Clinical Reviewer: Keith Chan, New York State licensed physical therapist and subject matter expert for ITNYCPT
Last Reviewed: June, 2026
Physical therapy can help people with ankylosing spondylitis manage stiffness, maintain movement, improve posture, and stay active.
Ankylosing spondylitis physical therapy does not cure the disease, but it can support physical function and make daily tasks easier.
ITNYCPT is an outpatient physical therapy clinic in New York City. This guide explains treatment, exercises, safety limits, and realistic results.
Key Takeaways
- Physical therapy can help reduce stiffness, maintain mobility, improve posture, and support daily function, but it cannot cure ankylosing spondylitis.
- Treatment may include mobility work, strengthening exercises, breathing drills, posture training, and low-impact aerobic exercise.
- Exercise plans should change based on symptoms, disease activity, bone health, spinal changes, and personal goals.
- Forceful twisting, aggressive stretching, and high-impact exercise may require changes when spinal fusion or osteoporosis is present.
- Long-term progress often depends on regular home exercise, follow-up checks, and care from both a physical therapist and a rheumatologist.
How Does Physical Therapy Help?
Physical therapy helps keep the spine, hips, shoulders, and rib cage as mobile and strong as possible. Ankylosing spondylitis often affects the spine and sacroiliac joints, which link the lower spine to the pelvis. Symptoms may include pain, morning stiffness, reduced joint mobility, and changes in posture.
Physical therapists may use movement training, strengthening exercises, breathing work, and education. These methods may help reduce pain and improve daily activity, but they cannot stop inflammation or reverse spinal fusion.
Current clinical guidance supports regular exercise and considers physiotherapy an important part of care for axial spondyloarthritis.
What Happens at the First Visit?
A first visit usually includes a health history, movement screen, physical tests, and goal setting. The therapist may ask about pain, stiffness, medicine, sleep, work, falls, past injuries, and current physical activity. They may also ask whether movement helps your symptoms or makes them worse.
The physical exam may assess:
- Spinal and hip range of motion
- Posture, walking, and balance
- Core, hip, shoulder, and leg strength
- Breathing patterns and chest expansion
- Sitting, lifting, and bed mobility
The tests should match your health and current ability. A person with mild stiffness may complete a broad movement screen. Someone with spinal fusion, weak bones, or a higher fracture risk may need a slower and more careful exam.
Ankylosing Spondylitis Physical Therapy Treatment
Physical therapy treatment for ankylosing spondylitis should focus mainly on active care. Exercise aims to maintain movement, build strength, support good posture, and improve stamina. Clinical guidance favors active methods, such as supervised exercise, over passive care used alone.
Spine and Hip Mobility Exercises
Mobility exercises help maintain movement in the spine, hips, shoulders, and ribs. They should feel controlled and should never force a stiff or fused joint. Common ankylosing spondylitis physical therapy exercises may include the following movements.
Pelvic tilts: Lie on your back with your knees bent. Gently flatten your lower back into the floor, then return to a neutral position. This small movement helps build control around the pelvis and lower spine.
Seated trunk rotation: Sit upright with your feet on the floor. Turn your chest slowly to one side while keeping your hips facing forward. Return to the center and repeat on the other side.
Hip flexor stretch: Stand in a split stance or kneel with one knee supported. Shift forward until you feel a mild stretch at the front of the rear hip. Keep your trunk upright and avoid arching the lower back.
Thoracic extension: Sit against a firm chair with the top of the chair at the middle of your back. Support your head and lean backward through a small range. Stop if the movement causes sharp pain or pressure.
The amount of movement depends on disease activity, pain, and spinal changes. Mild tension may be normal, but sharp pain is not. Regular practice is often more useful than trying to achieve a large range of motion in a single session.
Posture and Strength Exercises
Strength work supports the muscles used for standing, walking, balance, and daily tasks. Key areas often include the upper back, core, hips, and legs. Good posture does not mean holding one stiff position all day, since poor posture can contribute to muscle tension when the body stays in one position for too long.
Wall posture drill: Stand with your back near a wall and your feet slightly forward. Bring your upper back and head toward the wall without forcing them. Hold for a few deep breaths, then relax.
Resistance-band row: Hold a band in both hands and pull your elbows back. Draw the shoulder blades together without lifting the shoulders. This strengthening exercise works the upper back and may support upright posture.
Bridge: Lie on your back with your knees bent. Tighten your core and lift your hips until your shoulders, hips, and knees form a line. Lower slowly and stop if back pain rises.
Sit-to-stand: Sit near the front of a firm chair. Lean forward and stand without using your hands when possible. Lower yourself with control.
Pilates-based therapeutic exercise may also support core strength, control, mobility, and a return to activity. The therapist should adjust the position, range, or resistance to suit the patient. No single exercise plan fits every person.
Breathing and Aerobic Exercise
Deep breathing exercises may help maintain rib movement and chest expansion. Sit upright, place your hands around the lower ribs, and take slow, deep breaths into the sides of your rib cage. Exhale fully without straining.
