Ankylosing Spondylitis (AS) is a form of arthritis that primarily affects the spine and pelvis. It also causes inflammation where tendons meet bone, such as the Achilles tendon. Although back pain is the primary symptom in the early stages, heel pain can also be a significant indicator of AS.
What is Ankylosing Spondylitis?
AS is in the same family as conditions like rheumatoid arthritis and they share a few similarities. Both are autoimmune: the body attacks its own joints during episodes of inflammation. Once this subsides, the healing process creates deformities where bone regrows in the wrong place. In the case of AS, the improperly formed bone lies over the spinal joints and pelvic joints (SIJ). Over a period of years, if left untreated, the spine will take on a characteristic “? shape”. Previously, when there was less understanding of the way AS works, this was considered a primary sign. Now we know that this is actually indicative of late stage disease. At this point, inflammatory episodes may no longer occur, and the strong anti-rheumatic drugs are unlikely to be effective.
Although medication might not be helpful, it’s still useful to have a diagnosis. In older age, it’s easy to write off the remaining symptoms as “postural” or “just arthritis“. But knowing if there is fragile bone causing spinal fusion helps us to treat safely. It would not be recommended to manipulate (click) the upper or lower back of someone with late stage AS, as it could fracture the fragile bone. At best, it would achieve very little as the muscular and neurological effects on the joints would mean little in a truly fused joint.
Diagnosis and Treatment
The difficulty in diagnosing as is that it’s often mistaken for typical “garden variety” lower back pain. Fortunately, Osteopaths have the benefits of experience with lower back pain, and time with the patient to be in a position to flag this. Diagnosis itself must be given by a Rheumatologist, but in order to see a Rheumatologist you need a referral from your GP. Your Osteopath can play a key role in supporting your referral, as it is often brushed off as simple back pain. Questionnaires like the SPADE tool can be really helpful here.
Diagnosis is very important for the best quality of life. In cases of active flares, fusion will continually develop over time until that fixed posture forms permanently. Painkillers can take the edge off the pain, and potentially reduce the inflammation, but it’s those elusive anti-rheumatic drugs that truly slow the disease progression. Only a Rheumatologist can prescribe these.
Your Osteopath’s role is to support your movement. With inflammatory conditions, symptoms are worst after rest and relieved by movement. So it’s key for us to help you maintain as much comfortable movement as possible. As mentioned above, manipulation might be inappropriate, but inflamed tissues tend to prefer gentle treatment anyway. Mobilising techniques for the back, and massage for the local muscles (especially the calf if the heel is involved) are a good place to start.
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