Ankylosing Spondylitis Exercises: Maintain Mobility and Reduce Stiffness

Ankylosing spondylitis (AS) is a chronic inflammatory condition that primarily affects the spine, causing pain, stiffness, and potentially fusion of vertebrae. Regular exercise is one of the most important treatments for AS, helping maintain posture, mobility, and quality of life. These exercises are specifically designed for managing this condition.

Understanding Ankylosing Spondylitis

What it is:

• Chronic inflammatory arthritis
• Primarily affects spine and sacroiliac joints
• Can cause vertebral fusion over time
• Part of "axial spondyloarthritis" family

How it affects the body:

• Inflammation at ligament/tendon attachments
• New bone formation
• Progressive stiffness
• Postural changes (forward stooping)
• Can affect other joints, eyes, heart

Why exercise is essential:

• Maintains spinal mobility
• Prevents/slows postural deterioration
• Reduces pain and stiffness
• Improves function
• One of the most effective treatments

Exercise Principles for AS

1. Daily practice is essential

• AS progresses without consistent exercise
• Better to do something daily than long sessions occasionally
• Morning stiffness requires morning movement

2. Focus on extension and rotation

• AS causes forward flexion and stiffness
• Counter with extension exercises
• Maintain rotation as long as possible

3. Posture is priority

• Stand tall, fight the forward curve
• Chest opening exercises
• Strengthen postural muscles

4. Low-impact cardio

• Swimming is ideal
• Walking, cycling also beneficial
• Maintain cardiovascular health

5. Listen to your body

• Differentiate disease flare from exercise soreness
• Modify during flares, don't stop completely
• Pain from inflammation needs rest; stiffness needs movement

Morning Routine (Essential)

AS causes significant morning stiffness. This routine helps.

Bed Mobility

Before getting up:

1. Lie flat on back
2. Gently rock knees side to side
3. Bring knees to chest (one at a time)
4. Perform gentle pelvic tilts
5. 2-3 minutes

Corner Stretch

For chest and shoulders:

1. Stand in corner, forearms on walls
2. Lean in gently
3. Feel chest opening
4. Hold 30-60 seconds
5. Repeat 2-3 times

Standing Back Extension

Counter forward posture:

1. Place hands on lower back
2. Gently arch backward
3. Look up at ceiling
4. Hold 5-10 seconds
5. 10 repetitions

Rotation in Standing

Maintain spinal rotation:

1. Stand with feet shoulder-width
2. Rotate torso to one side
3. Look over shoulder
4. Hold 10 seconds
5. Repeat each side 5-10 times

Spinal Mobility Exercises

Cat-Cow (Modified)

Emphasis on extension:

1. On hands and knees
2. Arch back, lift head (cow) - hold 5 seconds
3. Round back (cat) - hold 3 seconds
4. Emphasize the extension more
5. 10-15 cycles

Prone Press-Up

Lumbar extension:

1. Lie face down
2. Place hands under shoulders
3. Press upper body up, keeping pelvis down
4. Straighten arms as able
5. Hold 10-20 seconds
6. 5-10 repetitions

Thoracic Rotation (Side-Lying)

Maintain mid-back rotation:

1. Lie on side, knees bent
2. Extend top arm out
3. Rotate top arm open, reaching behind
4. Follow hand with eyes
5. Hold 20-30 seconds
6. 5 repetitions each side

Supine Spinal Rotation

For lumbar mobility:

1. Lie on back, knees bent
2. Lower both knees to one side
3. Keep shoulders flat
4. Hold 20-30 seconds
5. Repeat each side 3-5 times

Posture Exercises

Wall Standing

Postural awareness:

1. Stand with back against wall
2. Try to touch heels, buttocks, upper back, and head to wall
3. Hold 30-60 seconds
4. Do several times daily
5. Note: May not be possible for all—get as close as able

Chin Tuck

Counter forward head:

1. Draw chin straight back
2. Keep eyes level
3. Hold 5-10 seconds
4. 10-15 repetitions
5. Throughout day

Shoulder Blade Squeeze

Counter rounded shoulders:

1. Squeeze shoulder blades together
2. Hold 5-10 seconds
3. 15-20 repetitions
4. Don't shrug

Prone Y-T-W

Strengthen postural muscles:

1. Lie face down

Y position:

• Arms overhead, thumbs up
• Lift arms 2-3 inches
• Hold 5 seconds
• 10 reps

T position:

• Arms out to sides
• Lift and squeeze
• 10 reps

W position:

• Elbows bent, hands near shoulders
• Lift and squeeze
• 10 reps

Hip and Peripheral Joint Exercises

AS can affect hips and other joints.

