Axial Spondyloarthritis Exercises for Pain Management

Axial spondyloarthritis causes pain and stiffness, primarily in the spine and pelvis. Exercises focused on improving flexibility, endurance, strength, posture, and balance are essential to managing pain and other side effects of this condition.

This article discusses various exercises that can aid in treating axial spondyloarthritis.

Woman lying and doing Half Knees to Chest Pose

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Benefits of Exercise for Axial Spondyloarthritis

There are various potential benefits of exercising if you have axial spondyloarthritis. These can include:

  • Better sleep
  • Healthier lungs and heart
  • Improved posture and strength
  • Increased bone density
  • Increased flexibility and range of motion
  • Less pain
  • Lower blood pressure
  • Weight management

Try Some Deep Breathing

Deep breathing can help reduce the pain and stress that occur with axial spondyloarthritis. A 2017 study looked at the impact of deep breathing on cortisol (the stress hormone) levels and found that the group that practiced deep breathing over eight weeks had lower cortisol than the group that did not practice deep breathing.

Stretching and Flexibility Exercises

Axial spondyloarthritis typically causes stiffness in the back and pelvis, particularly first thing in the morning. Stretching exercises for the spine and sacroiliac joint (where the spine meets the pelvis) can improve flexibility and range of motion.

It's normal to feel a pulling sensation while stretching. However, if you feel pain, stop the exercise. Overstretching can cause more damage to your muscles and joints.

Below are stretches to try for flexibility. Perform each stretch 10 times.

Cat and Cow Stretch

  1. Begin on your hands and knees with your hands in line with your shoulders and knees in line with your hips.
  2. As you breathe in, bring your chin toward your chest and round your back toward the ceiling.
  3. Hold for three to five seconds.
  4. Return to the starting position.
  5. As you breathe out, raise your head and drop your belly toward the floor.
  6. Hold for three to five seconds.
  7. Return to the starting position.

Trunk Rotation

  1. Lie on your back with your knees bent and feet flat on the floor.
  2. Keeping your knees together, rotate your legs to one side until you feel a stretch in your lower back.
  3. Hold for three to five seconds, then rotate to the opposite side.

Prone Press-Up

  1. Lie on your stomach with your hands (palms down) resting directly underneath your shoulders.
  2. Keeping your back muscles relaxed, slowly straighten your arms, lifting your chest off the ground.
  3. Stop when you feel a stretch in your back.
  4. Hold for five seconds, then lower back down.

Single Knee-to-Chest

  1. Lie on your back with your legs out straight.
  2. Bend one knee toward your chest.
  3. Use your hands to gently pull your knee closer to your chest until you feel a stretch in your buttocks and lower back.
  4. Hold for five seconds, then straighten your leg back out.
  5. Repeat on the opposite side.

If this exercise causes discomfort in your back, keep the opposite knee bent with your foot resting on the floor rather than out straight.

Balance Exercises

Axial spondyloarthritis causes stiffness and muscle weakness, leading to challenges with balancing and walking, such as slower walking speed and shorter steps. Balance exercises can help. For support, perform these exercises next to a countertop, chair, or another sturdy surface.

Single-Leg Stance

  1. Stand with your feet hip-width apart.
  2. Place your hands on your hips.
  3. Bend one knee and balance on the opposite foot as long as possible.
  4. Repeat on the opposite leg.
  5. Perform three to five times on each side.

To make this exercise harder, try one of these modifications:

  • Close your eyes
  • Hold your arms straight up overhead
  • Stand on a surface that isn't flat (such as a pillow)

Tandem Walk

Tandem walking, or heel-to-toe, challenges your balance by making your support base smaller. Perform this exercise by placing one foot directly in front of the other, as if walking on a tightrope.

Begin by holding your arms out to your sides. As your balance improves, place your hands on your hips, then progress to holding them straight overhead. You can also tandem walk backward.

Make It Easier

If tandem walking is too hard, practice standing still in a heel-to-toe position with your arms out to the sides. Start by leaving some distance between your front and back foot, then gradually move them closer as your balance improves.

March in Place

  1. Stand with your feet shoulder-width apart.
  2. Lift one knee in front of you until your thigh is parallel to the ground.
  3. Lower your leg back down and raise the opposite knee.
  4. Repeat 10 to 20 times.

Aerobic Exercises

Aerobic exercise helps improve heart and lung health for people with axial spondyloarthritis. It can also improve overall endurance, reduce fatigue, and boost mood.

Aerobic exercise should be performed three to five days a week, aiming for 75 to 150 minutes in total.

