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1st Jan

2013

Physical Therapy with Manual Therapy Helpful for Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a form of inflammatory arthritis which affects primarily the spine, ribs, and pelvis (sacroiliac joints), but which may also affect the hips, shoulders, heels and small joints of the hands and feet. The disorder, which affects males more than females typically with onset in their late teens or 20s, causes inflammation, pain and stiffness in affected joints and attachments of ligaments and tendons, which can lead to new bone formation and partial or complete fusion (ankylosis), with the spine becoming immobile in a forward bent position. Some studies have shown weakness and partial paralysis (denervation) of back extensor muscles, theorized to contribute to the forward bent posture.

Almost all people with AS experience acute painful episodes, followed by temporary periods of remission, and the inflammation process usually ceases after 10-15 years. Genetics play a key role in AS, and 90-95% of the population with AS have a genetic marker called HLA-B27, but it is believed that other genes, as well as factors such as bacterial infections, are involved in triggering the onset of AS.

The diagnosis is typically established by the clinical presentation, laboratory studies showing the HLA-B27 marker and elevated sedimentation rate during acute episodes, and x-ray findings once extra bone has started to form in the spine and involved joints.

Physical therapy has been successfully utilized internationally for AS for many decades, in particular wherever orthopedic manual therapy is common practice, however research evidence has been sparse until lately. In 2009, a paper was published which looked at the Cochrane Musculoskeletal Group’s (independent group analyzing high-quality evidence) analysis of 11 studies with over 700 people with AS. They found that both individual and supervised exercise programs in physical therapy improved spinal movement and function more than no therapy, and that group exercises are better than home exercises, and improve movement and overall well-being.

A subsequent Cochrane Database review published in 2011 showed evidence that exercise is an effective physical therapy modality with respect to pain, spinal mobility, function, disease activity, depression, fatigue, quality of life, and a number of respiratory measures. It also stated that manual therapy shows promising results in terms of chest expansion, posture and spinal mobility.

The goal of treatment is to decrease pain and inflammation, maintain or improve spinal and joint mobility until the acute disease has ended, improve function of back extensor muscles and other key muscles, improve posture and prevent severe deformity, maintain or improve rib mobility and respiratory function, and in general improve function and quality of life.

Manual joint mobilization and specific exercise to improve joint mobility coupled with high repetition low to moderate intensity painfree resistance exercise can in particular be of value for people with AS.

With this first newsletter of 2013, I wish you a year of good health. If you know of anyone with ankylosing spondylitis, please feel free to forward this information, since I have found that physical therapy and in particular orthopedic manual therapy is not routinely being prescribed by the medical community. Also feel free to visit our website (click Homepage on top of the letter) to read past newsletters.

Best wishes,

Gunnar

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