Massage and Ankylosing Spondylitis
Ankylosing Spondylitis (AS) is an inflammatory condition of the spine and other parts of the body, related to various arthritis conditions. It affects men 3:1 over women, and generally starts within second or third decade of life. Its initial symptoms typically include pain and inflammation in the hips and low back caused from inflammation of the sacroiliac joint. Over time, this inflammation can lead to fusion of the SI joints, as well as fusion of vertebrae, resulting in the inability to bend the spine and pain and loss of range of motion, sometimes known as “bamboo spine.” Also, AS can affect other organs of the body, including the liver and kidneys and eyes (iritis). In women, AS can start in non-vertebral joints, or the cervical spine instead of the sacral or lumbar spine. The inflammation often leads to a flattening out of the lumbar spine, which has the tendency to make the curvature in the upper spine become more pronounced, causing the person with AS to look hunched over, or looking down all the time. Extending the spine becomes increasingly difficult. This increased curvature of the thoracic and cervical spine collapses the chest cavity, decreasing lung capacity and making breathing more difficult and shallow.
Medical treatment for AS typically involves the administering of NSAIDS (asprin, ibruprofen, etc), physiotherapy, and prescribed exercise (typically swimming and breathing exercises). Firm mattresses and thin pillows, encouraging patients to sleep on their back to increase spinal extension are also recommended.
A client in his mid-30s diagnosed from childhood with Ankylosing Spondylitis came to me recently seeking relief from his back pain and to try to regain some flexibility. He has lost appoximately 40% of the range of motion in his spine. He works and has a relatively normal life, but doesn’t enjoy swimming, so has little physical activity outside of normal life activities.
My goal for him is going to be to work on lengthening the hip flexors (iliopsoas), and spinal flexor muscles (rectus abdmoninus, sternocleidomastoids, etc), as well as work on relaxing spinal extensor muscles. AS sets up a serious tug of war between the spine and the muscles that move it, and the increased flexing of the spine causes chronic shortening of the flexor muscles, which cause the extensors to have to compensate by increasing contraction to maintain as upright posture as they can.
So, our first session was performed in sidelying and supine positions, and focused on relaxing the erector spinae muscle group, some work in the sacral ligaments, then work in opening up the chest with work in the pectoralis major and minor to assist in increasing chest capacity.
At the end of the session, client was observed to have slighly improved range of motion in spinal extension. Client also reported that he felt some of his kidney stones start to move during the session, and later that evening he passed three stones. Kidney stones are not uncommon with people who have AS.
Recommended to the client a start of regular bodywork sessions to improve range of motion and pain relief.
amused10 Responses to “Massage and Ankylosing Spondylitis”
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Mary Lou says:
March 30, 2009 at 1:28 pm
Nice description of working with this condition. I’m a fairly recent grad and have a client (another LMT) that just found out she has AS.
Nice website too. I’m on the east coast.
take care,
ML
Paul Brown says:
April 8, 2009 at 12:48 pm
Thanks, Mary Lou, I am glad you found my writing helpful!
Jenny says:
April 28, 2009 at 12:41 pm
Hi Paul,
Interesting article. I had my first AS client yesterday and am now reading up on the condition.
This male client has quite an advanced stage of AS: severey hunched over, has had hip replacements on both sides 10 years ago and suffers from severe joint and muscle pains all around his hips (flexors, adductors, hamstring attachements) and buttocks as well as his neck. I think his spine is pretty much completely rigid.
He came for deep tissue massage in these areas, which I provided. Would any (passive) stretching be appropriate for this client, or has the condition progressed too far?
Thanks,
Jenny
Paul Brown says:
April 28, 2009 at 3:05 pm
A fused spine from AS is pretty fragile, as the bone where the fusion take place is really weak. It is not terribly uncommon for the bone to fracture. Some types of massage are contraindicated with AS clients.
In such a case, I would consult with his physician and/or physical therapist on crafting a treatment plan for him. Proceed carefully with this client, and you should be able to help him with his pain issues.
Jenny says:
June 7, 2009 at 1:15 pm
hi Paul,
i am currently a college student studying to become a Massage Therapist. i am researching different pathologies and came across your article. i was curious what types of massage would be appropriate (if any) for a client with AS.
Paul Brown says:
June 7, 2009 at 3:14 pm
Any techniques that help relax the spinal erectors and lengthens the spinal flexors will help.
Las Vegas Neuromuscular Massage says:
July 31, 2009 at 8:49 pm
I have clients that I work on who have this problem
Dawn Pugh says:
August 3, 2009 at 8:40 am
Hi Paul,
Reading your post I wanted to express my appreciation for such a positive article.
I can only imagine how painful this disease can be, so to hear of positive outcomes is somewhat inspiring.
Thank you
Regards
Dawn Pugh
Paul Brown says:
August 4, 2009 at 8:33 am
What sort of techniques do you use, Lisa, when dealing with clients with AS?
Antonio says:
March 6, 2010 at 5:08 am
Nice web site and very good information on AS. Had my first client with AS last week and he will be coming back. Thanks for your info.