Which exercises help ankylosing spondylitis?

What is ankylosing spondylitis?

Ankylosing spondylitis is a long-term inflammatory condition that mainly affects the spine and the sacroiliac joints, where the spine meets the pelvis. It is part of a group of conditions called axial spondyloarthritis. Inflammation causes back pain and stiffness and, over time, may lead to new bone formation that reduces spinal flexibility.

Symptoms often start at a relatively young age, with back pain that comes on gradually, is worse in the morning or after rest and improves with activity. Other joints, tendons, the eyes, skin and bowel can also be affected.

Why is exercise important?

Exercise helps maintain spinal mobility, posture, chest expansion and muscle strength, and it reduces stiffness and pain. International recommendations for axial spondyloarthritis advise that people should be encouraged to exercise regularly, and that physiotherapy should be considered 2.

Exercise does not replace medication, which controls inflammation, but the two work together. Most exercise programmes studied were delivered alongside drug treatment 1.

What does the evidence show?

A Cochrane review of 14 randomised trials with 1,579 people with ankylosing spondylitis found that exercise programmes, with a median duration of 12 weeks, reduced pain compared with no intervention, with a mean difference of 2.1 points on a 10-point scale, based on low-quality evidence 1.

Compared with no intervention, exercise also improved physical function and spinal mobility, although these differences were smaller 1. The most common exercises in the studies focused on strength, flexibility, stretching and breathing.

Which exercises are commonly recommended?

Spinal mobility exercises include gentle rotation, side bending and extension of the spine, such as cat-camel movements and lying face down and raising the chest. Stretching of the hip flexors, hamstrings and chest muscles helps maintain upright posture. Deep breathing exercises support chest expansion.

Strengthening of the back, buttock and core muscles, and aerobic exercise such as swimming, cycling or brisk walking, improve fitness and heart health, which matters because inflammatory conditions increase cardiovascular risk.

How often should I exercise?

Many people find a short daily routine of mobility and stretching exercises helpful, especially in the morning to reduce stiffness, combined with aerobic and strengthening exercise several times a week. Supervised group exercise or hydrotherapy may help motivation and technique.

During a flare, exercises can be reduced in intensity rather than stopped completely. Gentle movement within comfort helps limit stiffness.

Are there activities to avoid?

Most activities are possible. People with significant spinal fusion or osteoporosis should take care with high-impact and contact sports, as the stiff spine is more vulnerable to fracture after falls.

Any new severe neck or back pain after even a minor fall in someone with long-standing ankylosing spondylitis should be assessed urgently, because spinal fractures can occur with little force.

How can posture be protected at work and at home?

Setting up a desk so that the screen is at eye level, using a chair that supports the lower back and taking regular movement breaks helps reduce stiffness. Standing and walking during phone calls and stretching every hour or so keeps the spine moving.

At home, sleeping on a firm mattress with a thin pillow, lying face down for a short period each day if comfortable, and avoiding long periods slumped on a sofa help maintain upright posture.

What else supports long-term health?

Stopping smoking is recommended, as smoking is linked with worse disease outcomes. Maintaining good posture when sitting and sleeping, using a firm mattress and a thin pillow, and staying active throughout the day all help.

Regular review by a rheumatologist ensures that inflammation is controlled. Eye pain and redness with blurred vision may indicate uveitis and needs same-day assessment.

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