Lower back pain is the most common symptom of ankylosing spondylitis (AS), and it can be much more intense — and debilitating — than the back aches that affect about one quarter of all adults. In many cases, it takes a variety of strategies to manage AS back pain.
“This is inflammatory back pain, affecting the lower back above the buttocks, and the treatment is different from treatment for [non-AS] lower back pain,” explains rheumatologist Erik Peterson, MD, an associate professor of medicine in the division of rheumatic and autoimmune diseases at the University of Minnesota in Minneapolis.
Dr. Peterson emphasizes that while non-AS lower back pain tends to arrive suddenly, worsen with activity, and resolve with a few days of rest, AS back pain tends to do the opposite: improve with activity and worsen with prolonged inactivity.
Easing AS Back Pain
You have many options for managing the back pain associated with AS, including:
Heat. Peterson explains that pain is likely to be worse when you first wake up and at night after a busy day. Applying heat can help. Depending on your morning and evening routines, take a warm shower or bath or apply a hot pack to the area.
Light exercise. Exercise can help reduce pain and discomfort, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). On a regular basis, swimming and water-based activities may be particularly helpful. But when first starting your day, try light stretching and taking a walk. Light movement can help ease the pain. “Walking can be one of the best exercises,” says Mary Ann Wilmarth, DPT, a physical therapist in Boston and a spokesperson for the American Physical Therapy Association. Make a point of maintaining good posture and looking straight ahead while walking, but allow your arms and torso to swing freely, she adds.
Mindfulness. Take a mind-over-matter approach with this stress-reducing therapy. A study published in March 2016 in the Journal of the American Medical Association found that eight weeks of learning mind/body approaches such as mindfulness or cognitive behavioral therapy improved low back pain for up to 26 weeks.
Medications. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may be enough for some people to control the inflammatory pain of AS. But if these drugs aren’t sufficient, talk to your doctor about prescription medications that might help get your inflammation under control, such as corticosteroids, disease modifying anti-rheumatic drugs (DMARDs), or biologics, according to NIAMS.
Lifestyle Habits for Less Back Pain
Wilmarth suggests working with a physical therapist on a plan that incorporates the following elements to improve back health and fend off pain:
Always practice good posture. The goal is to keep ears, shoulders, and hips aligned at all times, whether walking, sitting, or sleeping, Wilmarth says. She recommends asking loved ones to let you know when you’re out of alignment. Although AS is different for each person, it can cause spinal fusion, or inflammation that can lead to the formation of extra bone in the spine, which fuses it into a curved position. Using good posture in all your daily activities, including sleep, increases the chances that, if your spine fuses, it will fuse in a functional position, according to Peterson.
Use props. Try a lumbar support cushion when sitting. When sleeping, use a pillow between your legs when on your side or under your knees when on your back, to keep your spine straight.
Lie on your stomach. “Spend time on your stomach every day,” Wilmarth says. Keep your head in a neutral position, facing down, with a rolled towel as a cradle, and use pillows as props if needed. Start with a few minutes at a time and work up to 20 minutes.
Be active at work. If you work at a desk, get up and walk around at least once each hour, Wilmarth says. A sit/stand work space can also help keep your body in motion throughout the day.
Do range-of-motion exercises. Wilmarth recommends working with a physical therapist to assess your range of motion and develop a series of exercises, such as drawing your knee to your chest, to preserve it.
Strengthen your core. According to the Arthritis Foundation, exercises such as planks and side planks can help strengthen the muscles of your back and abdomen, which are essential for protecting your back.
Maintain a healthy weight. Obesity has been linked to worsening inflammatory arthritis and a poor response to medications, according to a study published in June 2015 in the journal Rheumatic and Musculoskeletal Diseases. Reaching and then maintaining a healthy weight for you can help.
Peterson emphasizes eating a varied diet with plenty of whole grains, fruits, vegetables, and lean proteins. There is no single diet recommended for people with AS, he says, but cutting out processed foods with added sugar, fat, and salt could help with weight management
Because AS is a progressive disease, it’s important to keep working with your doctor and therapist on your back pain relief plan. You may need to tweak it over time.
Source : everydayhealth.com