How to Exercise with AS: Safe & Effective

by

Ankylosing Spondylitis (AS) can feel like a relentless battle against stiffness, pain, and restricted movement. Yet, exercise isn’t just a recommendation; it’s a powerful, non-pharmacological cornerstone of managing AS. It’s about more than just staying active; it’s about strategically moving your body to preserve spinal mobility, strengthen supporting muscles, improve posture, and enhance overall quality of life. This definitive guide cuts through the noise, offering clear, actionable exercise strategies to help you navigate AS with greater ease and confidence.

Understanding the AS-Exercise Connection: Why Movement Matters

AS primarily affects the spine, leading to inflammation that can cause stiffness, pain, and, in severe cases, fusion of the vertebrae. The natural inclination might be to rest, but inactivity often exacerbates symptoms. Regular, targeted exercise counters the effects of AS by:

  • Maintaining Spinal Flexibility: Movement helps prevent joints from stiffening and fusing, preserving your range of motion.

  • Strengthening Core and Back Muscles: Stronger muscles support the spine, reduce pain, and improve posture, combating the common stooped posture associated with AS.

  • Improving Posture: Specific exercises can help you maintain an upright posture, which is crucial for preventing kyphosis (a forward curvature of the upper spine).

  • Enhancing Lung Capacity: As AS can affect the rib cage and breathing, exercises that promote chest expansion are vital.

  • Boosting Cardiovascular Health: Chronic inflammation in AS increases the risk of heart disease, making aerobic exercise particularly important.

  • Reducing Pain and Fatigue: Regular physical activity can release endorphins, acting as natural pain relievers, and improve sleep, thus reducing fatigue.

  • Improving Balance: AS can affect proprioception and balance, increasing the risk of falls, especially with long-term steroid use that can lead to osteoporosis. Balance exercises are key for stability.

Before embarking on any new exercise regimen, a crucial first step is always to consult with your rheumatologist or a physical therapist experienced in AS. They can assess your specific condition, identify any limitations, and help tailor a safe and effective program for your individual needs.

Essential Pillars of an AS Exercise Program

A well-rounded AS exercise program should integrate four key types of physical activity: stretching, strengthening, cardiovascular exercise, and balance training. Consistency is paramount; aim for daily movement, even if it’s just a few minutes of targeted stretches.

1. Stretching: Unlocking Spinal Mobility and Flexibility

Stretching is arguably the most critical component for individuals with AS. It directly addresses stiffness and helps maintain the range of motion in your spine and other affected joints. Perform these stretches slowly and gently, holding each for 15-30 seconds, and never push into pain.

  • Spinal Extension (Press-Up):
    • How to do it: Lie on your stomach with your forearms on the floor, elbows directly under your shoulders. Gently push through your forearms to lift your chest off the floor, keeping your hips and pelvis grounded. You should feel a gentle arch in your lower back. If comfortable, you can extend your arms further, pushing up more while keeping the hips down.

    • Why it helps AS: This stretch directly counteracts the forward-flexing posture common in AS, promoting spinal extension and flexibility in the lumbar and thoracic spine.

    • Concrete Example: Imagine you’re trying to gently “peel” your upper body off the floor like a snake, leading with your chest, without lifting your hips. Hold for a count of 15, then slowly lower. Repeat 3-5 times.

  • Cat-Cow Stretch:

    • How to do it: Start on your hands and knees, wrists under shoulders and knees under hips. Inhale as you drop your belly toward the floor, lift your tailbone, and gently look up (Cow pose). Exhale as you round your spine toward the ceiling, tucking your chin to your chest (Cat pose).

    • Why it helps AS: This dynamic stretch mobilizes the entire spine, improving flexibility and circulation to the spinal joints. It encourages both flexion and extension, which are essential movements for maintaining spinal health in AS.

    • Concrete Example: As you inhale, imagine a string pulling your belly button towards the floor. As you exhale, imagine a string pulling your spine up to the ceiling, like a Halloween cat. Flow smoothly between these two positions for 8-10 repetitions.

  • Chest Expansion:

    • How to do it: Stand or sit tall with feet shoulder-width apart. Interlace your fingers behind your back or hold a towel between your hands. As you inhale deeply, gently pull your shoulder blades together and lift your arms slightly away from your body, opening your chest. Keep your gaze forward.

    • Why it helps AS: AS can affect the rib cage, restricting breathing. This stretch helps expand the chest and improve thoracic spine mobility, facilitating deeper breaths.