Hip Flexor Stretch

Prevent hip tightness:

1. Kneel on one knee
2. Tuck pelvis under
3. Lean forward gently
4. Hold 30-60 seconds
5. Repeat each side

Hip Rotation Stretches

Internal rotation:

1. Sit with feet wide
2. Let knees fall inward
3. Hold 30 seconds

External rotation:

1. Sit with feet together, knees out (butterfly)
2. Gentle pressure on knees
3. Hold 30 seconds

Hamstring Stretch

Maintain hip mobility:

1. Lie on back
2. Lift one leg, keeping knee straight
3. Use strap or towel if needed
4. Hold 30 seconds each leg

Breathing Exercises

AS can affect rib mobility, impacting breathing.

Diaphragmatic Breathing

Maintain chest expansion:

1. Lie on back or sit
2. Place hand on belly
3. Breathe deeply into belly
4. Feel belly rise
5. 5-10 deep breaths

Chest Expansion

Maintain rib mobility:

1. Place hands on sides of ribs
2. Breathe deeply, expanding ribs into hands
3. Try to increase expansion
4. 10 deep breaths

Arms Overhead Breathing

Full expansion:

1. Raise arms overhead
2. Take deep breath
3. Feel maximum expansion
4. Lower arms on exhale
5. 5-10 repetitions

Cardiovascular Exercise

Swimming (Ideal for AS)

Benefits:

• Horizontal position
• Works all muscles
• Low impact
• Buoyancy supports spine
• Backstroke particularly good

Recommendations:

• 20-30 minutes, 3-4 times weekly
• Focus on backstroke and freestyle
• Avoid breaststroke if neck stiff

Walking

Benefits:

• Weight-bearing (bone health)
• Functional
• Adaptable to fitness level

Recommendations:

• 30+ minutes most days
• Focus on posture while walking
• Vary terrain gently

Cycling

Benefits:

• Low impact
• Cardiovascular fitness
• Can use recumbent bike

Caution:

• Upright cycling can worsen forward posture
• Ensure proper bike fit
• Recumbent may be better for some

Strengthening Exercises

Core Strengthening

Plank (modified as needed):

1. On forearms and knees/toes
2. Keep body straight
3. Hold 20-30 seconds
4. Build duration

Bird Dog:

1. On hands and knees
2. Extend opposite arm and leg
3. Keep spine neutral
4. Hold 5 seconds
5. 10 each side

Back Strengthening

Swimming (floor exercise):

1. Lie face down
2. Alternately lift opposite arm and leg
3. Small movements
4. 20-30 repetitions

Back extension (prone):

1. Lie face down
2. Lift chest slightly
3. Hold 5 seconds
4. 10 repetitions

Managing Flares

During flares:

• Reduce intensity but don't stop completely
• Focus on gentle mobility
• Aquatic exercise often tolerated
• Modify positions for comfort
• Return to full program as flare settles

What helps:

• Gentle movement
• Heat application
• Pool exercises
• Rest when needed
• Medication as prescribed

Sample Daily Program

Morning (15-20 minutes):

• Bed mobility: 3 minutes
• Standing back extension: 10 reps
• Corner stretch: 1 minute
• Rotation stretches: 2 minutes
• Chin tucks: 10 reps
• Deep breathing: 2 minutes

Throughout Day:

• Posture checks
• Standing back extensions
• Chin tucks
• Movement breaks from sitting

Evening (15-20 minutes):

• Cat-cow: 10 cycles
• Prone press-up: 10 reps
• Thoracic rotation: 5 each side
• Hip stretches: 2 minutes
• Y-T-W: 1 set
• Breathing exercises: 3 minutes

3-4 times weekly:

• Swimming: 20-30 minutes
• Or walking: 30 minutes
• Strengthening: 15 minutes

Measuring Progress

Track:

• Morning stiffness duration
• Posture changes
• Range of motion
• Chest expansion measurement
• Schober's test (doctor can measure)
• Pain levels

Expect:

• Reduced morning stiffness
• Maintained or improved mobility
• Better posture
• Improved function
• Better quality of life

When to Seek Help

See your rheumatologist if:

• Significant flare not responding
• New symptoms developing
• Eye inflammation (seek urgent care)
• Medication questions
• Need disease activity assessment

See a physical therapist if:

• Need personalized program
• Difficulty with exercises
• Postural concerns
• Peripheral joint involvement
• Pool therapy prescription

Key Takeaways

1. Exercise is treatment: One of most important interventions for AS
2. Daily is essential: Consistency prevents progression
3. Fight the curve: Extension and posture exercises counter forward flexion
4. Swimming is ideal: Best overall exercise for AS
5. Breathe deeply: Maintain chest expansion
6. Morning routine matters: Combat morning stiffness
7. Don't stop during flares: Modify, but keep moving
8. Measure progress: Track mobility and stiffness

With consistent exercise, many people with ankylosing spondylitis maintain excellent function and quality of life. The key is making movement a non-negotiable daily habit.