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8 Things That May Be Making Your Ankylosing Spondylitis Worse

Medically reviewed by Nancy Carteron, MD, FACR on February 5, 2018Written by Valencia Higuera on February 5, 2018
habits to avoid

Ankylosing spondylitis (AS) is a type of arthritis characterized by pain and inflammation of the spine and pelvic region. This condition can also cause sections of the spine to grow and fuse together, resulting in stiffness and immobility.

Even though there’s no cure for AS, anti-inflammatory medications, over-the-counter pain relievers, immunosuppressants, and biologics (drugs that target specific proteins causing inflammation) can help control symptoms. But even if you take prescribed medication to improve your quality of life, there are a few lifestyle choices that may worsen symptoms.

1. Sedentary lifestyle

When you’re living with chronic back pain, exercise may seem impossible, but leading a sedentary lifestyle could aggravate symptoms. Physical activity can help improve joint flexibility and lessen the pain and stiffness caused by AS.

You don’t have to engage in high-impact activity to feel better, but you should add some physical activity to your daily or weekly schedule.

Aim for about 30 minutes of activity at least five days a week. Things to try include swimming, biking, walking, and strength training (Pilates, tai chi, yoga).

Ask your doctor for activity recommendations before beginning an exercise regimen.

2. Poor posture

Poor posture can also worsen AS. Keep your body properly aligned to strengthen your back muscles, help prevent anterior flexion deformity (where your spine is fixed in a stooped position), and alleviate pain.

Resolve to practice good posture, whether you’re sitting or standing. When sitting in a chair, your back should be straight, your shoulders should be back, and your buttocks should be touching the back of your chair. Keep your knees bent at a 90-degree angle and your feet flat on the floor.

Practice good posture while standing the old fashion way: Walk around with a book on your head. This teaches you how to stand tall with your body aligned.

3. Smoking

Studies such as this one have found a link between smoking and disease activity in people with AS. This study followed nonsmokers and smokers living with AS (a total of 30 people). According to researchers, smokers with AS reported longer bouts of morning stiffness, higher disease activity, and a poorer quality of life compared with their nonsmoking counterparts.

This could be due to the inflammatory effect smoking has on the body. These researchers believe that smoking cessation should be included in treatment plans for AS.

4. Doing too much

Because this condition can cause inflammation, stiffness, and joint pain, it’s important that you don’t overdo it and learn how to recognize your limitations. Failure to pace yourself could result in burnout, or you might engage in activities that put too much strain on your joints. This can make it harder for your body to recover and trigger long-term stiffness and joint immobility.

So, while activity is recommended, pace yourself. Listen to your body and rest when you feel tired or burnt out.

5. Not taking medication as directed

There’s no cure for AS, so you may require ongoing medication to manage symptoms. Your doctor will recommend a medication and dosage based on your individual condition. It’s important to take your medication as directed to slow disease progression, so don’t skip doses.

If you feel that your medication isn’t improving your condition, speak with your doctor. You may need to adjust your dosage or take a different type of medication.

6. Being overweight

Being overweight may also worsen symptoms of AS. Excess weight can put too much pressure on your joints and raise your pain level. As well, obesity is associated with increased inflammation. Adding physical activity to your schedule can help you shed excess pounds. You should also modify your diet.

Reduce your intake of processed foods, sugary foods, and fatty foods, which can inflame your body. Increase your consumption of fruits, vegetables, whole grains, lean meats, and healthy fats like nuts and avocados.

7. Lack of sleep

Sleeping is hard when you're in pain. You may have trouble falling asleep, or you may wake up frequently throughout the night. Sleep is how your body repairs itself, so lack of sleep may worsen AS symptoms.

To reduce nighttime pain and boost sleep, you may need to get a mattress that provides more comfort and support, such as a medium-firm mattress. Limit the number of pillows you sleep with to lessen neck pain during the night.

Also, develop a bedtime routine that encourages sleep. Take a hot bath or shower before bed, and turn off the TV and other electronic devices about one hour before going to bed. Such measures will help to prevent overstimulation.

Avoid alcohol or caffeine before bed, and don’t eat large meals two to three hours before you hit the hay. You should also create a comfortable sleep environment. Keep your room temperature cool, turn off all lights, and create a quiet environment as best you can (a white noise machine can help block out noises).

8. Chronic stress

Stressful situations may also unknowingly worsen symptoms of AS. Stress triggers the release of stress hormones like cortisol and adrenaline, which send your body into fight-or-flight mode.

This increases your blood pressure and heartbeat, and stress hormones stimulate your immune system to release cytokines (a chemical in your body that causes inflammation). Chronic stress can keep your body in an inflammatory state and worsen AS.

To manage stress and reduce inflammation:

  • practice deep breathing exercises and meditation to relax your mind and body
  • learn how to say “no”
  • reduce your personal obligations
  • get more rest
  • talk about your problems with a friend
  • distract yourself with a fun activity whenever you’re feeling stressed out
  • set reasonable goals for yourself
  • spend time in nature
  • adopt a pet

The takeaway

Symptoms of AS can be mild or severe. Depending on the severity of your condition, everyday activities can become challenging during a flare. Although medication can help you feel better, you should also make lifestyle changes to help improve your prognosis and enjoy life to the fullest.

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