Ankylosing Spondylitis Posture: Effects and Tips

Ankylosing Spondylitis Posture: Effects and Tips


Ankylosing spondylitis (AS) is a chronic (long-term) inflammatory condition that primarily affects the spine, leading to pain, stiffness, and changes in posture. At least 1.7 million adults in the United States have this condition.

Ankylosing spondylitis symptoms vary from person to person. Common early symptoms are frequent pain and stiffness in the lower back and buttocks.

This condition can significantly affect posture, causing issues such as forward head posture, reduced lumbar curvature, and pelvic rotation.

Ankylosing spondylitis is a type of arthritis that causes inflammation in the joints and ligaments of the spine. It can also affect joints like the ankles, knees, and hips.

Your spine’s joints and ligaments normally help you move and bend easily. However, if you have AS, the inflammation can make these joints stiff. In severe cases, it can even make the bones in your spine grow, or fuse, together. This makes your spine less flexible.

This stiffness can affect your posture because your spine can’t move as it should. Some people with this condition have mild back pain and stiffness that comes and goes, while others have more constant and severe pain.

Depending on which other parts of your body are affected by the disease, you may also have other symptoms like uveitis (inflammation of the eyes). AS may also affect the joints between your breastbone and ribs, making it difficult to expand your chest as you normally would.

Common posture symptoms in ankylosing spondylitis include:

  • Forward head posture: The head may jut forward from the shoulders, leading to neck strain and discomfort.
  • Reduced lumbar lordosis: The natural curve in the lower back (lumbar spine) may decrease, resulting in a flatter back appearance.
  • Kyphosis (hunched upper back): The upper spine may curve forward excessively, causing a rounded or hunched appearance.
  • Pelvic tilt: The pelvis may tilt backward, affecting the alignment of the spine and hips.
  • Limited spinal mobility: Stiffness and reduced flexibility in the spine can lead to difficulty in bending or twisting the torso.

Not addressing posture issues in AS may lead to several consequences, including increased pain and stiffness, reduced range of motion, and spinal deformities.

Posture refers to the way you position and hold your body, encompassing both dynamic and static aspects:

  • Dynamic posture: How your body is positioned during movement, such as walking, running, or bending
  • Static posture: Your body’s alignment at rest, such as when sitting, standing, or sleeping

Maintaining good posture is crucial for overall well-being. The backbone of good posture lies in the alignment of your spine, which naturally forms three curves: at the neck, mid-back, and lower back. Proper posture preserves these curves without exaggerating them, ensuring that your head aligns with your shoulders and your shoulders align with your hips.

The effects of posture on health can be significant. For example:

  • It may lead to misalignment in the musculoskeletal system, potentially causing discomfort and dysfunction.
  • It can contribute to spinal wear and tear, making the spine more vulnerable to injuries.
  • It is often associated with neck, shoulder, and back pain, limiting comfort and mobility.
  • It can reduce flexibility and compromise joint movement.
  • It can affect balance, increasing the risk of falls and injuries.
  • It can interfere with digestion and respiratory function, affecting overall health and well-being.

Ankylosing spondylitis primarily affects the spine, leading to pain, stiffness, and reduced flexibility. Maintaining proper posture can help alleviate symptoms and improve the quality of life for people with this condition. Proper posture training may also help prevent falling.

Here are some tips and strategies for improving posture and incorporating these changes into everyday life.

Standing Posture

When standing, think about aligning your body from your ankles through the top of your head:

  • Stand tall with your shoulders back
  • Keep your head level (e.g., tuck your chin a bit if it tends to jut forward)
  • Avoid slouching or leaning forward
  • Stand with your feet firmly on the ground
  • Keep your weight even distributed in your feet, but lean slightly onto the balls of your feet

Sitting Posture

When sitting, try to keep your head in line with your hips, which can help prevent forward slouching. Avoid sitting for long periods of time by taking frequent movement (e.g., walking) or stretch breaks. You can also do some simple seated stretches or change your seated position if you can’t get up. Here are some more tips:

  • Keep your back straight
  • Relax your shoulders to avoid them creeping up toward your ears (imagine a string gently pulling your shoulder blades downward)
  • Use a cushion to support your back
  • Keep your computer screen at eye level
  • Keep your elbows close to your body, around 90-120 degrees, when working at a desk
  • Avoid sitting in cramped positions
  • Avoid looking down at your phone (“texting neck”) by keeping your phone at eye level
  • Alternate between standing and sitting to prevent stiffness

Sleeping Posture

You can even practice posture in bed. How you sleep can greatly affect how you feel during the day. Here are some ideas:

  • Sleep on a mattress that evenly distributes your weight and has a supportive foundation
  • Sleep on your back with no pillow or a thin pillow
  • Place a pillow between your knees if you sleep on your side
  • Avoid sleeping on your stomach
  • Ensure your head, neck, and spine are aligned during sleep
  • Try gentle stretches before bed to reduce stiffness and improve sleep quality

A physical therapist (PT) can design a tailored exercise program to improve your posture and reduce pain. They can help with joint-directed exercises that promote spinal extension (the opposite of a hunched-over posture) and mobility.

PT might include:

  • Strength exercises (e.g., to strengthen back abdominal muscles)
  • Flexibility exercises to support mobility
  • Low-impact aerobic exercise like swimming, bike riding, and walking
  • Deep breathing exercises to support chest expansion and oxygen and blood flow to your body

Talk to your healthcare provider about medications that can reduce your symptoms and support your ability to perform posture-related exercises. For example:

  • First-line pain medications include nonsteroidal anti-inflammatory drugs (NSAIDs).
  • For localized joint swelling, corticosteroid injections into the joint or tendon sheath can be quickly effective.
  • In the case that these above medications are ineffective, disease-modifying antirheumatic drugs (DMARDs) may be used to relieve symptoms and prevent joint damage.
  • Some biologics (a class of drugs that require a living component) may help treat spinal and peripheral joint symptoms.

Improving posture with AS requires a multifaceted approach that includes proper standing, sitting, and sleeping habits, as well as regular exercises and stretches. Incorporating these strategies into your daily routine can help alleviate symptoms and improve your overall quality of life.

Incorporating proper posture habits and regular exercises into your daily routine can significantly r reduce symptoms of ankylosing spondylitis. For example, you can focus on maintaining a tall, aligned posture whether standing, sitting, or sleeping to reduce strain on your spine.

Regular stretching and strengthening exercises and physical therapy can improve flexibility and mobility. Medications can also be crucial in managing symptoms like pain and increasing your ability to engage in posture-improving activities.

Talk with your healthcare provider to discuss how you can effectively manage the effects of ankylosing spondylitis.

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