Physical therapy for ankylosing spondylitis can help reduce pain and stiffness and improve posture and mobility. A physical therapist can help select and guide you in exercises for your specific symptoms.

Ankylosing spondylitis (AS) can cause severe pain and limit your mobility. If you have AS, you might not feel like moving or exercising because you’re in pain.

But not moving can actually do more harm than good. If you have AS, a doctor will likely recommend some type of exercise as part of your treatment plan. In addition to helping reduce AS symptoms, exercise can also support your overall health.

Physical therapy (PT) under the guidance of a trained physical therapist experienced in PT for AS can help you stay active and reduce the risk of injury. PT can help:

  • reduce stiffness in your joints
  • improve your posture and coordination
  • decrease your pain
  • strengthen your muscles
  • improve your balance and flexibility
  • improve sleep

Read on for information about how a physical therapist can help and exercise tips that can ease your symptoms.

Physical therapy (PT) is a guided and structured exercise program designed for rehabilitation or strengthening in response to a chronic condition, surgery, or injury.

When you receive PT, a physical therapist safely guides you through exercises at your level. They create an exercise plan that is specific to you. They may also teach you how to maintain proper posture when participating in daily activities, such as walking, standing, or lifting, and instruct you on movement strategies that support pain management.

Depending on insurance coverage, people may see physical therapists from three times per week to once per month, generally for an hour or less.

PT may also include a home exercise component, where the therapist teaches you exercises to perform at home.

If you’d like to see a physical therapist, ask your doctor if they have a recommendation and check with your insurance provider about coverage. Even with insurance, you may have to pay an out-of-pocket cost, such as a copay, for PT services.

During a PT session, a physical therapist will likely teach you about different exercises you can do during your session and at home to help you manage your AS.

According to a 2024 study, physical therapy can improve mobility, functional capacity, sleep quality, and pain associated with AS. A study from 2021 noted that physical therapy on land and in water also supported lung function in people with AS compared with home exercising.

During a PT session, your physical therapist might ask you to try the following types of exercises while monitoring and correcting your form or posture:

Posture training

Improving your posture is key to managing your AS symptoms. Your physical therapist may suggest the following:

  • Prone lying: To do this, you lie face down on a firm surface with a pillow or towel under your chest and forehead. Lie in this position for 1 to 2 minutes, working your way up to 20 minutes.
  • Standing against the wall: Stand against the wall with your heels 4 inches away and your butt and shoulders lightly touching the wall. Try to bring the back of your head to the wall and hold this pose for 10 seconds. Repeat 5 times.

Your physical therapist may also recommend that you stand, walk, and sit tall while doing all exercises to maintain proper posture.

Strengthening exercises

The Spondylitis Association of America notes that core strengthening exercises are key to managing back pain in AS. Strengthening the abdominal and back muscles that make up your core can take stress off your back and reduce pain.

Strengthening exercises can include:

  • yoga
  • tai chi, which increases strength and balance through slow movements based on martial arts
  • exercises with your body weight, light hand weights, or resistance bands

Flexibility and stretching exercises

Flexibility exercises can increase your range of motion. These are exercises that you do without weights, focusing on stiff joints.

Flexibility exercises are especially important for people with AS to counter the natural tendency to avoid moving joints and areas that hurt. Immobility can lead to further stiffness and increased pain when you move.

Lack of movement can also lead to AS complications like spinal fusion. This is when the bones of the spine grow together. It causes the backbone to become rigid and can make it difficult to walk.

Your physical therapist can help design a routine with the flexibility exercises you need. Consistency is key in your practice. Your therapist will make recommendations about how frequently to do the exercises. Some stretches can be done in a chair if standing exercises are too challenging.

One to try is the seated glute stretch:

  1. Sit in a chair with your back upright and your feet flat on the floor.
  2. Lift your right leg and put the outside of your right ankle on your left thigh above your knee, letting your right knee fall out to the side.
  3. Slant your upper body forward while keeping your spine straight. Hold for 10 to 20 seconds.
  4. Sit upright again and repeat on the other side.
In the seated glute stretch, you sit cross-legged.
Goodboy Picture Company/Getty Images

Deep breathing exercises

If you have AS, you may sometimes find it difficult to take a deep breath. You may feel short of breath even during daily activities. This is because the chest cavity may be inflamed and stiff, and it does not expand as it should.

