Back Pain Relief from 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.

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, where the spine articulates with the back of the pelvis, become inflamed and painful. As the disease progresses, ossification is triggered by the Immune system’s 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

  • Dull low back pain and localized stiffness involving 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 of the spine as the symptoms progress up the spine.
  • Stiffness and discomfort of the hips, shoulder and ankle joints arise.
  • Symptoms tend to worsen in the morning and following 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 physician prescribed non-steroidal anti-inflammatory medicine.
  • Adhere to a physical therapy program that will strengthen back muscles, improve posture, increase flexibility and range of motion, and techniques to enhance breathing.
  • Consistently participate in activities that help alleviate stiffness. Warm baths, stretching activities performed in bed prior to rising and aquatics activities such as swimming and pool running are strongly advised.
  • Management may also include the use of drugs that block cell growth (cytotoxic drugs) in people who do not respond well to 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

Here’s 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 can I expect with this disorder?
  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 from Mike Ryan

  • IMPROVE YOUR RANGE.  Regular daily exercise is an effective method to deal with symptoms of AS. Complete body flexibility exercises are needed to maintain joint motion from head to toe.
  • WATCH YOUR WEIGHT. Maintain your optimum weight and embracing a healthy diet will minimize the stress on your spine.
  • STAY HOT. Use a heat pack and warm baths help to increase the blood flow to the spine and surrounding tissue to help reduce pain and stiffness.
  • AIM TO BE ACTIVE. It is very important to understand that excessive rest is not the best solution to decreasing your stiffness. Maintain an active lifestyle.
  • ALWAYS WATCH YOUR STEP. Sports carrying a higher risk of falls such as skiing as horseback are best avoided to minimize the risk for spinal fractures.
  •  GAIN BY REDUCING THE PAIN.  Deep tissue massage, ultrasound, passive stretching, heat/ice and acupuncture may all have a positive 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 while rapid twisting movements should be avoided.

What to Do When Suffering from “Damn Back” aka Spondylolysis

Spondylolysis is a condition created when a localized fracture of the bony arch, referred to as the pars interarticularis. This injury is most commonly located in the lumbar spine. This stress fracture is usually do to excessive force or repeated strain. Learn how to fix that “damn back” problem.

Understanding Spondylolysis

Spondylolysis is a condition created when a localized fracture of the bony arch, referred to as the pars interarticularis. This injury is most commonly located in the lumbar spine. This stress fracture is usually do to excessive force or repeated strain. This low back injury is typically found unilateral and if it becomes bilateral, it can easily progress into spondylolysthesis, characterized as having bilateral fractures and a forward “slippage” of the body of the vertebral spine.  An injury to the pars interarticularis is often referred to as a pars defect.

Young athletes participating in sports which involve contact, backward bending and aggressive rotation such as football, wrestling, martial arts and gymnasts are more succesptable to suffering this type of a back injury.  A comprehensive history is needed to determine if past activities contributed to the current low back pain. Obtaining lumbar spine x-ray, CT scans or even MRI may be required to confirm the diagnosis.

Signs & Symptoms of Spondylolysis

  • Pain and stiffness located at the center of the lower back.
  • An increase in symptoms with backwards bending or lumbar extension.
  • Patient notices an increase in symptoms with an increase in activities and an decrease in symptoms with rest.
  • With more severe cases of spondylolysis, the patients can experience pain radiating down one or both legs which is referred to as neurogenic pain.
  • A localized ache or stabbing pain involving the central low back region following prolonged standing or sitting.
  • If nerves are involved, there may be a decrease in lower extremity reflexes and/or the sensation of pins and needles in the low back, hips or legs.

Professional Treatment for Spondylolysis

Treatment of symptoms from these stress fractures are often accomplished in 3 general steps.  Initially, the low back is “quieted down” followed by efforts to improve both the core strength and core flexibility and lastly, returning to normal activities with a comprehensive education of the “Do’s and Don’t’s” to avoid any setbacks.

  • Implement an aggressive flexibility plan focusing on the low back, hamstrings, quads, groins and hip flexors.
  • Using a low back brace if needed to stabilize the lower back and pelvis during functional activities.
  • Initiate a progressive core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid excessive lumbar extension.
  • Continue to apply ice to the entire low back while resting on a firm surface with a pillow under your abdomen.  Only when the main symptom is “stiffness” should heat  be used.  The heating can be utilized via a hot tub, heating pad or hot packs.
  • Postural training to promote a painfree posture involving the pelvis, low back, upper back, shoulders, neck and head.  All of these areas have a direct impact to the lumbar spine and the pars defect.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Avoid all activities and positions that promote hyper-extension of the lower lumbar spine.  This “sway back” or lordotic curve is normal and necessary but when it becomes excessive and the pelvis rolls too far forward, that’s when spondylolysis becomes painful.
  • Slowly progress with low back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises.
  • In extreme cases where non-surgical treatments becomes ineffective, a surgical laminectomy or posterior lumbar fusion is considered.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. How bad is my back injury and do I have spondylolysis or spondylolysthesis?
  2. Can you show me the “Scotty Dog” view on my x-ray?  This is a key view on an x-ray of the lumbar spine used to confirm the diagnosis for and the difference between spondylolysis and spondylolysthesis.
  3. How can I alleviate the pain I’m currently experiencing without causing further injury to my back?
  4. What activities and exercises do I need to avoid while I rehab my back to significantly improve my back function?

Elite Sports Medicine Tips from Mike Ryan

  • Stick to the Plan – Your specific physical therapy program is individually planned for you. The program may take weeks or months but stick to the plan to ensure an optimum recovery.
  • Balance is the Best –  Your goal is to attain the perfect combination between strength and flexibility of your paraspinal and abdominal muscle groups.
  • The Nasty S Word – Sitting may be easy to do but it can destroy your low back.  Learn to sitting properly and do as little of it as possible.
  • Body Mechanics is Key – As with sitting, poor body mechanics with standing and lifting will hurt your back very quickly.  Become a believer in that and you will quickly get back to an active lifestyle.
  • Become The Ab King – Flexible low back muscles with strong Abs is the winning combo with spondylo.
  • Know the Good C Curve – With standing and walking, the “C” curve of your low back has it’s opening facing backwards.  Strive to maintain the “Good C Curve” and your back will thank you.