More than medication

Your physiotherapist will usually work with you to draw up a range of exercises that are specifically designed to keep you supple and active. To learn more, see our section on Living well. You can also get more information on exercise to help manage ankylosing spondylitis from the National Ankylosing Spondylitis Society (NASS).

Taking control

Help yourself continue to take an active role in your treatment by keeping informed. Don't be afraid to ask your doctor questions about ankylosing spondylitis or your treatment. You can also use books, magazines, and online resources to learn more about ankylosing spondylitis and stay up- to-date on new developments in medicine and treatment options.

Physiotherapy

Physiotherapy is a central part of managing your ankylosing spondylitis. It helps to maintain or improve movement in the spine, improve fitness and reduce pain. It may also help to maintain muscle strength and have a positive impact on your emotional wellbeing.

Physiotherapy programmes are normally developed by a physiotherapist and tailored to each person.

There may be an organised exercise group run by a physiotherapist in your local area that you can join. These groups give you the opportunity to meet other people with ankylosing spondylitis and may help with motivation to maintain these exercises. It is important to ask for advice from your doctor, nurse, or physiotherapist before taking on any new activity as some may cause you additional problems or pain.

Exercising is extremely important and should be continued where possible at home or as part of a group.

Other therapies that may be offered dependant on availability in your local area are:

• Massage therapy - this type of therapy relaxes muscles and can help to reduce pain
• Hydrotherapy - a water-based therapy involving exercises in a warm water swimming pool
• Spa therapy (sometimes known as balneotherapy)
• Transcutaneous electrical nerve stimulation (TENS) - a TENS machine is a small electronic device that sends electrical pulses to nerve endings via pads placed on the body. This method has been shown to help with chronic musculoskeletal (bone and muscle) pain. It is believed to work by blocking pain messages to the brain.

It is important to speak to your physiotherapist about other resources that might be available in your local area.

Embracing change

There are a number of practical things you can do to help you to manage your everyday activities:

• When you're sitting at a desk, sit up straight and try not to bend forward.

• When driving a car, put a small cushion behind your back or under your bottom. During a long journey you may wish to make frequent stops to rest and stretch your legs and back.

• Don't sit still for long periods - get up and move around regularly.

Help others understand your ankylosing spondylitis

Here are some tips to help you talk about your condition so that people around you can understand better what you are going through:

• Learn as much as you can about ankylosing spondylitis. The more you know about your condition, the better you can explain it.
• Be open and honest about how you are feeling. Tell your friends and family what you need and how they can help.
• Tell your family and friends that the pain, joint stiffness and fatigue you experience will vary. Ask them to be understanding if you need to change or postpone activities.
• When you get together with your family and friends, plan activities in which you can all participate.
• Talk openly with your family or partner. Expressing your true feelings about your condition will help others have an understanding of it and allow them to help during difficult times.

Moving forward

While living with Ankylosing Spondylitis can be a challenge, you can remain optimistic about the future. By knowing more about your condition and treatment, you may be able to have better control of your disease.

Alternative approaches

A number of alternative approaches can help you manage your symptoms of ankylosing spondylitis:

• An occupational therapist can give you support and advice on what you can do to maintain everyday activities. The therapist can also give you advice about how to adapt your lifestyle to reduce the impact of the condition on what you do.
• Cognitive Behavioural Therapy (CBT) is a form of talking therapy. Your doctor might recommend a course of CBT to help you deal with certain symptoms of ankylosing spondylitis, such as fatigue caused by sleep problems.
• Tai Chi is a combination of physical exercise and relaxation techniques which may help improve your flexibility and posture.
• Acupuncture involves a qualified practitioner inserting needles at key points in your body. Research studies have shown that this may help with pain relief.

Not everyone with ankylosing spondylitis will need surgery. However, if specific symptoms are being experienced, surgery may help relieve these symptoms and improve a person's quality of life. Surgery is normally carried out on the hip or the spine.

People with ankylosing spondylitis may develop hip arthritis. For people who have hip arthritis and associated pain which does not respond to treatment or those who are disabled, a hip replacement may be considered.

Spinal surgery may also be considered in selected patients with ankylosing spondylitis. This can include:

• Surgery for segmental instability (abnormal movement between two or more vertebrae in the spine)
• Upper spinal surgery to help with kyphosis (curvature of the spine)
• Surgery to stabilise the spine
• Neurological problems