Why Do I Have Back Pain?
Ankylosing Spondylitis Means a Lifelong Commitment to Exercise
A diagnosis of ankylosing spondylitis no longer means a lifetime of restrictions. But AS patients cannot be couch potatoes.
By Dr. Sanjay Gupta
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Patients with ankylosing spondylitis have a much better prognosis today than they did a generation ago. Ben Everett climbs mountains, literally. But to keep his disease at bay, Ben meets regularly with Jenny Gallinaro, a physical therapist at New York University Medical Center’s Center for Musculoskeletal Care.
“What I did with Ben was take him through an evaluation,” she says, “to find areas that he was most restricted in — so where was he least flexible, where was he weakest.”
Everett is a healthy-looking 30-year-old who likes hiking, fishing and other outdoor activities. He came to Gallinaro after he had been diagnosed with ankylosing spondylitis, an inflammatory form of arthritis that attacks the lower back and spine.
In extreme cases, the vertebrae of the spine can fuse together, becoming stiff, and rod-like. Luckily, Everett’s case was caught before any such damage could set in. And committing to a daily exercise routine is one way to help make sure it never does.
After years of back pain, Everett began taking medication right after he was diagnosed, which made him feel so much better, he was able to jump right into an exercise routine. Gallinaro set to work, using a regimen that applies to AS patients, focusing on the joints in the spine and lower back.
“Stretching the muscles around the joints that are stiff is very helpful, doing some mobilization of the joint itself if appropriate is helpful, also strengthening to help stabilize and support them," she says. “It’s also important to work on posture, and also get them to expand their ribs and their lungs.”
In a typical session, Gallinaro stretches Everett’s spine and hips, then he goes to work on a rowing machine and with a set of stretching bands. Everett has incorporated Gallinaro’s exercises into his daily gym workout.
“I think the most important factor in my well-being now would be two things,” he says. “One would be being on the medicine, and also being consistent with the physical therapy and exercise which is always the harder part of that.“
Rheumatologists, including Everett’s doctor, Jonathan Samuels, MD, at NYU, agree that medication can only do so much.
Exercise and physical therapy have to become “part of the patient’s daily regimen,” Dr. Samuels says. “They brush their teeth, they do the stretches and really maintain the strength of those core muscles that will really enable them to feel better.”
The commitment has paid off for Everett, who climbed the Rockies last summer.
“It’s a very scary sounding diagnosis, but the treatment can work extremely well, and to be honest I rarely think about the fact that I have this in an average week. It doesn’t really impact what I’m able to do or how I’m going about my life,” Everett says.
The combination of regular exercise and medication is helping Everett stay fit, but it cannot cure the disease. Gallinaro remains aware of the limitations of the treatment for more advanced AS patients.
“We won’t change the fact that the spine is fused,” she says. “That’s going to be there for life, but we can continue… to try to increase the flexibility of the muscles around the joints and also continue to get them stronger.”
Many forms of exercise can be appropriate for AS patients. Medical studies have shown Pilates to be effective.
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