How to Manage Pain With Ankylosing Spondylitis

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Ankylosing spondylitis (AS) is a type of inflammatory autoimmune disease that leads to bone fusion in the spine. The soft tissue and muscle surrounding the joints and the sacroiliac joint (which connects the spine to the hips) can also be affected.

When a person develops AS, they experience symptoms such as spine stiffness, back pain, and inflammation in other joints, such as the hips, shoulders, fingers, and toes. These symptoms can be incredibly painful and require ongoing management.

This article discusses treatment options for people who experience pain associated with AS.

Person feeling back pain in morning

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Ankylosing Spondylitis Treatment

Treating ankylosing spondylitis pain involves a multipronged approach. There are various steps a person can take to help improve their pain levels.

Physical Therapy

Physical therapy, or physiotherapy, is designed to help improve mobility, well-being, and physical function in people with ankylosing spondylitis. Research has shown that people who participate in physiotherapy benefit greatly when it comes to pain, stiffness, and mobility.

One study investigated a four-phase approach using physiotherapy, which includes:

  • Phase 1: Phase 1 focuses on relieving pain and improving mobility.
  • Phase 2: The focus of phase 2 is to restore flexibility and train a person for better posture, since the disease can cause postural changes that lead to hunching.
  • Phase 3: During phase 3, aerobic conditioning and strengthening exercises are introduced.
  • Phase 4: The main focus of the final phase is to maintain physical function and improve participation in the activities of daily life.

Each phase introduces different types of physical movement or exercise so that a person with the disease can continue to progress positively.

Physiotherapy Exercises for AS

There are various exercise types used in physiotherapy to help people with ankylosing spondylitis. They include:

  • Core strengthening exercises to improve and manage back pain
  • Stretching to improve flexibility
  • Deep breathing exercises to help improve lung function


Exercise is similar to physiotherapy in that it focuses on movement to help improve AS pain. When a person has gone through physiotherapy and is ready for other types of exercise, they have to know which ones are appropriate.

Cardio and strength training should both be incorporated into your exercise routine to help provide overall pain relief benefits.

Since the spinal joints are affected, it's recommended that people with AS who exercise choose low-impact activities that will provide the benefits of exercise without the risks of injury. Exercises can include:

  • Pilates (set of low-impact exercises to improve flexibility, strength, and body awareness)
  • Water aerobics (performing aerobic exercises in water)
  • Yoga (a mind-body practice combining poses with breathing techniques)
  • Tai chi (system of gentle exercise and stretching)
  • Somatic exercises (gentle movements performed while lying down)
  • Spinning (indoor cycling)

How to Know When It’s Time to Start New Exercises

You know your body and what it can handle better than anyone. That said, you should speak to your healthcare provider before you try any new exercise routine. They will be able to recommend the most appropriate and beneficial exercises for your individual case. Certain exercises should always be avoided, such as boxing, running, tennis, and squash. These exercises could lead to an increase in pain.

Improve Posture

Posture improvement is an important aspect of pain management. This is because poor posture can lead to increased pain in the neck, shoulders, and back.

While exercise and physiotherapy will address posture, there are other things you can do in your day-to-day life that will help, such as:

  • Being aware of your posture while sitting or standing and correcting it if you notice that you are hunched or slouched forward
  • Choosing a chair to sit in that is firm and has a straight back
  • Taking breaks from sitting

Eat Healthy

Eating a healthy diet is important for everyone, and while it won’t treat AS pain on its own, choosing the right types of foods can be helpful in keeping inflammation down.

A healthy diet should include:

  • A variety of fruits and vegetables that have high levels of antioxidants
  • Foods that contain omega-3 fatty acids, such as salmon and other types of fish
  • Drinking at least eight glasses of water per day

While studies surrounding a specific type of diet and AS are limited, some research suggests that certain foods may trigger symptoms in some people.

Foods to Avoid With AS

Processed and fried foods should be avoided if you have ankylosing spondylitis. You should also avoid or limit:

  • Alcohol
  • Foods that are high in saturated fats, cholesterol, sugar, or salt
  • Foods that contain high levels of preservatives
  • Meat
  • Coffee

Stop Smoking

Research shows that people who smoke and have AS could greatly benefit from quitting smoking. This is because smoking has been shown to increase disease activity and cause the disease to progress faster.

