Ankylosing Spondylitis – Symptoms, Causes, and Treatment Options

Overview of Ankylosing Spondylitis

Ankylosing spondylitis is a long-term (chronic) condition that causes inflammation in the spine and nearby joints. It belongs to a group of inflammatory diseases called spondyloarthropathies. Unlike common back pain from a pulled muscle, ankylosing spondylitis is linked to the immune system attacking the body’s own tissues.

Prevalence and who it affects

• Ankylosing spondylitis affects about 0.1% to 1.4% of people worldwide, depending on the population studied (Rudwaleit et al., 2009, Ann Rheum Dis).
• It is more common in men than women, often starting between ages 15 and 35.
• Family history plays a role, especially if a relative has ankylosing spondylitis or another inflammatory condition.

Impact on daily life

Ankylosing spondylitis can affect much more than just the spine:

• Work: Ongoing stiffness may limit bending, lifting, or long hours at a desk.
• Sports and fitness: High-impact sports may be difficult, but low-impact exercise like swimming or yoga can help.
• Sleep: Back pain often worsens at night, making restful sleep harder.
• Relationships: Chronic pain and fatigue can affect social life and intimacy.
• Mental health: Long-term illness may contribute to anxiety, depression, or stress.

In severe cases, AS can cause the spine to curve forward, leading to a stooped posture. It may also affect the eyes (causing uveitis), the hips, or even the heart and lungs in rare instances.

Reference: Rudwaleit M, van der Heijde D, Landewe R, et al. (2009). The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis. Annals of the Rheumatic Diseases, 68(6), 770–776. https://doi.org/10.1136/ard.2009.108233

Symptoms of Ankylosing Spondylitis

The main symptoms of ankylosing spondylitis are chronic back pain, stiffness, and reduced mobility that improve with movement but worsen with rest.

Common physical symptoms

• Back pain and stiffness that lasts longer than 3 months.
• Morning stiffness that improves after stretching or activity.
• Pain in the hips, buttocks, or neck, not just the lower back.
• Fatigue from inflammation and poor sleep.
• Reduced flexibility in the spine over time.
• Eye inflammation (uveitis): causing redness, pain, and blurred vision.

Functional impacts

• At work: Sitting too long may trigger stiffness. Standing desks or movement breaks often help.
• In sports: High-energy movements may worsen symptoms, while controlled, low-impact exercises help mobility.
• On sleep: Night pain may force you to change positions often.
• On mood and relationships: The stress of living with chronic pain can impact both self-esteem and connections with others.

Red flag symptoms (seek urgent care)

• Sudden, severe eye pain with blurred vision (possible uveitis).
• Sharp chest pain or difficulty breathing (may signal heart or lung involvement).
• Sudden increase in back pain or neurological symptoms like weakness or numbness.

How is ankylosing spondylitis different from regular back pain?

Unlike short-term mechanical back pain, AS pain usually improves with exercise and does not improve with rest.

Reference: National Institute for Health and Care Excellence (NICE). (2017). Spondyloarthritis in over 16s: diagnosis and management. NICE guideline [NG65]. https://www.nice.org.uk/guidance/ng65

Causes and Risk Factors for Ankylosing Spondylitis

The exact cause of ankylosing spondylitis is not fully known, but it is linked to a combination of genetics, immune response, and environmental factors.

Key risk factors

• Genetics: The HLA-B27 gene is present in up to 90% of people with AS, though not everyone with the gene develops the disease.
• Family history: Having a close relative with AS or another autoimmune disease increases risk.
• Age: Most people are diagnosed between ages 15 and 35.
• Sex: Men are more likely to develop AS than women.
• Other autoimmune conditions: Psoriasis, inflammatory bowel disease, and reactive arthritis are linked to higher risk.

How it develops

Ankylosing spondylitis is thought to begin when the immune system mistakenly attacks healthy tissue in the spine and sacroiliac joints. This causes chronic inflammation, which can lead to:

• Erosion of bone in affected joints.
• Formation of new bone, which can fuse the spine.
• Stiffness and loss of mobility over time.

