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What is it?

Ankylosing Spondylitis is a type of arthritis affecting the joints and ligaments of the spine. It is a chronic, inflammatory condition that may also affect other joints such as the hips, knees and and ankles.

Ankylosing = stiff 

Spondylo = vertebra 

Over time, the vertebrae (bones in the spine) may become increasingly stiff and fuse together making the spine less flexible. This can also lead to a more hunched-forward posture being developed.   


The exact cause of Ankylosing Spondylitis remains unclear. However, research has shown that both the environment and the presence of the gene HLA-B27 may play a contributing role in the development of the condition.

Signs and Symptoms

Many individuals with Ankylosing Spondylitis have intermittent episodes of low back pain, however, in more severe cases, individuals have ongoing pain and stiffness.

Common Symptoms

  • Chronic back pain 
  • Progressive Stiffness 
  • Buttock Pain 
  • Hip Pain 

Symptom Characteristics

  • Symptoms usually persist longer than 3 months
  • Morning stiffness lasting >45 minutes
  • Improves with physical activity
  • Worse with rest and prolonged sitting
  • Age at symptom onset <40 years old

The symptoms of Ankylosing Spondylitis, whether mild or severe, go through periods of flare-ups (where symptoms are more intense), followed by periods of remission (where symptoms ease).


Ankylosing Spondylitis can only be identified through a thorough medical history in combination with findings from imaging and laboratory investigations i.e. blood tests.

  • Magnetic Resonance Imaging (MRI): Can be helpful in identifying early disease
  • X-Ray: Can be helpful in evaluating joint integrity


Ankylosing Spondylitis is commonly managed through a multi-modal approach. Although there is no cure, there are many treatment options available to help manage symptoms.

These may include medical management strategies such as:

  • Non-Steroidal Anti-Inflammatories (NSAIDs)
  • Corticosteroids and Disease Modifying Anti-Rheumatic Drugs
  • Biological Medications

How can Physiotherapy help?

Physiotherapy is crucial in the management of Ankylosing Spondylitis, with regular exercise and education considered to be the cornerstones of symptom management. Physiotherapy can help you maintain spine flexibility, normal posture, decrease functional limitations, relieve symptoms and reduce complications.

Physiotherapists can also provide insight into pain management strategies as well as education around long-term self-care and fatigue management. Additionally, physiotherapists can also equip you with assistive devices and alternative techniques to help with activities of daily life.

The long-term effectiveness of exercise rehabilitation is dependent on adherence and so seeing a physiotherapist may not only improve compliance, but help you to improve your self-efficacy. This is through correct technique instruction and demonstration as well as equipping you with strategies to independently perform safe exercises at home.

Evidence has also shown supervised physiotherapy programs to be associated with improvements in functional capacity and disease activity, as well as a decrease in pain in individuals with Ankylosing Spondylitis.


Gravaldi, L. P., Bonetti, F., Lezzerini, S., & De Maio, F. (2022). Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Healthcare (Basel, Switzerland)10(1), 132. https://doi.org/10.3390/healthcare10010132

Helliwell, P., Abbott, C. and Chamberlain, M. (1996) ‘A randomised trial of three different physiotherapy regimes in ankylosing spondylitis’, Physiotherapy, 82(2), pp. 85–90. doi:10.1016/s0031-9406(05)66956-8.

Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/