Ankylosing Spondylitis, Posture and Spine Stiffness Therapy at Home
Therapy for Ankylosing Spondylitis and Spine Stiffness
Physical and occupational therapy for a stiff spine: exercise, posture and daily habits that keep you moving.
ELEVATE provides in-home rehabilitation for adults with ankylosing spondylitis, spine stiffness and posture problems in Oakland and Macomb County, Michigan. Licensed physical and occupational therapists build strength, flexibility, posture and daily routines alongside the care your physician provides.
- Ankylosing spondylitis is a type of arthritis that causes inflammation in the joints and ligaments of the spine. It may also affect the hips, knees and ankles, and in severe cases the vertebrae can fuse, leading to a rigid spine (NIAMS).
- The most common symptom is lower back or hip pain and stiffness that typically worsens with rest or inactivity. Movement and exercise usually help.
- There is no cure, but treatment helps. NIAMS notes that in most cases treatment includes medication and physical therapy, and that most people with the disease can have productive lives with treatment.
- Not every stiff or rounded back is ankylosing spondylitis. Posture also reflects muscle strength, joint mobility, pain, habits and bone health, and therapy can address those.
- ELEVATE Therapy Services brings therapy to your home in Oakland and Macomb County, Michigan. Visits are private-pay and one-on-one.
What ankylosing spondylitis is, and why posture changes
Ankylosing spondylitis is a type of arthritis that causes inflammation in the joints and ligaments of the spine. It may also affect peripheral joints such as the knees, ankles and hips. Normally, the joints and ligaments of the spine help us move and bend. When they are inflamed, the spine becomes stiff. In severe cases the vertebrae (the bones of the spine) can fuse together, which leads to a rigid, inflexible spine.
Many people have mild episodes of back pain and stiffness that come and go. Others have severe, ongoing pain with loss of flexibility. Symptoms may worsen in “flares” and improve during periods of remission. Depending on which other areas are affected, some people also develop eye disease (uveitis), skin disease (psoriasis) or gut disease (inflammatory bowel disease).
Posture and spine stiffness without ankylosing spondylitis
Not everyone with a stiff spine or rounded posture has ankylosing spondylitis. Posture reflects muscle strength, joint mobility, pain, daily habits, work and sleep positions and bone health, and a therapist looks at all of them. Back pain that is worse at rest, better with movement and started before age 45 is worth raising with your physician.
Causes and risk factors
Researchers do not know the cause of ankylosing spondylitis. Studies show that both genes and environment may play a part.
- Genes: the HLA-B27 gene increases the risk, but many people have the gene and never develop the disease, so no single gene explains it.
- Family history: if a family member has ankylosing spondylitis you are more likely to develop it.
- Age: most people develop symptoms before age 45, although some develop the disease as children or teens.
- Other conditions: people who have Crohn’s disease, ulcerative colitis or psoriasis may be more likely to develop it.
For posture and stiffness in general, common contributors are long periods of sitting, weak back, hip and core muscles, pain that makes you guard your movement, and bone loss or spine fractures. See our arthritis and osteoporosis guide and our low back and neck pain guide.
Common signs and symptoms
Symptoms vary from person to person. Doctors diagnose ankylosing spondylitis with a medical and family history, a physical exam, imaging such as X-rays and MRI, and lab tests. No single test diagnoses it.
| Sign | What it is | Who helps |
|---|---|---|
| Lower back and hip pain with stiffness | The most common symptom. Over time it may spread to other areas of the spine or body. | Your physician, physical therapy |
| Pain that is worse at rest | Pain typically worsens during rest or inactivity, so some people wake in the middle of the night or hurt after prolonged sitting. Moving and exercise usually help. | Physical therapy |
| Difficulty taking a deep breath | Possible if the joints connecting the ribs are affected. | Your physician, physical therapy |
| Pain and stiffness in other joints | Ribs, shoulders, knees or feet may be affected. | Physical therapy, occupational therapy |
| Fatigue | Feeling very tired is common with the disease. | Occupational therapy, your physician |
| Eye pain and vision changes | May be uveitis, an inflammation of the eye, and needs prompt medical care. | Your physician |
| Loss of flexibility and posture change | In severe cases the vertebrae can fuse, which leads to a rigid spine. | Physical therapy, occupational therapy |
When to get help
Call your physician promptly for eye pain, redness or vision changes, a sudden flare of pain and stiffness, new joint swelling, or back pain with fever or unexplained weight loss. If you have had stiff-back pain for months, especially if it began before age 45 and eases with movement, ask your physician about an evaluation.
