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Ankylosing Spondylitis

Understanding Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the sacroiliac (SI) joints and the axial skeleton often having a strong genetic predisposition. Ankylosing spondylitis is a disease characterized by pain and progressive stiffness. It is part of a group of rheumatic diseases medically known as spondyloarthropathies which actually involves the vertebral joints and shares the human antigen HLA-B27. Ankylosing spondylitis is considered to be hereditary, even though environmental factors have been suggested. Most people with the HLA-B27 antigen do not develop AS. It is known to affect white males about four times as often as females. Onset typically occurs between the ages of 15 and 45. In the early stages of the disease, the sacroiliac joints (back of the pelvis) become inflamed and painful. As the disease progresses, ossification is triggered by the Immune systems defense mechanism. Ossification causes new bone to grow between vertebrae eventually merging them together increasing the risk for fracture. Eventually, ossification affects the spinal ligaments leading to the stenosis or narrowing of the spinal canal which can cause neurologic deficits.

Signs & Symptoms of Spondylolisthesis

Low back pain is dull and poorly localized to the gluteal and lumbo-sacral areas. Insidious or gradual onset of symptoms experienced by people younger than 40 years. As the disease progresses, pain and limitation of movement becomes more persistent and experienced on both sides while moving up the spine. Involvement of the hips, shoulder and ankle joints are possible. Symptoms tend to worsen in the morning or with inactivity Alleviation of low back pain with exercise or activity. Patients may complain of difficulty in breathing or chest tightness.

Cauda Equina Syndrome (specific nerve compression) may develop causing bilateral lower extremity numbness, weakness, and incontinence.

Professional Treatment for Ankylosing Spondylitis

Treatment for Ankylosing spondylitis (AS) is aimed at relieving the patient's symptoms and preventing spinal deformity which mainly includes nonsteroidal anti-inflammatory agents. Adhere to a Physical therapy program that will strengthen back muscles, improve posture, increase flexibility and range of motion, and techniques to enhance breathing. Endeavor in activities that help alleviate stiffness. Taking a warm bath, moderate stretching movements performed in bed prior to rising, or aquatics such as swimming are advised. Management may also include the use of drugs that block cell growth (cytotoxic drugs) in people who do not respond well to corticosteroids or who are dependent on high doses of corticosteroids. Non-surgical treatment such as traction and/or bracing are used to manage spinal fractures resulting from AS. Corticosteroid therapy and TNF-alpha inhibitors have been FDA-approved for the treatment of Ankylosing Spondylitis and can lead to stunning improvement in the inflammatory and systemic nature of AS.

Asking the Right Questions Like a Pro

Heres what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports: 1. What is a Schober test? 2. How early should Ankylosing Spondylitis be treated with a Tumor Necrosis Factor-blocker? 3. What associated symptoms should I look out for accompanying this disease? 4. My blood workup tested positive for HLA-BA27 antigen, what are my chances of contracting AS?

5. What does the Gaenslen's maneuver measure? 6. What is a Bamboo Spine and how do I prevent it? 7. Can you elaborate more on the use of a halo brace or a TLSO device and how will they help me?

Elite Sports Medicine Tips

IMPROVE YOUR RANGE. Regular daily exercise is an effective method to deal with symptoms of AS. Range of motion exercises especially maintains how well your joints move. WATCH YOUR WEIGHT. Maintain your optimum weight by staying fit and taking a healthy diet to place as little strain on the spine as possible. STAY HOT. Use a heat pack or warm bath to reduce pain and stiffness. AIM TO BE ACTIVE. It is very important to understand that rest is not advisable as it will increase their stiffness. Maintain an active lifestyle. ALWAYS WATCH YOUR STEP. Sports carrying a higher risk of falls like skiing or horseback sports are best avoided as they carry a risk for spinal fracture. GAIN BY REDUCING THE PAIN. Deep tissue massage, ultrasound, passive stretching, heat/ice and acupuncture may all have a role to play in reducing pain and maintaining mobility. SUSTAIN THE FLOW BUT KEEP IT SLOW. Swimming, dancing and exercises to improve muscle tone, strength and flexibility are ideal, but rapid twisting movements should be avoided.