Lifestyle and environmental influences

• Smoking is linked to more severe symptoms.
• Sedentary lifestyle may worsen stiffness.
• Poor posture can amplify discomfort but does not cause AS directly.

Comparison:

Unlike rheumatoid arthritis, which often affects the small joints in the hands and feet, ankylosing spondylitis primarily affects the spine and pelvis.

Reference: Braun J, Sieper J. (2007). Ankylosing spondylitis. The Lancet, 369(9570), 1379–1390. https://doi.org/10.1016/S0140-6736(07)60635-7

Clinical Path for Ankylosing Spondylitis – Diagnosis, Recovery, and Management

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting the spine and sacroiliac joints. Diagnosing the condition early, understanding recovery timelines, and following evidence-based management strategies are key to slowing progression and improving quality of life.

Diagnosis of Ankylosing Spondylitis

Ankylosing spondylitis is diagnosed through a combination of medical history, physical examination, imaging, and lab tests. Because early symptoms often resemble mechanical back pain, careful evaluation is essential.

How do doctors test for ankylosing spondylitis?

Doctors usually begin with a detailed clinical interview, asking about:

• How long you’ve had back pain.
• Whether pain improves with activity or rest.
• Morning stiffness and fatigue.
• Family history of autoimmune or inflammatory conditions.

Physical examination often includes:

• Checking spinal flexibility with tests like the Schober test (measuring forward bending).
• Assessing chest expansion, since AS can limit rib movement.
• Palpating the sacroiliac joints for tenderness.

Imaging tests confirm structural changes:

• X-rays may reveal sacroiliitis (inflammation where the spine meets the pelvis) or syndesmophytes (bony growths along the spine).
• MRI scans can detect early inflammation before damage appears on X-ray.

Lab tests may include:

• HLA-B27 gene testing, as this gene is present in up to 90% of people with AS, though not everyone with the gene will develop the condition.
• Blood markers of inflammation such as ESR or CRP, which are sometimes elevated.

How do doctors find the root cause of symptoms?

The key to diagnosis is distinguishing AS from other causes of back pain:

• Mechanical back pain (from injury or posture) usually improves with rest, unlike AS.
• Rheumatoid arthritis tends to affect smaller joints first, not the spine.
• Fibromyalgia causes widespread pain without visible joint inflammation.

By piecing together your history, exam findings, imaging, and lab results, specialists can identify AS as the underlying cause.

Reference: Ward MM, Deodhar A, Gensler LS, et al. (2019). 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Guidelines. Arthritis Care & Research, 71(10), 1285–1299. https://doi.org/10.1002/acr.24025

Recovery Timeline and Prognosis for Ankylosing Spondylitis

Ankylosing spondylitis is a lifelong condition, but treatment can reduce symptoms and slow progression. Recovery is not about “curing” AS, but about controlling inflammation and maintaining mobility.

How long does it take to see improvement?

• Mild cases: With early diagnosis and treatment, many people see reduced stiffness and improved function within 6–12 weeks of therapy.
• Moderate cases: It may take several months for medications and exercise routines to fully control pain and stiffness.
• Severe cases: People with advanced spinal fusion may not regain lost flexibility, but symptoms like pain and fatigue can still be managed over the long term.

Factors that influence long-term outcomes

• Early diagnosis and treatment lead to better results.
• Adherence to exercise programs is strongly linked to improved mobility.
• Smoking worsens progression and increases disability.
• Comorbidities such as psoriasis or inflammatory bowel disease may complicate recovery.

Risk of recurrence and progression

While AS symptoms may flare and improve over time, the condition does not usually “go away.” Instead, it can progress slowly if not treated. Many people experience cycles of flare-ups and remission.