You can add arm movement to the breathing drill. Raise both arms as you breathe in, then lower them as you breathe out. Seek medical care for chest pain or shortness of breath that is new or unexplained.
Aerobic exercise supports heart health, stamina, and long-term physical function. Walking, cycling, swimming, and water exercise are common low-impact choices. Regular exercise plans for axial spondyloarthritis may include mobility, strength, and aerobic work based on the person’s changing needs.
McKenzie Exercises for Ankylosing Spondylitis
McKenzie exercises use repeated movements and held positions to test how symptoms respond. They often include backward bending, but they are not a standard answer for every person. Spinal fusion, osteoporosis, prior injury, and pain patterns can affect whether these movements are safe.
Standing extension: Place your hands on your hips and lean backward through a small, comfortable range of motion. Return to upright slowly. Stop if pain spreads, rises, or lasts after the exercise.
Prone press-up: Lie on your stomach and place your hands under your shoulders. Lift your chest with your arms while keeping your hips down. Use only a range that feels safe and comfortable.
These movements should not be used as a fixed routine without checking how the spine responds. Stop for lasting pain, numbness, weakness, or loss of balance.
Manual Therapy and Graston Technique
Manual therapy may be used for tight muscles or selected soft-tissue limits. Graston Technique is a form of tool-based soft-tissue work that may be relevant when tight tissue affects movement. It may provide short-term relief, but it does not treat the inflammation that causes ankylosing spondylitis.
Other physical therapy modalities may help manage selected symptoms, but they should support an active treatment plan rather than replace exercise.
Strong spinal manipulation may be unsafe when fusion, osteoporosis, or fracture risk is present. Active exercise programs should remain the main part of care. Hands-on methods should support movement rather than replace it.
Physiotherapy Management of Ankylosing Spondylitis
Physiotherapy management of ankylosing spondylitis should change as symptoms change. A flare may call for shorter sessions and lighter exercise, while stable periods may allow more strength and aerobic work. Ankylosing spondylitis physiotherapy should follow the person’s response rather than a fixed schedule.
During a flare, useful changes may include:
- Using less weight or resistance
- Moving through a smaller range
- Replacing impact exercises with gentle activity
- Breaking one workout into short sessions
- Adding more rest between sessions
Complete rest may increase stiffness, but hard exercise may also raise symptoms. During stable periods, the program can gradually add resistance, longer walks, or more challenging balance work. Changing one part of the program at a time makes it easier to judge the response.
Home exercise is central to long-term care. The plan should be short, clear, and realistic enough to be completed often. Follow-up visits allow the therapist to check form, reassess symptoms, and update the types of exercise used.
Physical Therapy Contraindications and Precautions
Ankylosing spondylitis physical therapy contraindications depend on bone health, spinal fusion, balance, pain, and past injuries. Forceful twisting, heavy bending, aggressive stretching, and high-impact exercise may need to be changed or avoided. Exercise should never force movement through a fused part of the spine.
Stop exercise and seek guidance for sharp pain, new numbness, weakness, poor coordination, or dizziness. New neck or back pain after a fall or hit may need urgent medical review because a stiff or fused spine can face a higher fracture risk. ASAS-EULAR guidance also treats spinal fractures as an important part of medical management.
Sudden eye pain, redness, light sensitivity, or blurred vision also needs prompt care. New bowel or bladder changes, severe weakness, chest pain, or ongoing shortness of breath require medical assessment. Physical therapy should not delay care for these symptoms.
Physical Therapy and Medical Care
Physical therapy supports movement, strength, posture, breathing, and daily function. A rheumatologist treats the inflammation and may prescribe medicine to manage disease activity. These forms of care work together but do not replace each other.
Axial spondyloarthritis is the broader term for inflammatory arthritis that mainly affects the spine and pelvis. Ankylosing spondylitis is often defined as cases with structural changes seen on X-ray. The rehab plan should be based on the person’s symptoms, health history, imaging, and physical exam.
What Results Can You Expect?
Results depend on disease activity, spinal changes, fitness, sleep, work demands, pain levels, and exercise consistency. Some people notice less morning stiffness or easier movement within weeks. Gains in strength and stamina may take longer.
The goal is often better control, not complete symptom removal. A clear plan may help reduce pain, stay active, and complete daily tasks. Long-term progress usually depends on regular mobility work, strengthening exercises, deep breathing exercises, and aerobic activity.
Clinical References
- ASAS-EULAR Recommendations for the Management of Axial Spondyloarthritis, 2022 Update. The recommendations encourage regular exercise and state that physiotherapy should be considered as part of care.
- NICE Quality Standard: Physiotherapy for Spondyloarthritis. NICE recommends an exercise plan tailored to the person’s needs, with goals that include reducing stiffness and pain while supporting mobility and fitness.
- American College of Rheumatology Axial Spondyloarthritis Guideline. The guideline strongly recommends physical therapy and favors active exercise-based care over passive methods alone.
- Physical Therapy in Axial Spondyloarthritis: Guidelines, Evidence, and Clinical Practice. This clinical review supports physical activity and prescribed exercise as key parts of physical therapy care.
