ankylosing spondylitis treatment

Natural Ankylosing Spondylitis Treatment

Last Updated on February 17, 2022 by Dr Timothy Lim

Ankylosing spondylitis treatment with chiropractic care and physical therapy can effectively relieve lower back pain early to middle stages. Ankylosing spondylitis (AS) was initially described by Marie in 1898, Strumpell in (1897), Von Bechterew (1899), hence AS is also called Marie-Strumpell disease and Bechterew’s disease. Today, the term axial spondyloarthritis is becoming more commonly used to describe AS. In the long term, understanding the Ankylosing spondylitis (AS) disease process is the key to developing a holistic treatment program. 

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Diagnosis of Ankylosing spondylitis

Ankylosing spondylitis (AS) is a disease where the body’s immune system has “gone nuts”. Diagnosis with x-rays may or may not show the classic candlewax appearance in the neck or lumbar spine until a more advanced stage of the disease. AS primarily affects the spine and pelvis. When calcification of the ligaments are significant, it can be observed on the sacroiliac joints or along the border of the lumbar spine on x-rays (Figure 1).

Figure 1: Calcification of the ligaments along the border of the lumbar spine.

On a blood test, AS patients may or may not be HLA-B27 positive but yet have all the signs of the disease. Chronic inflammation commonly develops in the lower back spine and the sacroiliac joints that trigger the feeling of pain. AS is about four times more common in men than in women, with age predominance in the third decade of life. 

On a physical exam and history taking, your doctor may ask if you have had lower back pain for longer than 3 months that is not relieved by rest. When bending your spine forward while standing, you may find range of movement is limited more than usual.

Symptoms of Ankylosing spondylitis

Ankylosing Spondylitis usually cause lower back pain that can spread and be felt in the buttocks and thighs lower back stiffness. Other symptoms include tiredness and weight loss. Most commonly, patients come in with symptoms that begin with decreased spine flexibility and morning stiffness during the first thirty minutes upon awakening.

The pain from is often relieved with some form of exercise but not from resting. Generally it feels better with more movement as the day progresses. Because the spine loses its flexibility when staying still for too long, people may find their back bent forward, making walking and moving around painful and challenging.

Calcium minerals deposit in the spinal ligaments lead to the fusion of vertebral bodies. The phenomenon can also occur in other joints such as the jaw or TMJ, ankle and feet. Mineral deposits may also occur in other joints even organs such as the eyes, heart valves, lungs, and kidneys. As the ligaments lose their flexibility, patients may correspondingly experience decreased mobility.

Ankylosing spondylitis Treatment Options

Ankylosing spondylitis treatment by medical doctor usually begins with NSAIDs or pain killers for mild to moderate pain to give relief, and if that does not work, they will give you anti-rheumatic medications, including steroids, methotrexate, and sulfasalazine. Newer drugs such as Janus Kinase or JAK inhibitors are also being used to treat for AS pain.

As a Chiropractor, many of my patients report that the best form of Ankylosing Spondylitis treatment you can do to relieve discomfort is to include some form of exercise. These self mobilization exercises includes movement such as Tai Chi, Pilates, Yoga, swimming; anything to get your body moving to give you an improved functional quality of life. 

In older patients with Ankylosing Spondylitis, fractures are more common, resulting in surgical thoracic or cervical intervention. These fractures in older patients with Ankylosing Spondylitis must be considered highly unstable and should be treated as if they have osteoporosis. 

AS patients aged thirty to forty years are now showing signs of abnormally low bone density. I believe Ankylosing Spondylitis is caused by the calcium not being able to incorporate into the bone. Calcium is going in the wrong places such as soft tissue such as ligaments and fascia.

Most practitioners prescribe anti-inflammatory drugs or Turmeric for ankylosing spondylitis treatment. One of my patients was on Enbrel (Etanercept) 50mg, Indomethacin 25mg. Since Indomethacin, an anti-inflammatory drug, can cause gastric ulcers, he was also prescribed Famotidine 20mg to counter any gastric problems. Famotidine helps prevent gastric ulcers by inhibiting stomach acid. 

Low stomach acid is needed for the efficient digestion of proteins. Indigestion arises when you don’t have enough low stomach acid. Reducing inflammatory food such as gluten or wheat products like bread, pasta, biscuits may reduce pain or flareups. 

An Ankylosing spondylitis treatment protocol might include a reduced or elimination of wheat products. Research evidence AS patients may also be gluten sensitive. Gliadins are polypeptides found in wheat, rye, oat, barley, and other grain glutens and are toxic to the intestinal mucosa in susceptible individuals. Because of subclinical gliadin intolerance, healthy adults and children may have a positive antigliadin test. Their symptoms include mild enteritis, occasional loose stools, fat intolerance, marginal vitamin and mineral status, fatigue, or accelerated osteoporosis.

Questions on Ankylosing Spondylitis Treatment and Chiropractic

Can MRI and CT scans be an alternative form of diagnosis for Ankylosing Spondylitis apart from X-rays? If yes, what are the differences?

X-rays are usually sufficient together with blood tests to diagnose Ankylosing Spondylitis. MRI and CT scans may be used for further investigation.
I know sometimes not all the puzzle pieces seem to fit your condition. I had one patient who does not have stiffness but has X-rays to show they have AS, but his main complaint is feeling hot all over his body. This disease does not follow the textbook’s description for symptoms one might experience.

Hi, Dr. Lim, I’m turning 35 this year, and I’ve just been diagnosed with suspected Ankylosing Spondylitis by doctors at Singapore General Hospital (SGH) and Changi General Hospital (CGH).
A recent X-ray shows that 2 of my lower back spine has bone growth over the cartilage. My back became very stiff, and I couldn’t bend forward.
Currently, my Ankylosing spondylitis treatment medication is Diclofenac prescribed by my Rheumatologist. The doctor said that my blood test was negative, but all other symptoms, X-rays, and MRIs indicate Ankylosing Spondylitis. So can Chiropractic indeed help to reduce my stiffness?

Have you had any recent infection(s), viral or allergies to any foods? Not all AS patients have pain. Do you experience any pain?

The results depend on how severe your condition is. Some of our patients have to use drugs prescribed by a Rheumatologist to help and slow down the disease progression. Often increase in dosages or change in medication is necessary later on.

Diagnostic testing demonstrates an elevated Erythrocyte Sedimentation Rate (ESR) during active phases of the Ankylosing Spondylitis disease, a negative antinuclear antibody, and rheumatoid factor. HLA-B27 haplotype is present in 60%-90% of Ankylosing spondylitis (AS) patients compared to only 4%-8% of normal controls.

Standard chiropractic spine mobilization or physiotherapy can help some to help relieve the stiffness but does not fix the root problem. No one is addressing the root cause here, which in my opinion, is an inflammatory process triggered by an event or a process. (The above labs mentioned, including hs-CRP, ESR are helpful.)

We help our patients with AS via spine mobilization and design a nutritional protocol to slow down the inflammatory process. In addition, we recommend our patients follow an exercise program to maintain posture (prevent kyphosis) and build muscle strength in areas of affected joints. Patients report swimming helps and stiffness worsens when not moving for a long period.