8 Exercise Dos and Don’ts for Ankylosing Spondylitis

Exercise is good for just about everybody. It can make us stronger, more flexible, and better able to handle the ups and downs of life. This is also true for people with arthritis — and especially for those with ankylosing spondylitis, a form of arthritis that primarily affects the spine and can lead to chronic pain and stiffness.

In fact, exercise is a vital part of the treatment equation for spondyloarthritis, including ankylosing spondylitis (AS), according to the Spondylitis Association of America (SAA). Exercise is crucial to help people with AS maintain joint motion and function. It can also help ease pain, improve posture, tackle muscle imbalances, make it easier to breathe, and enhance your overall quality of life.

There are many effective exercise options, so you don’t have to worry about getting bored with your workout routine. “As long as it doesn’t make you feel worse, then most exercise can be good for you,” notes Arya N. Shamie, MD, a professor and the chief of orthopedic spine surgery at the UCLA School of Medicine. But it’s important to make sure you’re exercising properly and that you’re careful, especially during flare-ups, to avoid aggravating your condition. Here are some general dos and don’ts for exercising if you have ankylosing spondylitis:

1. Do Work With a Physical Therapist

A skilled physical therapist can help you create an exercise routine tailored to your specific needs. Ask your doctor or rheumatologist for a recommendation.

2. Do Make Time to Exercise Every Day

Finding time every day to work on building or maintaining strength, flexibility, and function is essential. Set aside a regular time to exercise that works for you. You may even want to schedule your workout like you would a meeting or an appointment to help you stick to it. With 24 hours in the day, if you exercise for even 20 minutes, you’ll notice the benefits and still have a lot of time for other things.

3. Don’t Just Do One Form of Exercise

Aim for a combination of stretching, posture-focus, range-of-motion, cardiovascular, and strengthening exercises, especially in the hips. Lan Boehme, a physical therapist for UCLA Health in Los Angeles, says that if your hips are weak, your spine will try to compensate — and that can lead to unhealthy posture and pain. “We can’t change the spine,” says Boehme, “but we can change the mobility of what the spine sits on.”

4. Don’t Do Movements That Cause Pain

Any exercise that requires you to twist your spine too much or that stresses your back and spine could cause problems, according to Versus Arthritis. Carefully consider high-impact exercises, such as running, or jarring and twisting sports, such as tennis, squash, and racquetball. These could increase pain in the spine, hips, and knees.

5. Don’t Assume Some Sports Are Automatically Off Limits

If you love to run, you can probably continue to run — but maybe not during flare-ups. Advances in treatment and medication have allowed many people with AS to maintain their posture and strength and to continue to do the activities they love, says Dr. Shamie. But if your neck and spine are stiff, certain activities, such as contact sports, can increase your risk of bone fractures, particularly in your spine. If you’re considering a contact sport or other high-impact exercise, talk to your doctor or physical therapist first.

6. Do Focus on Good Posture

Because ankylosing spondylitis primarily affects the spine, maintaining good posture with all of your exercises is essential. You should do regular posture checks: Back up to a wall. Place your heels and buttocks against the wall. Can you get your shoulders back against the wall? Can you get your head back to touch the wall? The Mayo Clinic also recommends practicing standing straight in front of a mirror to help improve posture. Your physical therapist can recommend additional posture exercises.

7. Don’t Overdo It 

Start slowly, especially if you’re new to exercising or if you’re experiencing a flare. Disease activity fluctuates, so if pain and stiffness are worse, ease off your activities. If you’re feeling okay, you may be able to increase the frequency or intensity of your exercise. If an exercise causes more than mild aches and pains, stop doing that exercise and talk to your doctor.

8. Do Stick With It

An exercise program is only effective if you keep doing it consistently, according to the SAA. Find exercises and activities you enjoy, and involve your family and friends. Walking is usually a comfortable activity, so take the kids and the dog for a walk. Just remember to work with your doctor and physical therapist before starting or changing any exercise program — they can help ensure you’re performing all exercises safely and provide modifications to suit your needs.

When you’re exercising, you’re doing something good for yourself. And chances are you’ll feel good, too. Enjoy it!