knowledge about ankylosing spondylitis and its physiotherapy management

1. ANKYLOSING SPONDYLITIS
(Marie-strumpell
disease/bechterew’s disesase)

3.  Ankylosing spondylitis (AS) is a chronic,
inflammatory disease of the axial spine .
 Chronic back pain and progressive spinal
stiffness are the most common features of the
disease.
 Involvement of the spine and sacroiliac (SI)
joints, peripheral joints, digits are
characteristic of the disease.

4.  Ankylosing spondylitis (AS) is typically
diagnosed in people younger than 40 years
 more common among men than women.

5.  The cause of ankylosing spondylitis (AS)
remains largely idiopathic, but probable
etiologic factors are:
 Genetic predisposition: % of people with AS
share the genetic marker HLA-B27.
 Bacterias : klebsiella pneumoniae and sone
other enterobacterias.

6.  Sacroilliac joints are usually the first to get involved followed by the
spine from the lumbar region upwards.
 The hip,knee and manubrio-sternal joints are involved frequently.
Initially synovitis occurs,followed later by cartilage destruction and bony
erosion.
 Resultant fibrosis ultimately leads to fibrous,followed by bony
ankylosis.
 Ossification also occur in the anterior longitudinal ligament and other
ligaments of the spine.
 After bony fusion occurs,the pain subside,leaving the spine
permanently stiff.

12. 1.Stiffness of the lower back
2.Gradual onset of pain
3.Pain in the heel,pubic symphysis,manubrium
sterni and costosternal joints
4.Inflammatory bowel diseases
5.In later stages,kyphotic deformity of spine and
deformity of hips may be prominent features.

14. Ankylosing spondylitis (AS) has articular and
extra-articular complications. These include:
 Chronic pain and disability
 Aortic regurgitation
 Pulmonary fibrosis
 Cauda equina syndrome
 Mood disorders

15. A. Radiological examination:
x-ray of lumbar spine may show the following:
1.Squaring of vertebra
2. Loss of lumbar lordosis
3. Bamboo spine appearance
B. ESR:elevated
C.HB:mild anaemia
D.HLA-B27:positive

16.  SCHOBAR’S TEST

18. Conservative treatment: it consists of
 Rest
 NSAIDs (indomethacin)
 Physiotherapy
 Radiotherapy
 Surgical treatment:
 Spinal osteotomy to correct spine deformity
 Total hip and knee replacement for hip and knee joint
ankylosis.

19.  GOALS:
1. Relieve pain
2. Maintain the mobility of joints affected
like spine,hip,thorax
3. Prevent and correct deformity
4. Increase chest expansion and vital capacity
5. Attention to posture
6. To maintain and improve physical
endurance

23. Stretching exercises Aerobic exercises Pulmonary exercises
1.Forward and backward
head stretch
1. march 1.To increase chest
expansion,following
pulmonary exercises were
applied:
2.Sideways head stretch 2.V step a.Normal inspiration
through nose and normal
expiration through the
mouth
3. Chest and shoulder
stretch
3. Step touch b. Respiration through the
chest and abdomen
4.Deltoid and triceps
muscle stretch
4.Turn step c.Deep breathing and then
expiration through mouth
slowly
5.Arched back stretch 5.Grapevine with knee up 2.Resistance exercises for
inspiratory pulmonary
muscles
6.Overhead stretch 6.Grapevine with leg curl
7.Upper back prayer