    • Concrete Example: Stand in a doorway, place your forearms on the doorframe, and gently lean forward to feel the stretch across your chest. Hold for 20 seconds. If using hands behind your back, imagine you are trying to touch your elbows together. Repeat 3-4 times.

  • Side Bends:

    • How to do it: Stand tall with feet hip-width apart. Place one hand on your hip and slowly lean to the side, reaching the opposite arm overhead, stretching your side body. Keep your hips stable and avoid twisting.

    • Why it helps AS: Improves lateral flexibility of the spine, which is often compromised in AS.

    • Concrete Example: Stand, place your left hand on your left hip, and reach your right arm straight up overhead. As you exhale, gently bend to your left, feeling the stretch along your right side from your hip to your armpit. Don’t let your torso rotate. Hold for 15 seconds, then switch sides. Perform 5-8 repetitions per side.

  • Neck Stretches (Chin Tucks & Rotations):

    • How to do it:
      • Chin Tucks: Lie on your back with your head flat, or sit upright. Gently tuck your chin towards your chest, creating a double chin, without lifting your head. You should feel a stretch at the base of your skull.

      • Neck Rotations: Sit or stand tall. Slowly turn your head to one side, keeping your chin level, looking over your shoulder. Return to center and repeat on the other side.

    • Why it helps AS: AS can lead to a forward head posture. These stretches strengthen deep neck flexors and improve cervical spine mobility, preventing stiffness and associated headaches.

    • Concrete Example: For chin tucks, imagine trying to hold a small ball under your chin. Hold for 10 seconds. For rotations, slowly turn your head as if you’re trying to see what’s directly behind your ear, holding for 15 seconds. Do 3-5 repetitions of each, twice daily.

2. Strengthening: Building Stability and Support

Strong muscles provide vital support for your joints, especially your spine. Focus on core, back, glute, and hip muscles to improve posture and reduce pain. Use bodyweight or light resistance, prioritizing proper form over heavy loads.

  • Plank:
    • How to do it: Start on your forearms and toes, or forearms and knees if a full plank is too challenging. Keep your body in a straight line from head to heels (or knees), engaging your abdominal muscles and glutes. Avoid letting your hips sag or rise too high.

    • Why it helps AS: A powerhouse exercise for strengthening the entire core (abdominals, back, glutes), which is essential for spinal stability and maintaining good posture.

    • Concrete Example: Imagine you’re a rigid board. Engage your core as if bracing for a punch. Hold for 20-30 seconds, building up to 60 seconds or more. Repeat 3-5 times.

  • Bird-Dog:

    • How to do it: Start on your hands and knees. Slowly extend one arm straight forward and the opposite leg straight back, keeping your core engaged and your back flat. Avoid arching your back or shifting your hips. Return to the starting position and alternate sides.

    • Why it helps AS: Strengthens the core, glutes, and back extensors while promoting balance and spinal stability. It teaches controlled movement.

    • Concrete Example: If extending your right arm, extend your left leg. Imagine a glass of water on your lower back that you don’t want to spill. Hold the extension for 3-5 seconds, then slowly return. Perform 8-12 repetitions per side.

  • Bridge:

    • How to do it: Lie on your back with knees bent, feet flat on the floor hip-width apart, and arms by your sides. Engage your glutes and core, then lift your hips off the floor until your body forms a straight line from shoulders to knees.

    • Why it helps AS: Strengthens the glutes, hamstrings, and lower back, all crucial for supporting the pelvis and lumbar spine.

    • Concrete Example: Imagine you’re squeezing a ball between your glutes as you lift your hips. Don’t arch your lower back excessively; focus on the glute activation. Hold for 3-5 seconds, then slowly lower. Repeat 10-15 times.

  • Wall Slides/Wall Angels:

    • How to do it: Stand with your back flat against a wall, feet shoulder-width apart and slightly away from the wall. Your head, shoulders, and glutes should be touching the wall as much as possible. Bend your elbows to 90 degrees, forearms flat against the wall if possible, palms facing forward. Slowly slide your arms up the wall as high as you can, keeping your back and arms pressed against the wall. Slowly lower them.

    • Why it helps AS: Improves shoulder and upper back mobility, combats rounded shoulders, and reinforces good posture.

    • Concrete Example: Focus on keeping your entire back, including your lower back, pressed against the wall as you slide your arms up. If your elbows or wrists lift off the wall, don’t go as high. Perform 8-12 repetitions.

  • Standing Leg Raises (Side and Back):

    • How to do it: Stand tall, holding onto a chair or wall for balance.
      • Side: Keeping your back straight, slowly lift one leg out to the side a few inches, leading with your heel. Lower with control.