Deep breathing exercises can help keep the chest wall flexible, especially the joints where the ribs meet the vertebrae of the spine. Daily breathing exercises may gradually increase your capacity to take a deep breath.

You can try this simple exercise of alternating deep breaths with regular breaths to feel how deep breathing can help your chest expand:

  1. Start by sitting or lying down and inhale one slow, deep breath. Allow your abdomen and your chest cavity to expand fully.
  2. Breathe out slowly and feel your abdomen fall as you exhale.
  3. Alternate regular breaths with deep ones several times.

Pain management and exercise

One 2019 analysis of 14 trials in 9 countries found that those with AS who exercised experienced a 21% reduction in pain over those who didn’t exercise.

Deep breathing and relaxation exercises can also help. They reduce tension and stress in the body, which in turn can help reduce pain.

It’s sometimes difficult to exercise when it hurts, even if you know it will help in the long run. Your physical therapist can help develop an individual exercise program for you that will be gentle enough, yet effective.

Individual and group activities

A physical therapist can help design a personalized exercise plan that accommodates your AS stage, lifestyle, and physical condition. Every person is different.

In addition to your individual exercise routine, your physical therapist may have you try cycling, swimming, or another low impact aerobic exercise.

They may also recommend taking an exercise class. You can start with a beginner’s class. It’s best to make sure your instructor knows about your AS.

The National Axial Spondyloarthritis Society in the United Kingdom recommends people with AS choose gentle, low impact activities that involve minimal body contact with others. Some of the organization’s choices include:

  • Pilates
  • tai chi
  • indoor cycling (on a static bike)
  • water aerobics
  • yoga

When you have AS, exercise can affect you differently at different times. You may need to change your exercise choices as needed.

Your physical therapist can help you choose activities you enjoy that don’t increase the risk of injury. They will help you modify your plan so you can keep it up over the long term.

Physical therapy has the added benefit of a trained professional who can instruct you in different exercises and stretches that specifically target areas of stiffness, pain, or other issues you experience.

A physical therapist can design an exercise program that meets you where you are and can help improve your mobility over time. They can also ensure that you learn to perform the exercises correctly, avoid injury, and adjust your plan as needed.

A 2024 review of research suggests that moderate exercise can relieve symptoms of AS and improve spinal mobility. Researchers noted that certain exercises had these effects on AS symptoms, including:

  • running
  • Pilates
  • stretching
  • yoga
  • tai chi

Other benefits of exercise for people with AS include:

  • More flexibility: It may be easier to go about daily tasks when your spine is more flexible.
  • Better posture: You may feel more comfortable when you can stand straight and tall.
  • Less stiffness and pain: Over time, performing a personalized exercise program can result in less pain.
  • Better sleep: Getting enough sleep can help support your overall physical and mental health. Exercise can tire you out, which can lead to better sleep.

Read more about the benefits of physical therapy.

Before you start PT, know that some slight pain or discomfort will likely occur when you begin exercising. But it’s best not to push through severe pain.

Let your physical therapist know if you’re experiencing extreme discomfort during your session.

Some people may need more strengthening exercises, while others may need more stretching. A physical therapist can help you figure out your specific needs.

Working with a physical therapist is a great first step to incorporating exercise into your daily routine. The last thing you want to do is injure yourself and cause more pain.

A physical therapist can teach you low impact exercises that don’t put extra strain on your joints or spine.

You can find resources on group exercise at the Arthritis Foundation and Spondylitis Association of America.

You can find a physical therapist in your area by searching the American Physical Therapy Association’s online database.

You can also ask your doctor for a recommendation. They may be able to recommend a physical therapist who specifically works with people living with conditions like AS.

You can also check with your insurance provider for a list of physical therapists in your area covered by your plan.

PT has many benefits for people living with AS. The targeted exercises can improve your strength, posture, and flexibility. Physical therapists can also help ensure you’re doing all the exercises correctly and safely.

Talk with your doctor to see if they can recommend a physical therapist as part of your treatment plan. Consult your doctor before doing any exercise on your own.

It’s best to make sure the location and services you choose are covered by your insurance plan. Insurance coverage may only allow a specific number of sessions in a time frame. You may also have some out-of-pocket costs.

Knowing about these before you begin can help you and your physical therapist get the most out of your time. They can also recommend exercises to do at home between sessions.