Return to work, sport, and daily life

• Work: With proper ergonomics and flexibility exercises, most people can continue working, though modifications may be needed.
• Sport: Low-impact sports (swimming, cycling, walking) are generally encouraged, while high-impact contact sports may increase risk of injury.
• Long-term lifestyle: The goal is to maintain independence and reduce long-term disability. With treatment, many individuals live full and active lives.

Decision pathway for recovery:

• If symptoms are mild: Start with exercise, posture training, and NSAIDs.
• If symptoms are moderate: Combine physical therapy with long-term medication like biologics.
• If symptoms are severe: Use multidisciplinary care (rheumatology, physiotherapy, pain management) to maintain mobility and reduce complications.

Reference: van der Heijde D, Ramiro S, Landewe R, et al. (2017). 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the Rheumatic Diseases, 76(6), 978–991. https://doi.org/10.1136/annrheumdis-2016-210770

Management of Ankylosing Spondylitis

Managing ankylosing spondylitis involves a combination of medication, physical therapy, lifestyle changes, and long-term prevention strategies.

What’s the best way to manage ankylosing spondylitis at home?

Self-management plays a huge role in controlling symptoms. Key strategies include:

• Posture: Keep an upright posture when sitting, standing, and sleeping.
• Ergonomics: Use supportive chairs and adjustable desks.
• Activity modification: Avoid prolonged sitting and take movement breaks.
• Exercise: Focus on stretching, flexibility, and core strength.
• Breathing exercises: Help maintain chest expansion.

Step-by-step self-help & relief tips

1. Morning stretches: Start your day with gentle spinal stretches.
2. Heat therapy: Apply warm compresses or take hot showers to relieve stiffness.
3. Movement breaks: Every 30–60 minutes, stand and walk for 2–3 minutes.
4. Sleep support: Use a firm mattress and avoid overly soft pillows to keep your spine aligned.
5. Anti-inflammatory diet: Some people benefit from a diet rich in omega-3s, fruits, and vegetables.

Medical and therapeutic options

• Medications:
  • NSAIDs (ibuprofen, naproxen) are often first-line.
  • Biologic therapies (TNF inhibitors, IL-17 inhibitors) reduce inflammation and slow progression.
  • Corticosteroid injections may help in flare-ups.
• Physiotherapy: Tailored exercise programs to improve posture and mobility.
• Massage therapy: Can ease muscle tension and pain.
• Psychological support: Managing chronic illness often requires help with stress, anxiety, or depression.
• Community and social supports: Patient groups and online communities provide education and encouragement.

If/then approach to management:

• If you have mild stiffness: Daily stretching and NSAIDs may be enough.
• If you have moderate symptoms: Add physiotherapy and consider biologic treatment.
• If you have severe disease: Combine medication, physical therapy, lifestyle modification, and psychosocial support.

Reference: Ward MM, Deodhar A, et al. (2019). Arthritis Care & Research, 71(10), 1285–1299.

Multidisciplinary Care for Ankylosing Spondylitis at CARESPACE

At CARESPACE, ankylosing spondylitis (AS) is treated with a team-based, multidisciplinary approach that addresses both physical and mental health. By coordinating care across multiple disciplines, CARESPACE helps you manage pain, improve mobility, and reduce the stress that comes with living with a chronic condition.

How does CARESPACE treat ankylosing spondylitis differently?

Most clinics treat ankylosing spondylitis with a single type of care, such as medication or physiotherapy. At CARESPACE, you benefit from an integrated team of professionals working together on your care plan. This ensures that every part of your health—spine mobility, inflammation, stress, sleep, and lifestyle—is supported.

Your care may include:

• Physiotherapy to improve spinal flexibility, posture, and strength.
• Chiropractic care to support joint mobility and reduce stiffness.
• Massage therapy to release muscle tension caused by chronic inflammation.
• Kinesiology and fitness training to help you stay active safely.
• Psychotherapy or mental performance coaching to manage pain-related stress, depression, or insomnia.
• Nutrition and naturopathic medicine to support an anti-inflammatory lifestyle and overall health.
• Acupuncture to help with pain relief and relaxation.