      • Back: Slowly lift the same leg straight behind you, engaging your glute, without arching your back. Lower with control.

    • Why it helps AS: Strengthens hip abductors (side raises) and glutes (back raises), which are often weak in AS due to hip involvement and compensatory walking patterns. This helps with hip mobility and overall stability.

    • Concrete Example: For side raises, imagine a string pulling your outer ankle directly upwards. For back raises, imagine pushing your heel straight back. Keep your core tight to prevent your torso from swaying. Perform 10-15 repetitions per leg for each direction.

3. Cardiovascular Exercise: Heart Health and Endurance

Aerobic activity is vital for overall health, reducing systemic inflammation, improving lung capacity, and boosting mood. Choose low-impact activities to protect your joints.

  • Walking:
    • How to do it: Start with short, manageable walks (e.g., 10-15 minutes) and gradually increase duration and pace. Focus on maintaining good posture: head up, shoulders back, and a gentle swing of your arms.

    • Why it helps AS: Accessible, low-impact, and promotes overall mobility. It’s excellent for maintaining joint health and improving endurance without excessive joint stress.

    • Concrete Example: Begin with a brisk 20-minute walk around your neighborhood. If that feels good, gradually increase to 30 minutes, aiming for a pace where you can talk but are slightly breathless. Try to walk daily or at least 5 times a week.

  • Swimming/Hydrotherapy:

    • How to do it: Any stroke is beneficial, but backstroke and breaststroke can be particularly good for promoting spinal extension. Water aerobics classes are also excellent.

    • Why it helps AS: The buoyancy of water reduces stress on joints, making movement easier and less painful. It allows for a full range of motion that might be difficult on land. The resistance of water also provides gentle strengthening.

    • Concrete Example: Spend 30 minutes in a pool, alternating between gentle laps of backstroke and walking in the shallow end, focusing on big, sweeping arm movements to open your chest. If available, join a water aerobics class designed for arthritis or joint conditions.

  • Cycling (Stationary or Outdoor):

    • How to do it: Adjust the seat height to ensure a slight bend in your knee at the bottom of the pedal stroke. Maintain an upright posture, avoiding hunching over the handlebars if possible.

    • Why it helps AS: Low-impact, strengthens leg muscles, and improves cardiovascular fitness. It’s a great way to get a cardio workout without impact on the spine.

    • Concrete Example: Start with a 20-minute ride on a stationary bike at a moderate resistance. Gradually increase your time to 30-45 minutes, 3-4 times a week.

  • Tai Chi/Yoga (Modified):

    • How to do it: Seek out classes or instructors specifically experienced in working with individuals with joint conditions. Focus on gentle, flowing movements and modifications that don’t put undue stress on your spine.

    • Why it helps AS: Combines gentle movement, stretching, and mindfulness. Improves flexibility, balance, posture, and body awareness, while also reducing stress.

    • Concrete Example: Find an online beginner’s yoga or Tai Chi class that emphasizes gentle movements and modifications. Focus on holding poses for shorter durations initially and using props like blocks or straps to assist if needed. For instance, in a seated forward fold, bend your knees deeply and focus on hinging from the hips rather than rounding your spine.

4. Balance Training: Enhancing Stability and Preventing Falls

As AS can affect posture and lead to a higher risk of falls (especially if osteoporosis is present), incorporating balance exercises is crucial.

  • Single-Leg Stand:
    • How to do it: Stand tall, holding onto a counter or chair for support initially. Shift your weight to one foot and slowly lift the other foot a few inches off the ground. Hold as steadily as possible.

    • Why it helps AS: Improves proprioception (your body’s awareness of its position in space) and strengthens ankle and leg stabilizers.

    • Concrete Example: Start by holding on with both hands, then one, then no hands. Aim to hold for 30 seconds on each leg. Practice this while brushing your teeth.

  • Heel-to-Toe Walk:

    • How to do it: Walk in a straight line, placing the heel of your front foot directly in front of the toes of your back foot, as if walking on a tightrope. Keep your gaze forward.

    • Why it helps AS: Challenges balance and coordination, improving stability during walking.

    • Concrete Example: Practice walking heel-to-toe for 10-15 steps in a clear hallway. Focus on controlled, deliberate steps.

Incorporating Exercise into Your Daily Life: Practical Strategies

Making exercise a consistent habit is key to managing AS effectively.

  • Start Small and Progress Gradually: Don’t try to do too much too soon. Begin with short durations and low intensity, especially on days when pain or stiffness is more pronounced. Gradually increase time, repetitions, or resistance as your body adapts.