Choose low-impact activities to avoid increased stress on your painful joints. Examples include:

  • Elliptical machine
  • Recumbent cycling
  • Stationary bike
  • Swimming
  • Walking
  • Water jogging/water aerobics

Strengthening Exercises

Axial spondyloarthritis can lead to poor posture—forward head, rounded shoulders, and flattened lower back. Strengthening exercises for axial spondyloarthritis should target muscles in your "core"—muscles that move and stabilize your spine and help you maintain proper posture. Aim to perform strengthening exercises two to four times each week.

Chin Tucks

  1. Sit up straight on a firm surface, looking straight ahead.
  2. Pull your chin backward as if making a "double chin."
  3. Hold for five seconds, then relax.
  4. Repeat 10 times.

Scapular Squeezes

  1. Sit up straight on a firm surface with your arms resting by your sides.
  2. Squeeze your shoulder blades together as if you are trying to hold a pencil between them—but don't shrug your shoulders.
  3. Hold for five seconds, then relax.
  4. Repeat 10 times.

Bird Dog

  1. Begin on your hands and knees, with your hands in line with your shoulders and knees in line with your hips.
  2. Lift your right arm straight out in front of you. At the same time, lift your left leg straight out behind you. Keep your spine straight.
  3. Hold for five seconds, then return to the starting position.
  4. Repeat on the opposite side.
  5. Do 10 repetitions.

If this exercise is too strenuous, start by lifting just one arm or leg at a time.

Posterior Pelvic Tilt

  1. Lay on your back with your knees bent and feet flat on the floor.
  2. Place your hands on your hips.
  3. Tighten your lower abdominal muscles as if you are pulling your belly button toward your spine. You should feel the muscles under your fingertips tighten.
  4. Hold for five seconds—but don't hold your breath.
  5. Relax and repeat 10 times.

Advance this exercise by adding alternating leg lifts or marches while holding the pelvic tilt.

Working With a Physical Therapist

Working with a physical therapist can ensure you exercise safely with axial spondyloarthritis. If you're having difficulty walking or performing other tasks, your therapist can provide assistive devices (such as a cane or walker) and teach you how to adapt your daily activities to improve overall independence.

Physical therapists can also provide additional treatments to help reduce pain from axial spondyloarthritis, including:


Exercise is an integral part of treatment for axial spondyloarthritis. A well-rounded exercise program should include stretching, balance training, strengthening, and aerobic activities. See a physical therapist for an individualized exercise plan and additional interventions that improve overall function while living with this condition.

Frequently Asked Questions

  • What exercises should you avoid doing with axial spondyloarthritis?

    Avoid any exercises that cause pain if you've been diagnosed with axial spondyloarthritis. High-impact activities—such as running or jumping—should also be avoided. For an individualized exercise plan, see a physical therapist.

  • Can being sedentary make your arthritis worse?

    While being sedentary won't directly make your arthritis worse, it can make the symptoms of your condition worse. Stiffness, decreased range of motion, muscle weakness, balance difficulties, and poor posture are all potential side effects of arthritis that can be improved with exercise.

  • What is the best time of day to exercise?

    The best time of day to exercise is whatever time you can consistently set aside for physical activity. Axial spondyloarthritis tends to cause stiffness first thing in the morning—performing a few stretching exercises before you get out of bed can help.

6 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.
  1. Spondylitis Association of America. Exercise.

  2. National Axial Spondyloarthritis Society. Exercise.

  3. Busch V, Magerl W, Kern U, Haas J, Hajak G, Eichhammer P. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing--an experimental studyPain Med. 2012;13(2):215-228. doi:10.1111/j.1526-4637.2011.01243.x

  4. Ma X, Yue ZQ, Gong ZQ, et al. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy AdultsFront Psychol. 2017;8:874. Published 2017 Jun 6. doi:10.3389/fpsyg.2017.00874

  5. Barnett R, Ingram T, Sengupta R. Axial spondyloarthritis 10 years on: still looking for the lost tribeRheumatology (Oxford). 2020;59(Suppl 4):iv25-iv37.

  6. Soulard J, Vaillant J, Baillet A, Gaudin P, Vuillerme N. Gait and axial spondyloarthritis: comparative gait analysis study using foot-worn inertial sensorsJMIR Mhealth Uhealth. 2021;9(11):e27087. doi:10.2196%2F27087

By Aubrey Bailey, PT, DPT, CHT
Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public, specializing in the areas of orthopedic injury, neurologic diseases, developmental disorders, and healthy living.