Breathing exercises can help people with ankylosing spondylitis (AS) maintain spinal flexibility and ease breathing difficulties. The document recommends three breathing exercises: diaphragmatic breathing to learn deep breathing techniques, rib cage expansion to keep the rib cage flexible, and standing arm rotations to further improve breathing. Performing these exercises daily can help prevent loss of mobility, but will not stop the progression of AS, which requires medical treatment such as TNF-alpha inhibitors.

1. BREATHING EXCERCISES FOR
SPINAL MOBILITY
Having ankylosing spondylitis can leave you short
of breath. Here's how to keep your rib cage
flexible so you can breathe easy with AS.
By Jennifer Acosta Scott
Medically reviewed by Lindsey Marcellin, MD,
MPH
Ankylosing Spondylitis: Breathing Exercises for
Spinal Mobility
Although having ankylosing spondylitis, or AS —
an inflammatory form of arthritis in the spine —
can be painful, some simple breathing exercises
can help.
People with ankylosing spondylitis are at risk for
developing calcifications, which can cause the
bones in the spine to fuse together, according to
the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMSD).
Regular exercise can help prevent spinal fusion
and maintain spinal flexibility.
Some people with AS also find that the bones in
their rib cage are affected, causing pain and
difficulty breathing, the NIAMSD reports. But
utilizing specific deep-breathing exercises
regularly can help minimize these symptoms,
says Maria Stelmach, PT, a physical therapist at

2. the New York University Langone Medical Center
in Manhattan.
“Someone with ankylosing spondylitis might not
be able to take a deep breath and expand their
rib cage,” Stelmach says, "but if they can learn to
use their diaphragm, that can help with the
stiffness.”
Breathing Easier With Ankylosing Spondylitis
To keep your rib cage flexible and make
breathing less painful with AS, try these
exercises:
Diaphragmatic breathing. This move helps you
learn what a deep breath should feel like,
Stelmach says. Lie on your back on a flat, firm
surface, with your hands on your stomach. As
you breathe in deeply, feel your stomach expand
and push into your hands. Then notice how it
deflates as you breathe out. “This takes some
concentration and practice,” she says. “If you can
learn to do this, you’ll have more effective
breathing.”
Rib cage expansion. Lie on a flat surface and
place your hands at the base of your rib cage
with your fingers on your ribs and thumbs
toward the back. Breathe in deeply and hold for a
few seconds, feeling your ribs push into your
hands. Exhale and feel them lower back down.

3. “You can even add some resistance by pushing
down with your fingers and trying to breathe
against that pressure,” Stelmach says.
Standing arm rotation. For this exercise, the
National Ankylosing Spondylitis Society explains
that you should stand up straight, with elbows
bent and palms facing up — like you're balancing
a tray in front of you. Breathe in and rotate your
arms out to your sides, making sure to keep your
elbows close to your body. Try to imagine that
your shoulder blades are coming closer together.
Exhale and rotate your arms back inward.
For maximum benefit, you should perform the
exercises every day. Stelmach suggests
repeating each of these exercises about 10
times, working up to three sets of 10 each day. If
you feel pain while doing them, reduce your
intensity or lower the number of repetitions.
Staying Focused on Ankylosing Spondylitis
Treatment
Breathing exercises alone won’t slow or stop the
progression of AS — only certain medications,
such as TNF-alpha inhibitors, have been shown
to do that, according to the Spondylitis
Association of America. However, doing these
movements regularly in conjunction with your
prescribed treatment plan can help you prevent
loss of flexibility in your rib cage.

4. "The exercises themselves aren’t going to change
the disease process,” Stelmach says, "but they
can help you maintain your range of motion and
help you feel better.”
Last Updated: 10/08/2014
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