Why I relished my first physiotherapy appointment for AS
Finding safe exercises is key to managing my ankylosing spondylitis
A twinkly-eyed lady with a hospital name tag whisked the clinical dove-gray curtain along its track, giving the two of us some privacy from the rest of the ward. But don’t worry, I wasn’t in the hospital for an invasive procedure, or because of a new problem with my ankylosing spondylitis (AS). The appointment was something I’d been excitedly awaiting for months — my first visit to the physiotherapy department.
Assistance with exercise and mobility for my AS is something I’ve been chasing for a while. One of the first things a rheumatologist explained to me was that movement is critical for managing my AS because it keeps the joints flexible.
What he didn’t mention was that certain movements or exercises can actually make my joints feel worse. I was simply handed a smudged photocopy demonstrating a few helpful stretches for AS and sent on my merry way.
Finding exercises that don’t cause AS pain is hard
I love getting regular exercise, but sometimes it doesn’t love me back. I’m currently able to do my 30-minute brisk walk around the neighborhood park — which I’m grateful for because, during an AS flare, I can barely walk down the street. But many other simple exercises drastically increase the pain in my shoulder blades, middle (or thoracic) spine, or sacroiliac joints.
For the last few years I’ve been steering clear of anything that seems to make my joint pain worse. The long list of things I avoid includes compound exercises like dead lifts and shoulder or chest exercises like pushups. I’ve found in particular that any exercise that focuses on a single leg, like a walking lunge, makes me feel just awful the next day.
The hardest part about figuring out which movements my body can cope with, and what I should avoid, is that I don’t feel any discomfort while doing the exercise. I can be smiling happily to myself and thinking, “Hey, I’ve got this! I feel just fine!” as I add an extra 10 pounds to the barbell, but it’s not until the next day that I wake up with my joints screaming in protest.
The discomfort from performing the wrong exercise doesn’t feel like muscle soreness. It’s not the tenderness you feel after you’ve done a few hefty rounds at the gym and then realize you’ve got jelly legs. The bone-deep AS ache in my joints after some gym routines feels more like burning coals inside my hip joints or spine.
Going back to basics
What I wanted to know from a trained physiotherapist is, firstly, am I doing my little list of “safe” exercises correctly, and secondly, what movements can I add to expand my range of motion? I’m hoping to find exercises that will be beneficial for my ankylosing spondylitis and improve my strength and flexibility (plus the lovely dopamine hit I get from exercise).
After my new therapist checked my mobility by guiding me through a range of movements in the hospital cubicle, I excitedly explained what I was hoping to achieve. But instead of jumping into giving me a new exercise routine, she gently explained that I needed to get the basics right first.
Apparently, my thoracic spine has almost no movement, something I’d never fully realized. (I’m not an owl with a fully rotating head, after all.)
Instead of heart-pumping, muscle-building exercises, the therapist gave me a short list of stretches to perform daily for the next two weeks, personalized to my body’s requirements. What’s made all the difference is that she showed me exactly how to correct my posture and gave me very specific advice on where I’m going wrong, and probably have been for years. This individualized advice is brilliant because it’s not the kind of information I could learn from trying to mimic a video or image of the same stretch.
I’m so grateful that I’m able to access the physiotherapy department through the hospital system here in Australia, after requesting a referral through my rheumatologist. I’m not yet sure how many appointments I’ll be allocated, but I’m always excited to arm myself with any strategies that will help me manage this challenging disease.
Note: Ankylosing Spondylitis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Ankylosing Spondylitis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to ankylosing spondylitis.
About the Author
George
I know to be wary of physical therapy (the therapists and the regime) like the plague. I do want to know what is recommended though. I'm jealous you got personalized true expert help. My AS situation is trial and error and I continue to learn a lot. I do have the advantage that exercise and activity has always been a major priority for me (in between my now uncontrolled lengthy rest periods). I do not need to be pushed or coaxed. What I don't know is how much of that is a result of having AS, but obviously a lot.
Jemma Newman
Argh yes I'm also a bit wary of physical therapy, having seen Dave's symptoms get worse after a few ill-advised movements. I don't think many physios have experience with AS, which is why it's so great to go through the hospital. You sound like such a proactive person, I always appreciate your thoughts and encouragement!