What is Spondyloarthritis?
Spondyloarthritis (otherwise known as Spondyloarthropathy or SpA) is a family of back diseases caused by inflammation. This can affect the lower, mid or upper spine and in some types, can affect joints of the arms and legs as well. Here we will discuss the different types and our physiotherapy advice on management.
Spondyloarthritis is one of the less common causes of back pain; it is estimated that around 5% of people with back pain have spondyloarthritis. However, it is under-recognised and often goes un-diagnosed for years. This is mainly due to the gradual onset of the symptoms, but it can also be very hard to see on x-rays in the early stages of the disease.
There are several different types of spondyloarthritis:
Ankylosing Spondylitis - inflammation in the back that can cause some of the bones in the spine to fuse. This is the most common type of spondyloarthritis and tends to affect men more than women
Psoriatic Arthritis - arthritis that affects people with the skin condition, psoriasis
Reactive Arthritis (used to be called Reiters Syndrome) - arthritis triggered by an infection in another part of your body
Enteropathic arthritis - arthritis associated with Inflammatory Bowel Disease (Crohns, colitis etc)
Undifferentiated Spondyloarthritis - arthritis that does not meet criteria for the other types of spondyloarthritis
These can all affect the joints in lower and upper back. The arthritis can also be present in any of the other joints, but is most commonly seen in the shoulders, hands, hips, knees, ankles and feet. Neck pain and stiffness tends to occur in the later stages of the disease.
In some cases, the inflammation can also affect the entheses; the sites where tendons or ligaments attach to the bone. This can cause tendon problems, such as achilles tendinitis.
What are the symptoms of Spondyloarthritis?
Symptoms of spondyloarthritis vary from person to person depending on the location, type and severity of the condition. In the majority of cases, the pain starts at 45 years old or younger.
There are a few features to look out for and your physiotherapist is likely to ask you about:
Dull, aching pain in the lower back, buttock or hip area
Back stiffness in the morning that lasts longer than 30 minutes
Alternating buttock pain
Pain improves with activity and gets worse with rest
Waking in the second half of the night due to pain
Anti-inflammatory medication such as Ibuprofen helps the pain
What are the best exercises for Spondyloarthritis?
Exercise has been shown to improve function and reduce pain in people with spondyloarthritis. There have been several different programmes developed for this condition, but ultimately the best exercises for each patient will vary, depending on the location and severity of their symptoms.
Mobility exercises
One of the most problematic symptoms of Spondyloarthritis is stiffness in the spine and surrounding structures. It’s important that you take the time to stretch out these areas to help combat the stiffness and release tension in the muscles.
There are lots of different exercises you can do for this, but we have included some of our favourites that we find most effective for our patients.
Knee rolls
Lying on your back with your knees bent and your arms out to the sides.
Keeping your upper body still and your shoulders on the floor, slowly bring your knees down to the floor.
Then slowly bring your knees back to the middle.
Repeat to the other side.
Complete for 30 - 60 seconds.
Thoracic Spine Rotation Stretch
Kneeling with your bum down on your heels.
Rest your hands out in front of you. Lift your right arm up, twisting through your upper back.
Then bring your arm down and through the gap between your left hand and your knees to twist the other way.
Try to keep your bum by your heels to avoid too much movement through your lower spine.
Repeat 5 times on each side.
Knee Hugs
Lie on your back. Bend one knee and bring it up to your chest.
Put your hand around your knee and hug it into your chest.
Then complete the same on the other side.
Hold the stretch for up to 20 seconds, whatever feels right for you.
Repeat 5 times.
Back Extensions
Level 1: Lying on your tummy. Bring your chest up off the floor and rest up on your forearms.
Hold this position for up to 20 seconds. Then slowly lower. Repeat 5 times.
Level 2: Bring your hands underneath your shoulders. Slowly push through your arms and lift your chest off the floor.
Stop if you have any lower back pain. Hold this position for up to 20 seconds. Then slowly lower. Repeat 5 times.
Hip Flexor Stretch
Kneel on one leg and place other leg in front with your foot flat on the ground, toes pointing forwards and your left knee bent.
Bring your arm (the same arm as the leg which you are kneeling on) above your head.
Keeping your body upright, slowly bend your left knee and sink into the position until you feel a stretch in the front of your right hip.
If you want more of a stretch, move the front leg further away so you can sink further!
Hold the stretch for around 20-30 seconds.
Repeat 3 times.
You may find some of these are a little sore to complete. Make sure that you are not feeling any intense pain as you do the exercises, and take it slowly at first as your body gets used to the positions.
If you have ongoing pain as you complete the exercises, stop and speak to your physiotherapist, as there may be a more beneficial exercise that you could be doing.
If you want other ideas for exercises, the Spondylitis Association has a great exercise programme you can find here.
Aerobic exercise
Exercise that increases blood flow through your heart and body can be very effective for people with spondyloarthritis. Better results in pain reduction and function have been seen when patients combine aerobic exercise into their programmes.
This can be anything that gets your heart going, such as walking, swimming or cycling.
Some people may be able to run with spondyloarthritis, but this depends on the severity of the pain. Aim to run on softer surfaces where possible, and make sure that you have a decent pair of running trainers.
If you find that running begins to flare up your pain, then stop and work on lower impact exercise, like walking or using the cross trainer in the gym.
Strengthening exercises
It’s important to keep muscles around the spine and affected joints strong so that they are able to support the joint and offer some stability. Strengthening exercises can also contribute towards good posture.
If you have access to a gym facility, lifting weights as your body allows you to can help you to become stronger. Make sure that you speak to your physiotherapist first about which exercises would be suitable for you.
Some of the most important muscles to strengthen are your abdominal and lower back muscles, which we describe as your “core”. These can reduce the stress on the spine and reduce pain.
How much exercise should I do?
Again, this varies from person to person depending on pain location, severity and irritability, so it’s important to speak to your physiotherapist about this. This study found that 20 minutes a day significantly improved pain, stiffness, fatigue and function in people with spondyloarthritis.
Make sure that you vary your exercise, and spend time throughout the week working on the different types of exericse: mobility, aerobic and strengthening. And most of all, find something that you enjoy doing, as the important thing with exercise programmes for these conditions is that they are continued regularly on a long term basis.
This is absolutely not written to substitute medical advice and it is always important to see a qualified health care professional for a formal diagnosis. If any of the exercises cause pain during or after the exercise, discontinue and consult a physiotherapist.
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