Ankylosing spondylitis (AS) is a form of arthritis that primarily affects your spine. The main symptoms, pain and stiffness, can become worse after periods of inactivity.
So if you have AS, you may sometimes feel like the Tin Man in “The Wizard of Oz” before he finds relief from his can of oil.
Although AS (also called spondyloarthritis, or axSpA) is a progressive condition without a cure, some treatments can help you find relief from that locked-up feeling. Here, we take a look at where AS pain can crop up and ways to alleviate it.
AS commonly affects the spine, but you may also have pain or stiffness in other parts of your body. Your pain may even start elsewhere before affecting your back.
Here’s a look at some of the joints and other areas that may cause you trouble.
The spine is the most common site of AS-related pain. That’s because the condition causes inflammation in your vertebrae. Over time, AS can even cause these bones to fuse together, leading to severe stiffness as well as posture and mobility issues.
Buttocks and hips
AS can be a literal pain in the butt. The condition often starts in the lower back with inflammation and damage to the sacroiliac (SI) joints. The SI joints connect your hip bones to your sacrum, or the base of your spine. Aggravated SI joints can cause hip, pelvic, and buttock pain.
Neck and shoulders
Over time, as AS progresses, inflammation may spread and can lead to stiffness in your neck, upper back, and shoulders as well. If left untreated, over time, the inflamed and fused areas can coalesce.
AS can also affect the cartilage between your breastbone and your ribs. If AS affects your rib cage, breathing in and filling your lungs with air can become painful or difficult. But this type of impairment is somewhat rare.
AS isn’t like having a bum knee after years of crushing it on the soccer field or basketball court. It’s a systemic disease that can take a toll on different parts of your body.
Although the condition is characterized by back pain, you may have more widespread pain or arthritis-like symptoms that affect your hips, knees, elbows, wrists, and ankles as well.
Enthesitis, or inflammation in the spots where your tendons, ligaments, and joint capsules attach to bone, can also cause pain in areas like the backs of your heels.
AS treatment is important to prevent or slow the progression of related complications, such as joint damage or permanent posture or mobility issues.
Treatment options for AS range from medications and surgery to self-care. Many people with AS treat their condition with a combination of therapies, which may include any of the following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs like naproxen can help reduce inflammation, pain, and stiffness. They’re often used as an early line of defense when AS first shows up, as well as during mild flares. Some are available over the counter, while others are prescription-only.
- Analgesics. Analgesics like acetaminophen may be recommended for pain relief in addition to NSAIDs.
- Biologics. Most people with AS need treatment with a biologic medication, such as a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. These medications are taken by self-injection at home or as a shot or infusion at your doctor’s office. They work by targeting and blocking inflammation in your body that contributes to AS to help control symptoms and prevent disease progression.
- JAKs. If you can’t take a biologic, your doctor may prescribe a Janus kinase (JAK) inhibitor. This oral medication helps halt the immune response that promotes inflammation.
- Disease-modifying antirheumatic drugs (DMARDs). Traditional DMARDs are not typically prescribed to treat AS. But they may sometimes be used to treat AS inflammation that extends beyond the back and pelvic areas.
- Corticosteroids. These medications are also not commonly used to treat AS. But you may get a corticosteroid injection in your knee, shoulder, or ankle joint for quick relief when inflammation is causing pain or mobility issues.
- Physical therapy. Many people with AS see physical therapists. These specialists can teach you exercises and stretches that help enhance or preserve mobility or relieve pain when inflammation flares up.
- Occupational therapy. An occupational therapist can help you find ways to protect your joints as you go about daily activities. If necessary, they can also recommend assistive devices that make tasks easier.
- Surgery. In rare cases where AS has caused severe joint damage or debilitating pain, surgical options like joint replacement may be recommended.
- Exercise. Movement can help prevent or ease joint stiffness and maintain mobility and range of motion. If joint fusion does occur, the body becomes fixed in a more functional position. Core strength exercises and other activities that are kind to your joints can offer many benefits, including pain relief.
- Self-care. Exercise is just one form of self-care. Eating an anti-inflammatory diet, avoiding smoking or vaping, getting enough rest, and protecting your joints during everyday movements are all forms of self-management for AS.
If you have AS, you may be wondering what steps you can take to avoid feeling like the Tin Man before Dorothy discovers him.
Any of the following strategies — or a combination of a few — may become your oilcan. Experiment with a variety of approaches to figure out what works best for you.
- Try the Alexander Technique. The Alexander Technique teaches you awareness of how posture and movement affect your joints. It also helps you develop ways to protect your body as you go about your day.
- Make some dietary changes. Although there’s no specific diet for AS, the Mediterranean diet’s focus on anti-inflammatory foods may help. Cutting back on foods that can increase your inflammation, like sugar, might also be beneficial.
- Try hot or cold therapy. A warm bath or shower can go a long way toward helping you get moving when you wake up feeling as stiff as a board. If you have a hot or swollen joint, like a pesky ankle, an ice pack can help chill out inflammation.
- Stick to your med schedule. As with any chronic condition, staying on top of your medications and taking them as prescribed is important. But it’s easy to forget that afternoon pill. Set reminders on your phone or ask your pharmacist about packaging options that place all your meds in bubble packets for easy dosing. As a bonus, you can ditch those hard-to-open bottles.
- Get massages. Whether you go to a professional, ask your partner, or just take a few minutes to rub aching joints yourself, massage can provide temporary relief from pain and stiffness.
- Work on managing stress. Regular life can be stressful. Add a chronic condition to the mix and the stress meter can skyrocket. Stress can leave your body tense, adding to stiffness and pain. Find ways to cope with stress that work for you. Journal, read, enjoy a TV show, tend to your ficus and ferns, or just curl up with your cat.
- Try mindfulness and meditation. Even just 5 minutes of meditation can help you relax, which in turn can ease or stave off your body’s pain response. Plus, who doesn’t need time to just be? #Om.
- Get moving. Exercise causes your body to release endorphins, which can relieve pain and even prevent those dreaded aches. Plus, movement helps you maintain your range of motion. No burpees (ugh!) required, though. Just find a method of movement you enjoy, whether that’s gentle yoga or dancing in your living room.
- Avoid smoking. Smoking promotes inflammatory processes in the body, so if you’ve picked up the habit, talk to your doctor about a way to nix it. Same goes for vaping.
- Get enough sleep. Everyone needs an adequate amount of rest. But getting those Zzz’s is even more important for people with chronic pain. That’s because getting too little sleep or experiencing interruptions in sleep can make you more sensitive to aches, creating a vicious cycle. More pain can lead to less sleep.
- Stretch. Get bendy! OK, maybe not as bendy as the people showing off in the front row in yoga class. But gentle stretching can ease joint stiffness and help you maintain mobility.
If you have undiagnosed chronic pain or if your AS pain and stiffness aren’t well-controlled, definitely check in with your healthcare provider.
You should also talk with your doctor if your AS symptoms change or get worse or if you have an inflamed joint that isn’t responding to your usual methods of treatment.
Ankylosing spondylitis is a type of arthritis that affects the spine, but you may experience pain in other joints and in the places where tendons, ligaments, and joint capsules attach to bone.
While there’s no cure for AS, many treatment options exist. Self-care methods can also go a long way in helping to prevent or reduce pain and maintain flexibility. It may take a little trial and error to see what combination of treatments and preventive measures will work as well as the Tin Man’s oilcan.