By Dr. Andrew Cummins
Ankylosing Spondylitis and Quality of Life
How do I reduce symptoms, improve/maintain normal posture and spinal flexibility, maintain the ability to work, and reduce functional limitations?
How do I slow or stop spinal fusion?
These are the main questions I hear from individuals living with Ankylosing Spondylitis.
While there is no way to guarantee that spinal fusion will not develop, I can say that after living with Ankylosing Spondylitis for over 20 years and with many years of research and helping clients, the following factors in this two-part series will give you the best chance of preventing or slowing spinal fusion.
Ankylosing Spondylitis and Correct Posture
Ankylosing Spondylitis is trying to destroy our posture through inflammation, breakdown, degeneration, and new bone formation in the spine.
AS can ultimately fuse our spine in a hunched over position and reduce our normal posture and flexibility, which can dramatically affect our ability to work and quality of life.
To prevent or slow this process we must fight back against the desire for the spine and posture to go forward by being conscious of our posture and strengthening the muscles of the back.
Whenever we have incorrect posture this puts stress in the spine, sacroiliac joints, and hips causing damage in these areas.
This causes further inflammation and attack on the joints because whenever there is damage in the body the immune system tries to repair the damage with inflammatory chemicals.
This process of damage and inflammation can lead to new bone growth in the spine that is weaker and more vulnerable to fracture.
Correct posture decreases spinal, sacroiliac, and hip degeneration and breakdown.
Ankylosing Spondylitis and Sitting
It is best to avoid sitting on couches and chairs such as recliners that make it difficult to keep your spine straight.
When sitting we must be conscious of keeping the back of the neck straight and long and the spine straight. This is done by gently pulling the chin back.
I use a kneeling chair when I am at home which helps me keep good posture with a straight spine. This has decreased the pain and stiffness in my spine, sacroiliac joints, and hips. While a kneeling chair helps keep correct posture, you still need to be conscious of not letting your spine curve or hunch over while keeping your chin gently pulled back .
A self-inflating back rest helps me keep my spine straight and aligned in situations when I am not at home and I have to sit for an extended amount of time. This has helped decrease my pain and stiffness when I have to sit on any other type of chair. I use this back rest when I drive, fly, when I am at the office or anywhere else when I have to sit without my kneeling chair.
Ankylosing Spondylitis and Correct Posture when Lifting
Ankylosing Spondylitis and Walking
One of the best things you can do on a daily basis to relieve the pain and stiffness of Ankylosing Spondylitis is to walk. I have found that brisk walking at a faster pace helps relieve my joint pain and stiffness more than slow walking. Walking can stimulate the production of synovial fluid which lubricates the joints and can reduce inflammation in the joints. Walking and synovial fluid production also nourishes the joints and removes waste products.
After years of living with Ankylosing Spondylitis I found that no matter how bad my pain and stiffness becomes, the more I walk the better I feel. Even on the days when I used to have really bad flare ups I found that if I walked long enough I would eventually feel better. I would have to start slow because the pain in my sacroiliac joint would be so bad, but after about 35 minutes I could walk a little faster and feel much better.
It has been years since I last experienced a flare up, but I still experience some pain and stiffness especially first thing in the morning or when I sit for too long. When this happens I know if I take a brisk walk anywhere from 5 - 20 minutes that the pain and stiffness will usually go away. I have also found that if I break my walking up throughout the day I experience much less pain and stiffness in my spine, sacroiliac joints, hips, buttock, ribs, and shoulder blades. This pain and stiffness is also decreased at night when I sleep if I walk throughout the day.
For example, as opposed to walking 60 minutes all at one time, I will walk 5 - 30 minutes throughout the day. On some days I will have to walk for 30 minutes at two different times because of time constraints. Other days I will walk for 15 minutes at three to four different times throughout the day. Some days I will walk for 5 - 10 minutes around five - six different times throughout the day. No matter how short the period of time, if the walk is brisk and frequent throughout the day my pain and stiffness is much, much less.
One thing I have definitely discovered to overcome the pain and stiffness early in the morning is to take a brisk walk upon waking. A lot of the time I will only walk for 5 minutes first thing in the morning and this makes a huge difference in my level of pain and stiffness throughout the day. I am amazed at how much of a difference a 5 minute walk can make!
Having AS now for over 20 years I usually walk on a treadmill because it has less of an impact and force on my spine. At times I will also walk outside on pavement and it is still very beneficial in reducing my pain and stiffness. Surfaces of grass, dirt, sand, and cement will all work, it's just that the softer surfaces put less force into the spine. Also, the more level, even, and flat the walking surface the better. This makes it much easier to keep good posture and alignment while walking which is essential when living with Ankylosing Spondylitis.
Strong Back and Gluteal Muscles = Better Posture
Maintaining good posture while sitting, standing, and walking can be difficult. It can be exhausting and even feel uncomfortable to have to keep good posture all the time. This is why having strong back and gluteal muscles is so important. The stronger the back and gluteal muscles the easier it will be to maintain good posture throughout the day.
As mentioned, Ankylosing Spondylitis wants to take the spine forward in a hunched over position and fuse the spine. To fight back against this process the back and gluteal muscles need to be strong and good posture must be maintained.
The video below shows the exercise I demonstrated in the previous article that will strengthen the back and gluteal muscles giving support and stability to the spine, sacroiliac joints, and hips.
Summary
Focus on correct daily posture, continued walking, and strengthening the back and gluteal muscles with core exercises such as the one demonstrated above to have the best chance at preventing, stopping, or slowing spinal fusion with Ankylosing Spondylitis.
Poor posture causes breakdown, degeneration, and damage to the spine, sacroiliac joints, and hips. This leads to more damage and chronic inflammation.
Once the joints of the spine, hips, sacroiliac joints and other joints of the body are damaged the immune system and chronic inflammation continues to attack trying to repair the damage to the joints.
This cycle of damage and chronic inflammation causes breakdown, degeneration, pain, new bone growth, and possibly spinal fusion.
This process can dramatically affect spinal flexibility, the ability to work, and cause functional limitations.
Correct posture with the chin back and the spine straight slows spinal breakdown and degeneration.
DrCumminsWellness.com
Knowledge
Empowerment
Hope
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403253/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592781/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808006/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1468363/pdf/joa_1995_0503.pdf
https://www.health.harvard.edu/pain/exercise-an-effective-prescription-for-joint-pain