Ankylosing Spondylitis

A young man came to our office two weeks ago bent over in pain and unable to straighten his posture.  At first glance, we thought it was another classic case of an aggravated bulging disc.  We would have treated it as such until we took x-rays of his spine and discovered a very different situation and an often missed diagnosis.  I know this information might be a great candidate for the bank of useless knowledge for many, but no knowledge is useless and I feel compelled to share some information with you about a condition known as Ankylosing Spondylitis. 

Ankylosing Spondylitis, or AS, is one of several conditions which have a tendency to cause inflammation of the spine and are collectively called spondyloarthropathies.  These include psoriatic arthritis, reactive arthritis, and arthritis associated with Chrohn’s disease and ulcerative colitis.  AS is a form of spinal and sacroiliac joint inflammation.  The sacroiliac joints are two small joints at the base of the spine which are key in weight-bearing and become very painful when they are inflamed.  The condition causes substantial pain at times, stiffness in and around the spine, and left unchecked will result in permanent fusion or “cementing” together of the joints involved.  “Ankylosing” refers to the process of the fusing together of the spinal bones and “spondylitis” refers to chronic spinal inflammation.  The process of ankylosing eventually results in the complete loss of spinal mobility.

The symptoms most often experienced by those with AS include back pain or sacroiliac joint pain which is worse at night or after long periods of activity.  Often people with AS adopt a forward-leaning posture which naturally relieves the pain associated with the condition.  AS makes standing erect very painful, so curving forward eases this discomfort.  Curving forward, however, tends to compress the lungs and makes breathing sometimes difficult.

Ankylosing Spondylitis is thought to be inherited.  Nearly 90% of those with AS are born with the HLA-B27 gene.  Sophisticated blood tests have been developed to detect the marker for this gene, but it does not definitely predict that a person will develop AS.  The gene is not specific for the disorder.  For example, in the United States, 7% of the population has the HLA-B27 gene but only 1% of the population actually has AS.  Research is active in this area, and it is said that a negative HLA-B27 test is more useful in ruling out AS than a positive one is in predicting it.  X-ray is the gold standard for the diagnosis of AS since the spinal abnormalities it causes are very distinct and can be very easily seen on plain films.  This is one of the very reasons that x-ray is necessary in the treatment of people in a chiropractic practice.  If the aforementioned patient had been treated without x-ray, he would have been treated for a condition he doesn’t have and this diagnosis would have been missed.

Many people with AS are under the care of a medical doctor as well as under treatment with a chiropractor.  Medicines are used to control inflammation but, of course, come with their side effects.  A chiropractor can keep spinal mobility and flexibility for as long as possible and help to create better posture.  Gentle flexion/distraction techniques are available and are very helpful in treating this disorder.  Physical therapy and exercise are also helpful since AS tends to cause a forward posture.  Curving forward results in lung compression, so it is essential that extension exercises and those that expand the lung capacity are prescribed and practiced daily.  Stretching exercises help to improve overall flexibility.  Swimming might be described as the perfect exercise for those with AS and many other conditions because it avoids the jarring impact to the spine that many other forms of exercise create.  Of course, nutrition is also of utmost importance when trying to manage this and any other condition.  One specific area of focus nutritionally has been on leaky gut syndrome, or the inability to digest and absorb foods properly.  Information is available on the proper supplements to use in order to increase absorption of nutrients.  Some very beneficial ones are those that promote healthy bacterial flora and those that aid in digestion, specifically acidophilus and bromelain.  Any time the body is not using the food it is supplied with properly, any of a host of conditions might occur, and AS is one of these.

AS is not necessarily crippling or debilitating.  The main piece of advice for those who suffer from it is to become actively involved in your treatment.  Do all that you can to keep your body active, limber, and in good condition.  Work with a team of healthcare providers, and don’t limit yourself to just taking medications that might or might not be beneficial.  Keep a positive attitude, and treat your body well.

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