  • Listen to Your Body: AS is unpredictable. Some days you’ll feel better than others. On high pain days, focus on gentle stretches and mobility exercises. On better days, you can increase intensity. Never push through sharp or increasing pain. Differentiate between muscle soreness from exercise and AS pain.

  • Warm-Up and Cool-Down: Always dedicate 5-10 minutes to light cardio (e.g., marching in place, arm circles) and dynamic stretches before your main workout. Conclude with 5-10 minutes of static stretches, holding each stretch.

    • Concrete Example: Before a walk, do arm circles forward and backward for 30 seconds each, gentle leg swings, and torso twists. Afterward, hold a hamstring stretch for 30 seconds and a chest stretch against a doorway.
  • Prioritize Morning Stretches: Stiffness is often worse in the morning. A gentle stretching routine before you even get out of bed can significantly improve morning mobility.
    • Concrete Example: While still in bed, do gentle knee-to-chest stretches, spinal twists (knees falling to one side while upper body stays flat), and ankle circles.
  • Break Up Your Exercise: You don’t need to do all your exercise at once. Multiple shorter sessions throughout the day can be just as effective as one long one, especially for stretching.
    • Concrete Example: Do 10 minutes of stretches in the morning, a 30-minute walk at lunchtime, and 10 minutes of strengthening exercises in the evening.
  • Incorporate Movement into Daily Activities: Think about how you can move more naturally.
    • Concrete Example: Take the stairs instead of the elevator, park further away to walk more, stand up and stretch every 30-60 minutes if you have a desk job, or do a few squats while waiting for water to boil.
  • Stay Hydrated and Nourished: Proper hydration and a balanced diet support your energy levels and muscle recovery, making exercise more effective and reducing fatigue.
    • Concrete Example: Keep a water bottle handy throughout the day and sip regularly. After a workout, consume a snack or meal with a balance of protein and carbohydrates (e.g., Greek yogurt with berries, a piece of fruit and a handful of nuts).
  • Consider Professional Guidance: A physical therapist with experience in AS can provide a personalized exercise plan, teach you proper form, and help you modify exercises as your condition changes. They can also offer manual therapy techniques to improve mobility.
    • Concrete Example: Ask your rheumatologist for a referral to a physical therapist. Schedule an initial assessment to discuss your goals and limitations.
  • Consistency Over Intensity: It’s far better to do a little bit of exercise consistently every day than to attempt intense workouts sporadically. Building a routine is the most crucial aspect.
    • Concrete Example: Aim for 10-15 minutes of dedicated exercise daily, even if you don’t feel like it. On “off” days, focus solely on gentle mobility work.

What to Avoid: Safe Exercise Practices

While exercise is crucial, certain movements or approaches can worsen AS symptoms or lead to injury.

  • High-Impact Activities: Running, jumping, and contact sports can put excessive stress on inflamed joints and the spine, potentially causing pain flares or injury.
    • Instead: Opt for low-impact alternatives like swimming, cycling, or brisk walking.
  • Deep Twisting Movements: Excessive or forceful spinal twisting can be detrimental, especially if you have any degree of spinal fusion or inflammation.
    • Instead: Focus on gentle, controlled rotations within your comfortable range of motion, often keeping your hips stable.
  • Exercises that Exacerbate Pain: If an exercise causes sharp, radiating, or increasing pain, stop immediately. Pain is your body’s signal to re-evaluate.
    • Instead: Modify the exercise, reduce the range of motion, or choose an alternative movement that feels comfortable.
  • Overstretching into Pain: While stretching is key, never force a stretch beyond a comfortable tension. Pushing into sharp pain can lead to injury.
    • Instead: Be mindful of your body’s limits each day. Some days your flexibility may be greater than others.
  • Ignoring Warm-up and Cool-down: Skipping these critical phases increases injury risk and can leave you feeling stiffer.
    • Instead: Always dedicate time to preparing your body and then gently bringing it back down.
  • Sudden, Jerky Movements: Smooth, controlled movements are always preferred, especially with a condition that affects joint integrity.
    • Instead: Focus on slow, deliberate transitions between exercises.

The Long-Term Vision: Living Actively with AS

Exercising with Ankylosing Spondylitis isn’t about achieving peak athletic performance; it’s about fostering a sustainable relationship with your body that prioritizes mobility, reduces pain, and enhances your overall well-being. It’s a daily commitment, a form of self-care that empowers you to take an active role in managing your condition. By consistently applying these practical, actionable strategies, you can significantly improve your flexibility, strength, and quality of life, transforming your journey with AS into one of greater movement and less limitation.