Introduction:
* Ankylosing means stiff or rigid. Spondyl means spine. Itis refers to inflammation. The disease causes inflammation of the spine and large joints, resulting in stiffness and pain.
* Ankylosing spondylitis (AS) is a chronic form of arthritis. It mostly affects the bones and joints at the base of the spine where it connects with the pelvis. These joints can become swollen and inflamed. Over time, the affected spinal bones may join together.
* The spine, or backbone, is a bony structure which is made up of group of vertebrae that supports your body.
Differential Diagnosis
Certain diseases and conditions can mimic ankylosing spondylitis (AS) and must be ruled out. These include, but are not limited to:
Mechanical low back pain
Lumbar spinal stenosis
Rheumatoid arthritis
Diffuse idiopathic skeletal hyperostosis (DISH)
Each of these diagnoses has similarities with AS, but their differences should be ruled in or out for accurate diagnosis.
Signs and Symptoms of Ankylosing Spondylitis
The most common symptom of ankylosing spondylitis is low back pain that develops so gradually that it may go unnoticed in the early stages.
*Bamboo spine is a pathognomonic radiographic feature seen in ankylosing spondylitis that occurs as a result of vertebral body fusion .
Other signs and symptoms of ankylosing spondylitis include:
*Fatigue
*Stiffness that is worse in the morning
*Pain in the buttocks
*An improvement in pain and stiffness with physical activity
*Hunched posture
*Difficulty breathing deepl
Treatment
Physiotherapy Management
Hot packs:Hot packs or thermotherapy increase circulation and relieves pain.
Cryotherapy:Cryotherapy or cold therapy decreases inflammation and muscle spasm.
Hydrotherapy:Hydrotherapy uses the therapeutic effect of water in the treatment of Ankylosing Spondylitis as it relieves pain and muscle spasms, maintains and increases the range of motion of joints, strengthens the weak muscles, and increases circulation.
Mobilization:Mobilization helps to maintain the mobility of joints like the spine, hip, shoulder, and thoracic cage are essential in Ankylosing Spondylitis Treatment. As maintenance of mobility is essential so that all the joints are moved to their maximum limit and thus, we can delay the process of ankylosis.
Breathing Exercises:Breathing exercises are recommended to increase chest expansion and vital capacity. These exercises include apical breathing exercises, diaphragmatic breathing exercises, and lateral costal breathing exercises.
Range of motion, Strengthening, and Stretching Exercises:Simple range of motion exercises can slow or stop disease progression. Strengthening exercises are done by working muscles against light resistance and high repetition i.e, for a longer time. Strengthening exercises for abdominal and back muscles are recommended. Stretching exercises are also done for pain relief and to increase flexibility.
Rehabilitation
1.Back Extension Gentle: Lie on your front, and rest on your forearms. Your back will be gently arched. Hold this position. Start gently with this exercise as it can cause some stiffness when you first begin.
2.Superman: Lie on your front, and lift your opposite arm and leg, keeping them straight. Hold this position, and then relax. This exercise helps to arch your lower back (to create what is known as a lumbar lordosis) while strengthening the lower back and buttock muscles.
3.Lumbar Rotation Twist Stretch: Bend your knees, and keeping your feet flat on the floor, rotate your hips to one side creating a rotation through your lower back. Only go as far as feels comfortable, you do not need to get your knees to the floor. With straight arms, rotate to the opposite side at the same time. This is a strong lower back stretch suitable for more athletic people.
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