Ankylosing Spondylitis

Ankylosing Spondylitis

What is Ankylosing spondylitis?

Ankylosing spondylitis is an autoimmune condition where inflammation occurs first in the sacroiliac, intervertebral and intercostal joints. From there inflammation also occurs in joint cartilage causing degeneration, ossification (making bone) and then joint fusion.

Patients are more likely to develop ankylosing spondylitis if a family member has the disease due to the hereditary nature of the condition.

It is more likely to occur in the Caucasian population, males more than females and between the ages of 20-40 years. It typically presents as a sudden onset of low back pain that lasts for three months or more. The stiffness is worse after periods of inactivity, improved through the day, and is helped with heat. Pain and grinding can occur in the spine alongside muscle weakness and balancing issues.  

You may also develop associated issues such as tendonitis, fasciitis and dactylitis. Sometimes patients may also present with eye issues such as uveitis and iridocyclitis – inflammation of the eye. This can present with sudden eye pain, redness, light sensitivity and decreased vision.

Assessment:

When you come in for your appointment your osteopath will assess different regions of your body and spine including your neck, back, pelvis and hips.

We may send you for a blood test looking for HLAB27 and an increased level of inflammatory factors interleukin 12, 17 and tumour necrosis factor which can be an indication of a genetic disposition for ankylosing spondylitis. X-ray’s may also be ordered to confirm the presence of the disease.

To be diagnosed with ankylosing spondylitis you may need to have a combination of the below;

  • Inflammatory pain and morning stiffness in the low back for a minimum of three months. This should improve with exercise and is not relieved by rest.
  • Limitation of range of motion in the lumbar spine in rotation, flexion/extension and side bending
  • Decreased chest examination.
  • Sacroiliitis identified on X-ray that is between grades two and four.
  • Decreased joint space, calcification of ligaments, squaring of the vertebrae and joint fusion.

Medical Treatment:

Corticosteroids can be beneficial in a short course and long term non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs can assist in preserving quality of life.  

Osteopathic Treatment:

Osteopathic treatment is unable to cure ankylosing spondylitis, however it aims to improve quality of life and activities of daily living. This is through a holistic approach that focuses on the local biomechanical changes as well as the greater impact on muscles and posture.

Treatment focuses on mobilisation of joints, ligament and soft tissue techniques and decreasing swelling. There has been evidence that suggests significant improvement in pain and quality of life when combined with physical strengthening focusing on weightlifting, resistance training and core stability.

Typically, due to the progression of ankylosing spondylitis no manipulation is used as it poses significant risk of damage to soft tissue and joint structures.

Needling:

Use of needling through the modalities of acupuncture or dry needling has been shown to be effective.

Needling can have a pain-relieving affect and assist in immune function. In addition, the meridian theory followed in acupuncture believes that needling points related to the kidney can have a benefit in alleviating spinal pain, improving spinal function and reduce the levels of tumour necrosis factor and inflammatory factors.

Specific needling/acupuncture points that can be used to decrease pain include KD3/6, LV8, ST36, GB34, BL11/23/29/52/40

Referencing:

Ebrahimiadib, N., Berijani, S., Ghahari, M., & Golsoorat Pahlaviani, F. (2021). Ankylosing Spondylitis. Journal of Ophthalmic and Vision Research, 16(3). https://doi.org/10.18502/jovr.v16i3.9440

Seiler, M., Vermeylen, B., Poortmans, B., Feipel, V., & Dugailly, P.-M. (2020). Effects of non-manipulative osteopathic management in addition to physical therapy and rehabilitation on clinical outcomes of ankylosing spondylitis patients: A preliminary randomized clinical trial. Journal of Bodywork and Movement Therapies, 24(4), 51–56. https://doi.org/10.1016/j.jbmt.2020.06.028

Xuan, Y., Huang, H., Huang, Y., Liu, D., Hu, X., & Geng, L. (2020). The Efficacy and Safety of Simple-Needling Therapy for Treating Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine, 2020, 1–10. https://doi.org/10.1155/2020/4276380

Zhang, Y., & Song, A. (2022). Clinical research progress of acupuncture therapy in the treatment of ankylosing spondylitis. Medical Theory and Hypothesis, 5(2), 4. https://doi.org/10.53388/tmrth202206004

 

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