Because of these factors, smoking can cause a reduction in a person’s quality of life and physical capabilities.


The most commonly used medications to help treat pain in people who have ankylosing spondylitis are nonsteroidal anti-inflammatory drugs (NSAIDs). These medications can be prescribed or found over-the-counter (OTC), without a prescription. Ibuprofen (Advil, Motrin) is often the most used and can be found on store shelves.

Other medications may be used if NSAIDs do not provide significant relief to people with the disease. Other possible medications include:

  • Azulfidine (sulfasalazine): Used to control joint swelling (which could lead to pain)
  • Trexall (methotrexate): Used to reduce pain and swelling while helping to slow disease progression
  • Corticosteroids: Used to reduce inflammation
  • Biologics: Used to help reduce pain by preventing inflammatory processes within the body 

Medication and Side Effects

Each medication mentioned above comes with its own set of side effects, so it’s important to work with your healthcare provider to find a remedy that works best for you.

Preventing Flare-Ups

People with AS can sometimes experience a period in which symptoms become much worse than they are used to. This period is referred to as a flare-up.

When a flare-up occurs, all the typical symptoms of the condition, such as back and hip pain, spine stiffness, neck pain and stiffness, and fatigue, come on more severely.

At times, a flare-up may only last a few days, whereas at other times, the increased symptoms last for months.

By properly managing the disease, it's possible to help reduce or prevent flare-ups from occurring. This means that you have to exercise, eat well, avoid smoking and eating foods that may worsen your symptoms, and take all your medications as prescribed.

Flare-Up Triggers

People who have relative control over their disease and follow all the precautions to manage symptoms are much less likely to experience flare-ups than those who don’t. One study examined people undergoing AS treatment and found that only 28% had a flare-up over the course of the three-month study period. The common triggers outlined in the study included stress and a lack of physical movement or exercise.


Pain management for those with AS is important. If the disease isn’t managed, it can lead to some complications, including:

  • Reduced flexibility
  • Joint damage
  • Iritis (a condition that causes part of one eye to become swollen and turn red)
  • An increased risk of fractures (if a bone-weakening condition called osteoporosis develops in the spine)
  • An increased risk of heart disease, stroke, and other cardiovascular diseases
  • Cauda equina syndrome (a condition caused by compressed spinal nerves)
  • Amyloidosis (when the protein amyloid builds up within the body and organs)

Preventing Complications

The only thing you can do to prevent complications of AS is to manage it effectively. This can be done by teaming up with your healthcare provider to determine the best course of treatment for you and sticking to it.


Managing pain caused by ankylosing spondylitis requires a collection of different techniques, including physical therapy, exercise, eating healthily, and medications. Avoiding certain behaviors that can make the inflammation or pain worse, such as smoking or eating triggering foods or drinking alcohol, is also important in keeping the pain at bay.

While people with AS may experience times where their symptoms are less severe, they can experience flare-ups that cause symptoms to become worse. These flare-ups typically last about three days, but they can last up to three months or even longer. Because flare-ups and complications of AS can occur, it’s essential to follow your treatment plan to prevent the pain from worsening.

A Word From Verywell 

While coping with the AS pain isn’t easy, there are things you can do to ensure that your pain levels are low and to maintain movement. Exercising is a great way to do both, but it can be hard to exercise while you’re in pain. The trick is to choose the best types of exercise for your body. Ankylosing spondylitis pain is not curable, but it is manageable with the right techniques and tactics.

Frequently Asked Questions

  • What is the best pain medication for ankylosing spondylitis?

    The best pain medication for AS is the one that works for you. That said, healthcare providers typically begin pain treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). If these pain relievers, such as Advil (ibuprofen) and Aleve (naproxen), don’t work, your provider will move on to other forms of treatment for you.

  • What should you avoid with ankylosing spondylitis?

    One main thing to avoid is smoking, since smoking can make the symptoms much worse. People should also avoid exercises that require too much twisting, such as tennis, or those that involve being hit, such as boxing.

  • What foods should you avoid if you have ankylosing spondylitis?

    Foods that cause inflammation should be limited or avoided altogether. Those foods can include alcohol, fried foods, highly processed or preserved foods, and sugary foods. While it may be difficult to cut some foods out of your diet, if they are not helping your overall health, you shouldn’t eat them.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.