Ankylosing Spondylitis

Explanation of Diagnosis

Ankylosing spondylitis is a chronic inflammatory condition that mainly affects the joints of the spine and the sacroiliac joints in the pelvis. Over time, inflammation can lead to stiffness and, in some people, lasting fusion of parts of the spine. It often starts in early adulthood and may cause symptoms such as low back or buttock pain, morning stiffness that improves with movement, and pain that can feel deeper than typical “back strain.” Many people also notice reduced chest expansion, fatigue, or occasional pain in other joints.

Specific Work Modifications

• Adjust your workstation so you can keep your head and upper back over your pelvis, not slumped forward.
• Take movement breaks every 30 to 60 minutes to stand, walk, and gently change positions.
• Use a chair with good back support and consider a small lumbar roll or backrest support that keeps your spine more upright.
• Avoid long periods of stooping or repeated bending; use tools with long handles or raise items to waist level when possible.
• If your job requires lifting, keep loads close to your body and avoid twisting while lifting; ask for help with heavier or awkward items.
• If possible, alternate sitting and standing and use a supportive footrest or anti-fatigue mat to reduce low-back strain.

Specific Activity Modifications

• Choose low-impact activities like walking, swimming, cycling, or using an elliptical, especially during high-stiffness periods.
• Warm up gently before exercise, and cool down with easy mobility rather than stopping abruptly.
• Prioritize regular movement over long, intense sessions; if symptoms flare, reduce duration and intensity temporarily.
• Use good posture during sports or hobbies, and limit prolonged bending, deep squatting, or activities that force you into sustained rounded posture.
• Consider exercises that support chest mobility and upright posture, and be cautious with high-impact jumping or heavy twisting until symptoms are stable.
• If you have a flare, focus on comfortable range-of-motion work and light activity, and avoid pushing through sharp or worsening pain.

Recommended Supplements

• Vitamin D: 1,000 to 2,000 IU daily (or a dose guided by your blood level) may support bone health and immune function.
• Omega-3 (fish oil): about 1 to 2 grams per day of combined EPA and DHA may help some people with inflammation-related symptoms.
• Magnesium (often magnesium glycinate): 200 to 400 mg daily may support muscle relaxation and sleep quality for some people.
• Curcumin/turmeric extract: 500 to 1,000 mg daily with food may help some people with joint discomfort.

Recommended Nutrition and Hydration

Diet Recommendations

• Aim for a Mediterranean-style pattern with vegetables, fruits, beans/lentils, whole grains, olive oil, nuts, and fatty fish when tolerated.
• Include anti-inflammatory omega-3 sources (salmon, sardines, trout, chia, flax) and lean protein to support overall recovery.
• Limit processed foods, sugary drinks, and frequent high amounts of refined carbohydrates, which may worsen inflammation for some people.
• If overweight, gradual weight reduction can reduce stress on the spine and other load-bearing joints.
• If you suspect food sensitivities, track symptoms and discuss targeted changes with your clinician or a dietitian.

Hydration Tips

• Drink water regularly through the day and use extra fluids if you sweat more from activity or warm climates.
• Limit excess alcohol, which can worsen sleep and may increase musculoskeletal discomfort in some people.

Home Exercise Prescription

Do these exercises most days of the week, ideally 5 to 7 days, focusing on comfort and smooth motion.

1. Prone on Elbows (chest opening): Lie on your stomach on forearms with hips relaxed, gently lift your chest; hold 1 to 2 minutes, 2 to 3 times.
2. Thoracic Extension over a Towel Roll: Place a rolled towel across your upper back, support your head with your hands, and gently extend over the roll; repeat 6 to 10 times with slow breathing.
3. Hip Flexor Stretch (half-kneeling): Kneel with one knee down, tuck the pelvis slightly and gently lean forward until you feel the front of the hip stretch; hold 30 to 45 seconds per side, 2 to 3 rounds.
4. Hamstring Stretch (seated or standing): Keep your back tall, hinge at the hips until you feel a comfortable hamstring stretch; hold 30 to 45 seconds per side, 2 rounds.
5. Neck and Upper Back Mobility: Slowly move your head side to side and gently rotate within a comfortable range; do 5 to 8 slow repetitions each direction.
6. Deep Breathing for Chest Expansion: Sit tall, inhale slowly through your nose letting your ribs expand, then exhale slowly; do 5 to 10 breaths.

Helpful Books

• "Explain Pain" written by David Butler and Lorimer Moseley
• "Back Mechanic" written by Stuart McGill
• "The Athlete’s Guide to Recovery" written by Brock Adams
• "When the Body Says No" written by Gabor Maté