Condition guide
Ankylosing Spondylitis Physio: Movement and Exercise
Ankylosing spondylitis, now often called axial spondyloarthritis, is a long term inflammatory condition that mainly affects the spine and the joints where the spine meets the pelvis. It typically causes back pain and stiffness that is worse in the morning and improves with movement. Ankylosing spondylitis physio works alongside the care from your GP and rheumatology team, helping you keep moving, stay strong and manage flare-ups. This page is general information rather than a diagnosis, and an assessment is the sensible next step if your symptoms are not settling.
What is Ankylosing Spondylitis?
In ankylosing spondylitis, inflammation affects the joints and the places where ligaments and tendons attach to bone, especially in the lower back and sacroiliac joints. Over time, some people develop stiffness through the spine and rib cage, and a few develop new bone that limits movement. It often starts in late teens or early adulthood and can also affect the hips, shoulders, heels and eyes. Medication from a rheumatologist is a key part of treatment, and regular exercise is recommended to maintain movement and posture.
Typical Symptoms
- Back pain and stiffness lasting more than three months, often starting before the age of 45
- Stiffness worse in the morning or after rest, easing with movement and exercise
- Pain that can wake you in the second half of the night
- Buttock pain, sometimes alternating sides
- Reduced movement in the spine, neck or rib cage
- Tiredness, heel pain or pain in other joints during flare-ups
Common Causes & Triggers
- An inflammatory process that is not fully understood
- A genetic link, with the HLA-B27 gene common in people with the condition
- A family history of ankylosing spondylitis or related conditions
- Associated conditions such as psoriasis or inflammatory bowel disease
- It is not caused by injury or wear and tear
How We Treat Ankylosing Spondylitis at Bluebell
- 1
A detailed history, including how your diagnosis was made, your medication and how flare-ups affect you.
- 2
Assessment of spinal, hip and rib cage movement, posture, breathing and strength.
- 3
A daily mobility and stretching routine to keep the spine, hips and shoulders moving.
- 4
Strength and posture exercise, with breathing work for rib cage movement.
- 5
Hydrotherapy where suitable, plus advice on pacing during flare-ups and referral to your GP or rheumatology team if symptoms change.
Honest Recovery Timeline
Ankylosing spondylitis is long term, so the aim is a routine you can keep up for years rather than a short course. Many people find regular exercise helps with stiffness and confidence. Your physiotherapist will plan sessions around your flare-ups and review your programme as your needs change.
Hydrotherapy and inflammatory back pain
Our hydrotherapy page explains how warm water sessions work and who they suit. If you are not sure whether your pain is inflammatory or mechanical, our SI joint pain guide and lower back pain guide describe other causes of pain low in the back.
When Ankylosing Spondylitis Needs Urgent Medical Attention (Not Physio)
- •A red, painful eye with blurred vision or sensitivity to light, seek same day medical care, as it may be uveitis.
- •Numbness around the back passage or genitals, new bladder or bowel problems or weakness in both legs, go to A and E straight away.
- •New neck pain after a fall or knock with a stiff spine, go to A and E, as a fracture can be easier to miss.
- •Fever, feeling very unwell or unexplained weight loss, see your GP promptly.
Ankylosing Spondylitis — Common Questions
What does ankylosing spondylitis physio involve?
An assessment of movement, posture and strength, followed by a mobility, strengthening and breathing programme you can keep up at home. Hydrotherapy may be included where it suits you.
Is hydrotherapy good for ankylosing spondylitis?
Many people find warm water makes it easier to move a stiff spine and exercise comfortably. It works best alongside a land based home programme.
Can I exercise during a flare-up?
Gentle movement is usually helpful, but intensity may need to drop for a while. Your physiotherapist will help you adapt your routine.
Do I need a diagnosis before booking?
No, you can self-refer. If your back pain and stiffness suggest an inflammatory cause, we will advise you to see your GP for tests.
What affects the cost of treatment?
The number of appointments you need is the main factor. Ask the clinic for current fees when you book, and check with your insurer if you have a policy.