Ankylosing Spondylitis: Your Top Questions Answered on Drug-Free Physiotherapy Treatment

I answer all the questions most frequently asked by people who have been diagnosed with ankylosing spondylitis and are wondering about the best drug-free physiotherapy treatment options.

In my capacity as a physiotherapist, but also as someone close to several family members affected by this rheumatic disease. I also draw on the latest clinical recommendations published in international scientific literature.

♻️ Last update: March 4, 2025.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

A little background on ankylosing spondylitis

Spondylitis is a chronic inflammatory disease that typically begins between the ages of 20 and 40, especially in men.

It manifests itself as joint pain and stiffness , particularly in these areas:

1. +++ pelvis, hips, buttocks, back: sacroiliac joint and between the vertebrae ;
2. shoulder ;
3. achilles tendon;
4. thoracic cavity (ribs) ;
5. knees.

The disease can also increase the risk of cardiovascular and respiratory diseases, partly due to loss of mobility. Bones are also more fragile, and fractures are often more frequent.

Today, however, this disease is better and better managed. In addition to drugs to relieve symptoms (NSAIDs) and slow or even halt disease progression (biotherapy: anti TNF alpha), physical therapy (individual or with physiotherapy) is often appropriate.

Is a lifetime of physical therapy necessary for ankylosing spondylitis?

Physiotherapy sessions are never an obligation.

Whether you’re a patient or a physiotherapist, you can stop them at any time.

At the start of your treatment, your physiotherapist will usually carry out an assessment to help you set concrete objectives.

Depending on your expectations and progress, physiotherapy sessions may be interrupted for a short time, or permanently, until a new period in your life.

Your physiotherapist can also show you exercises that you can integrate into your daily life to :

• regain or maintain your mobility,
• or relieve your pain.

It is less and less common to have “lifelong” physiotherapy sessions for spondyloarthritis.

In a 2019 synthesis of scientific studies, a research team sought to evaluate the benefits of regular exercise programs, supervised by physiotherapists.

She concludes that there is moderate to low quality evidence to suggest that exercise programs may slightly :

• improve function,
• reduce pain,
• and slightly reduce patients’ overall assessment of disease activity, compared with no intervention.

Their impact on spinal mobility, fatigue and possible side effects is uncertain.

Source : Régnaux et al. 2019

Benefits of stretching for spondyloarthritis?

People with spondylitis are more susceptible to stiffening than others.

Making stretching part of your weekly routine is therefore a good idea to prevent stiffening and maintain good mobility.

Stretching and postures that involve the following joints should be prioritized:

• HIPS;
• back ;
• neck ;
• ankle and knee;
• shoulders.

A few minutes of stretching a week can make all the difference in the world!

And keeping as much mobility as possible is important to be able to do many everyday things:

• to parallel park in the car;
• get up from the ground if you fall ;
• cross-legged for a picnic ;
• be able to sleep in any position, etc.

See also: neck flexibility exercises.

Can TENS help relieve the pain of spondyloarthritis?

TENS is a small device connected to electrodes that delivers an electrical current that is harmless to the human body.

Electrodes are positioned on the painful part of the body.

This electrical current stimulates sensory fibers, in particular those that transmit pain messages to the brain. The aim is to reduce pain.

Although studies show no significant effect of TENS in chronic pain, it remains an interesting tool to test because :

• there are few side effects;
• it’s easy to set up at a low cost and without dependence on a third party.

See also: Which TENS to use at home?

Muscle strengthening exercises, weight training and spondylitis

Because of the pain and stiffness, you’re more likely to lose muscle strength if you have spondyarthritis.

Integrating muscle-strengthening exercises into your weekly routine is therefore an excellent idea for preventing this loss of muscle strength!

A few minutes of muscle-strengthening exercise a week can make a real difference in the long term!

By keeping your muscles strong and active, you can make many essential everyday gestures easier, such as :

• carry your groceries without pain;
• climb stairs or slopes without difficulty ;
• maintain your balance when walking on uneven surfaces;
• open a stubborn jar, etc.

Strength training doesn’t have to mean “weight-bearing exercises in the gym”. Here, for example, are some exercises targeting the leg muscles, very easy to set up at home and suitable for all levels.

Ideally, you should perform “all-in-one” exercises that target leg, arm and core muscles (abdominal and back muscles). All sheathing exercises, for example.

Of course, your physiotherapist can help you identify the exercises best suited to your level and the difficulties you encounter!

Are all sports good for spondyloarthritis?

Yes, all sports are good for spondyloarthritis.

No sport is absolutely contraindicated.

Some people are better able to tolerate what are known as “off-load” sports, i.e. where the entire weight of your body does not rest on your legs. For example:

• swimming ;
• Bicycles;
• water polo ;
• rowing, etc.

The opposite is true of sports that are more “traumatic” for the joints: running, soccer, trampolining, gymnastics, etc.

However, they are not contraindicated. It’s a question of finding the right dosage to suit you.

Spondylitis is a disease whose symptoms often fluctuate. That’s why it’s sometimes a good idea to stop a sport altogether if it becomes too painful, even if it means gradually reintroducing the activity later!

See also: examples of landfill sports and activities.

Thermotherapy and ankylosing spondylitis: hot and cold

Thermotherapy means temperature therapy.

Is hot or cold best for spondyloarthritis? It depends on the situation.

Spondylitis often progresses in “flare-ups”. When you have a flare-up, you often have one or more inflamed, red and painful joints.

In this case, applying a cold pack to the affected joint may provide temporary relief.

Outside the outbreak phases, some people are receptive to warmth: a hot water bottle or hot shower can help them relax and temporarily relieve their pain.

In practice, you can alternate between the two depending on how you feel.

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!