Warning: number_format() expects parameter 1 to be double, string given in /home/paulpvbrown/paulbrown.net/blog/wp-content/plugins/livepress/LivePress/lpmoods.php on line 77
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.
amused
Welcome Shannon Stone, CMP, to Paul Brown Massage Therapy Pain Relief Center. He's available on Sundays and Mondays here at the Center, so why not 
Loading...
Sacramento Top 10
{ 24 comments… read them below or add one }
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
Thanks, Mary Lou, I am glad you found my writing helpful!
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
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.
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.
Any techniques that help relax the spinal erectors and lengthens the spinal flexors will help.
I have clients that I work on who have this problem
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
What sort of techniques do you use, Lisa, when dealing with clients with AS?
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.
I was happy to find your site and found the info very helpful…my client who has advanced AS also is experiencing severe restriction in her arms. She can no longer straighten her right arm. It stays at a 60-70 degree angle. Without causing her anymore pain, I have been using myofascial release and resistance stretching techniques. Do you have any other techniques that might be useful?
Jennifer
Interesting reading. I am a MT student and just starting a case study with a client with AS. I am interested to know why you had your client lay in the sidelying position during your first session. Did your client feel discomfort laying in the prone?
My client had lost about 40% of ROM, and prone position is contraindicated with that much reduction in joint movement. Supine position is also contraindicated without proper support of the upper thorax and cervical area – use a wedge or pillows to provide proper support. The fusion of the spinal vertebrae is very brittle and can be damaged very easily. Fractures of the fusions are uncommon, but can definitely happen. Sidelying and well-supported supine position are best.
Im so glad to have come across your article, my cousin (25) just diagnosed with this. She already has damage to her neck and kidneys. I would love to work on her to help improve ROM and help with any pain of course. Would you use very light pressure when working the errectors? Which strokes have you found work best to relax the errectors? Effleurage and Vibration? Thanks for the help!
Dina,
Vibration is contraindicated, as are any form of rocking or shaking work. Slow, deep effleurage can be very helpful if Swedish massage is your area of training.
Hi Paul!
I am currently a massage student and i am writing a paper on AS and what a massage treatment would look like for a client with AS. As well as contraindications to massage. I also need to consider what a treatment plan could look like. Could you help me out?
Thanks
Hi Paul ,
I am suffering from AS for past 10 yrs , I can bend backward but not too much forward. I am going to Ayurveda massages , Where they are massaging with hot herbal oils , by doing so pains are becoming more.
Is this the right way of treatment.
Thanks
Vinay,
Without examining you, I would be hesitant to say anything, but generally, gentle massage should be fine. There are definite things they shouldn’t be doing, like going to deep in near the vertebrae, and no rocking or shaking.
If you can see a physician, I’d advise you to do so, as well. They may have specific recommendations for you for bodywork.
Paul
Hello Paul. very interesting article. i am a student of massage institute and i have a question. Do massage therapist need special certification to work on people with such disease? also what is the sourse of your knowledge about it.
thank you very much
Noura
A massage therapist doesn’t need special certifications, but training in physiology and pathology can be helpful in familiarizing an MT in the condition, as well as in how to do research on this or other conditions. My sources are the Mayo Clinic, National Institutes of Health, my own training at the National Holistic Institute, and other sources.
It’s important as a massage therapist to be passionate about researching and continued learning. Otherwise, you may as well just be a spa robot.
Paul, thank you so much for your answer! i appreciate your help and i agree about researching and continued learning!!!
Noura
“spa robot” ha, haven’t heard that one before! No offence to those working in spa’s I might add. My nephew was diagnosed with AS around four years ago and is only 20 years of age now. He has discovered surfing and it is one of the many activities that doesn’t give him a great deal of grief. Infact I’d say it is helping his condition. Thanks for sharing your knowledge. I’m a hot stone massage therapist and my nephew has been weary of any one massaging him due to fear of worsening his condition. I’ll certainly pass on your thoughts. Great site, thanks!
Paul, this information is awesome I’m glad that I stumbled across it. I myself am diagnosed with AS while also being a MT student and had tried previously to find info on recommended massage techniques for my condition but could never really find anything. Your info is very helpful though and now I’ll know what to specifically ask for when I get my own work done to try and keep myself healthy. Thank you =]
Kristen, There are many techniques that can be helpful, but allowing your spinal extensors to have a change to relax through shortening, will help give them a break.