How it affects daily life
| What a person may notice | Why it happens | Who helps |
|---|---|---|
| Stiffness after resting that eases once you move | The pain of ankylosing spondylitis typically worsens during rest or inactivity, and movement usually helps, so staying active matters. | Physical therapy |
| Trouble bending to put on socks or pick things up | Spine stiffness limits bending. NIAMS notes a device to grab or pick up items can help. | Occupational therapy, AdaPTive Mobility Solutions |
| Poor sleep or waking at night with back pain | Pain is often worse during the rest of the night. A physical therapist can recommend the best sleeping positions. | Physical therapy |
| A rounded or forward-leaning posture | Stiff joints and weak supporting muscles change how the spine is held. Therapy aims to improve and maintain posture. | Physical therapy |
| Tiredness through the day | Fatigue is a common symptom, so tasks may need to be paced and planned. | Occupational therapy |
| Difficulty taking a full breath | Stiffness at the joints that connect the ribs can limit chest movement. | Physical therapy, your physician |
How care works
NIAMS describes the goals of treatment as relieving symptoms, helping maintain proper posture, flexibility and strength, and halting or slowing progression of the disease. Your physician, often a rheumatologist, manages medications. Therapy is a core part of the plan, and it works best when you stay active.
- Evaluation: your physician confirms the diagnosis and manages inflammation, often with medication.
- Therapy: a physical therapist builds an exercise program to strengthen back, neck and core muscles and keep joints flexible.
- Daily habits: posture, sleeping positions, work set-up and pacing are practiced in your own home.
- Long term: a home program you can continue, adjusted during flares and remission.
The 2019 American College of Rheumatology, Spondylitis Association of America and SPARTAN treatment recommendations favor active physical therapy, meaning supervised exercise, over passive approaches such as massage, ultrasound and heat.
What PT and OT each do
Physical therapy: stay strong, flexible and upright
- Assessment of spine and hip motion, posture, chest expansion, strength and walking
- Strengthening of the back, neck, core and abdominal muscles that support the spine
- Flexibility and mobility work for the spine, hips and shoulders, with a written home program
- Posture training for sitting, standing, driving and sleeping, including the best sleeping positions
- Breathing and chest-mobility exercises when rib stiffness limits deep breaths
- Low-impact aerobic activity and balance work, with guidance for flares, and a plan for staying active long term
Occupational therapy: simplify daily tasks
- Joint-protection and energy-pacing strategies for fatigue and flares
- Easier ways to dress, bathe, reach and bend, including reaching aids and other devices
- Work, desk and vehicle set-up that supports better posture
- Home safety review and equipment recommendations with AdaPTive Mobility Solutions
Supporting services
These services complement rehabilitation and do not replace your medical care.
What an ELEVATE home visit looks like
- Review: your symptoms, how long they have been present, what makes them better or worse, medicines and your physician’s recommendations.
- Assessment: spine, hip and shoulder motion, posture, chest expansion, strength, balance and how you manage daily tasks at home.
- Plan: goals that matter to you and a written home exercise and posture program.
- Progress checks: motion, strength and function measures, and adjustments for flares.
- Communication: progress shared with your physician or rheumatologist as appropriate.
ELEVATE serves adults in Oakland and Macomb County, Michigan, with licensed physical and occupational therapists. ELEVATE visits are private-pay. Some plans may offer out-of-network reimbursement, so check with your plan, and see our Payments & Insurance page or call us with questions.
Questions families ask
Can ankylosing spondylitis be cured?
Why is my back worse after resting and better when I move?
Does having the HLA-B27 gene mean I have it?
What kind of exercise is best?
Can therapy fix my posture?
Does home therapy replace my doctor’s care?
How is care paid for?
Trusted resources for ankylosing spondylitis and spine health
These organizations are the leading sources of education and support for this condition. We are not affiliated with them.
Related guides
Browse every condition we treat on our Conditions We Treat page.
Sources and medical note
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Ankylosing Spondylitis and Ankylosing Spondylitis: Diagnosis, Treatment, and Steps to Take.
- Ward MM et al. 2019 Update of the ACR/SAA/SPARTAN Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care & Research. 2019;71(10):1285-1299. doi:10.1002/acr.24025.
- Spondylitis Association of America: spondylitis.org.
- MedlinePlus: Ankylosing Spondylitis.
This guide is general education and is not medical advice. Follow the instructions of your physician. If you think you are having an emergency, call 911.
Contact Elevate Therapy Services
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Phone: (248) 266-5721
Fax: (586) 788-1704
