Ankylosing Spondylitis

Question 1

An inflammatory disease of the axial skeleton, characterized by pain and progressive stiffening of the spine

Answer 1

Ankylosing Spondylitis (AS)

Question 2

• Unknown

- Genetic

Answer 2

Cause of AS

Question 3

Typically affects adolescent males between ages 15 – 35

Answer 3

Risk Factors of AS

Question 4

• Back pain for more than 3 months
• Pain worse at PM and after prolonged sitting
• Dull ache to constant pain
• Progressive rigidity and ↓ ROM
• Hypolordosis d/t spasm initially
• Discs are replaced w/ vertical bone (syndesmophytes)
• Typically begins w Bilateral, symmetrical SI joint pain/stiffness, palpable tenderness
• Sciatica
• If costal vertebra fuse, chest expansion becomes limited, breathing restricted resulting in abdominal breathing
• ↓ lateral flexion
• Cervical kyphosis
• Head protrusion
• Flexion contractures occur at hips creating a rigid gait

Answer 4

Clinical Manifestations of AS

Question 5

Surgery
Medication:
- NSAIDs-naproxen
- Corticosteroids: prednisone
- Biologic response modifiers (BRMs): Enbrel, methotrexate
- Sulfasalazine: also used for colitis-many side effects incl. HA, skin rash, loose skin, achy joints

Answer 5

Medical Treatment for AS

Question 6

• A, P, R of spine, hips
• Occiput to wall – heels and back to wall. Try to touch back of head to wall. Inability indicates cervical involvement.
• Chest Expansion – measure maximum chest expansion at level of axilla. Chest expansion of less than 3.5 - 7.5 cm is normal, less than indicates costovertebral involvement.
• Schober Test: Magee -mark between both PSIS’s. Mark 5 cm below and 10 cm above
  Measure distance. Have cl flex spine. Remeasure.
• SI Compression.
• Spinous Challenge (Rigid)

Answer 6

Assessment for AS

Question 7

• Prevent ankylosing in flexion
• ↓ protective compensatory spasm
• ↓ fibrosis
• ↑ circulation to immobilize tissue
• Maintain T-sp mobility or slow progression of ankylosis
• Maintain respiratory fx

Answer 7

Treatment Aims for AS

Question 8

• If no fusion, encourage extension by vertical towel in supine, towels under GH in prone
• Support ankylosed area
• Specific work to mm of respiration and ES
• TP work: trunk, neck, pelvis
• Joint mobilizations to lumbar spine/costovertebral jts

Answer 8

Massage Techniques for AS

Question 9

• Breathing exercises: hands-on lower ribs, just before inspiration press down and inward to stretch ext intercostals
• Chest expansion: seated, arms overhead – inspiration, on expiration drop chest to knees and arms down to ground
• Foam roll
• Scalenes Stretch
• Sub Occ stretch
• Lateral self-mobilizing: fist in side of torso, sidebend
• Swimming, walking
• Strengthen abs, ES
• Supine-bridging
• Pecs stretching
• Postural re-education
• Clapp’s Crawl

Answer 9

Remedial Exercise for AS

Question 10

True or False?

Prognosis is poor if AS disease remains active for 10 years or more

Answer 10

True