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Managing Ankylosing Spondylitis

Woman Exercising with Occupational Therapist

The symptoms of ankylosing spondylitis (AS) – morning stiffness, fatigue, back stiffness and pain – can make it difficult to perform everyday tasks and maintain your independence.  Tendons throughout your body may be symptomatic as well as your eyes.  Your medical team, including your occupational therapist, can help you find solutions and learn techniques to manage your symptoms effectively.

The Role of Occupational Therapy
Occupational therapy for AS would most likely be short term and focus on the tools and habits that can help people maintain their independence in daily life. Using adaptive equipment such as a sock aid, reacher, bath sponge, bed ladder, and/or a car door support handle can go a long way towards making everyday tasks easier. Your occupational therapist will review all the options with you and show you how to use them at home. Occupational therapists may also make recommendations about mobility, positioning, pain management, and exercises to make getting out of bed or driving a car safer and easier.

Staying Active
“Use it or lose it” is an aphorism that is appropriate with this diagnosis, as joints can fuse if mobility is not maintained.  The spine is typically affected the most, though other joints may be stiff as well. In addition, patients that exercise and stay active often say that they feel more “normal” than those that let their stiffness take control. Tendinitis can also occur from this pathology.  Physical therapy can help you develop an exercise regimen. While ongoing therapy may not be necessary, patients can sometimes benefit from an occasional check-in with their therapist to review and modify exercises.

Using Your Energy Wisely: The 4 Ps
Energy is consumed by the disease and is a burden to your body. Energy management strategies can be used to provide maximum benefit and prevent over-fatigue.

Considering joint involvement, energy, pain and stiffness, and anticipating the disease’s effect on the body can maximize functional independence. The 4Ps – Planning, Pacing, Prioritizing, and Positioning – can be a helpful pneumonic device to remember these principles:

  • Planning: Think about the way that your body functions and try to adapt. Get out your calendar.  Planning the day, the week or even the month to optimize your energy can allow you to do more. For example, if you’re a morning person then schedule activities that are difficult for the morning, when you typically feel your best.
  • Pacing: Movements that are either too fast or too slow can be taxing on your energy level. This may also mean that you have to take a break before an activity is completed. Also, make sure you have enough time to accomplish the task as rushing consumes more energy. Learn the subtle cues that your body is giving you with regard to fatigue. This can be hard to do when you’re in the zone, but over-fatigue can render you powerless and may take an unreasonable amount of time to recover.
  • Prioritizing: Perform the most important activities and postpone or eliminate tasks that are unnecessary. Wait to do a physically difficult task until someone is available to help you.
  • Positioning: Using your body to its mechanical advantage will reduce the amount of effort needed to complete a task. Change your position frequently. This is the principle behind ergonomics. For example, sit down to put on your shoes, and use a cart to move belongings.

Ankylosing spondylitis is a challenging condition, but there are resources available and musculoskeletal healthcare professionals who can help you. Assemble your medical team, communicate with them regularly, and don’t hesitate to ask for help when you need it.

John Indalecio, occupational and certified hand therapist

John Indalecio is an occupational therapist and certified hand therapist at the Hand and Upper Extremity Therapy Center at Hospital for Special Surgery.



The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.