Why does a team approach help ankylosing spondylitis recover faster?

Coordinated care means you don’t have to manage your condition alone. Each provider communicates with the others so your treatment plan is consistent and focused on your long-term goals. This prevents gaps in care and helps you see faster, more sustainable results.

For example:

• You may start with a physiotherapist for mobility assessment.
• At the same time, a massage therapist can reduce muscle tension that worsens stiffness.
• If stress and poor sleep are making symptoms worse, you may also see a psychotherapist to learn coping strategies.

This connected approach is more effective than isolated treatments because it addresses both the physical and emotional dimensions of ankylosing spondylitis.

Coordinated care across different phases of ankylosing spondylitis

AS is a long-term condition, but your needs change over time. CARESPACE adapts your care journey across three phases:

• Acute phase (flare-ups): Focus on reducing inflammation and pain.
  • Chiropractic and physiotherapy for safe mobility.
  • Massage for tension relief.
  • Short-term counselling to help manage pain-related stress.
• Subacute phase (stabilization): Support recovery and reduce recurrence.
  • Exercise-based rehabilitation with kinesiology.
  • Nutrition guidance to support anti-inflammatory habits.
  • Acupuncture or naturopathic medicine for symptom balance.
• Maintenance phase (long-term management): Prevent future complications.
  • Fitness training and posture-focused exercises.
  • Ongoing psychotherapy or coaching for stress, sleep, and resilience.
  • Team check-ins to update and adjust your personalized plan.

Supporting both body and mind with ankylosing spondylitis

Chronic pain conditions like AS affect not just your body but also your mental health. Many people struggle with:

• Pain-related stress that increases fatigue.
• Sleep problems from nighttime stiffness.
• Anxiety or depression linked to reduced mobility or uncertainty about the future.

At CARESPACE, mental health is built into your care plan. Psychotherapy, nutrition, and exercise work together to improve your coping strategies, mood, and resilience. This combination helps you live more fully, even with a long-term diagnosis.

Why CARESPACE’s multidisciplinary care is different

The CARESPACE advantage is in the coordination. Instead of visiting multiple clinics and piecing care together yourself, you have a team that collaborates behind the scenes and keeps you at the center of every decision.

Benefits include:

• Personalized care plans designed specifically for your symptoms, lifestyle, and goals.
• Faster results because therapies work together instead of separately.
• Lower risk of recurrence through prevention-focused care.
• Whole-person support that goes beyond physical therapy to include sleep, stress, diet, and mental health.

This integrated model helps you not only manage ankylosing spondylitis but also build long-term strategies for living well with it.

Related Conditions, FAQs, and Important Information for Ankylosing Spondylitis

Managing ankylosing spondylitis (AS) often involves looking at overlapping conditions, common client questions, and clear guidance to ensure you feel supported. This final section ties together related conditions, practical FAQs, and an important disclaimer for your safety.

Related Conditions for Ankylosing Spondylitis

Ankylosing spondylitis can sometimes be confused with or occur alongside other conditions that cause chronic pain and stiffness. Because these conditions share overlapping symptoms, proper diagnosis is essential.

• Mechanical back pain – Unlike AS, which is inflammatory, mechanical back pain comes from posture, injury, or muscle strain.
• Rheumatoid arthritis (RA) – RA can also cause joint inflammation but usually affects the small joints of the hands and feet rather than the spine.
• Psoriatic arthritis – Some people with psoriasis develop spine and joint inflammation similar to AS.
• Fibromyalgia – This condition causes widespread pain and fatigue but does not involve joint damage like AS.
• Osteoarthritis – A degenerative joint disease that may mimic stiffness but differs in cause and progression.

Because symptoms overlap, your provider may run specific tests to confirm whether it’s ankylosing spondylitis or another condition.

Looking for information on a different condition? Visit our full Conditions List.