocks are sitting on the heels
4. Touch the forehead lightly against the ground.
5. Hold the pose for several slow breaths.

Can a back brace be beneficial? 

According to the Arthritis Foundation, back or neck braces are not a practical solution for preventing forward flexion or bending forward.

Instead, the organization recommends:

• breaking up long periods of standing or sitting in a forward position with flexibility exercises
• practicing good posture while standing or sitting
• exercising regularly
• sleeping on the back with either no pillow or a very flat one

A person should discuss with a doctor the benefits and drawbacks of using a back brace to help treat AS.

Other treatment options

Physical therapy is an important part of the treatment plan for AS. It can help improve muscle strength and maintain spinal mobility.

Types of physical therapy include:

• group exercise programs
• an individual exercise program
• massage
• hydrotherapy, which is a water-based treatment in which a person performs exercises in a shallow swimming pool or hydrotherapy bath

People may also benefit from swimming.

Complementary treatments may include:

• acupuncture
• tai chi
• using a transcutaneous electrical nerve stimulation (TENS) unit, which delivers mild electrical impulses through the skin

Medications

A person can also take medications to help relieve back pain.

According to the SAA, the first-line treatment for pain is nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, which include ibuprofen (Advil) and naproxen (Aleve), come in over-the-counter and prescription strengths.

Other medications include biologics, such as anti-tumor necrosis factor and anti-interleukin-17 medications. A doctor will recommend these medications if anti-inflammatories and exercise are not helping or the disease is progressing.

Biologic agents are more recent treatment options for AS.

Surgery 

A doctor will not likely recommend surgery unless other treatments have not worked or AS has progressed to the point where it is severely limiting a person’s daily activities.

Research indicates that surgery to correct fractures or a malaligned ankylosed spine has a good outlook despite a high rate of complications.

When possible, a doctor should use minimally invasive surgical procedures to correct the condition.

Summary

AS can cause back pain. Although a doctor may recommend several medical treatment options, regular strength and stretching exercises can help prevent pain and other complications of AS.

A person should speak with a doctor about the best treatment options for them.