While anti-inflammatory medications can help relieve the pain and reduce inflamed joints, other courses of action such as physical therapy can also relieve pain and inflammation naturally. “Ankylosing spondylitis symptoms can be managed with conservative care such as physical therapy, chiropractic care, and acupuncture,” says Joshua Kollmann of Carolina Sports Clinic and team chiropractor for the NFL’s Carolina Panthers. “The earlier this type of care occurs after diagnosis, the greater ability it has to help relieve discomfort and pain.”

Why Stretching Is Important

Range of motion and stretching exercises can reduce stiffness in your joints and help you maintain flexibility and preserve good posture. “In general, any movement activities that don’t worsen your symptoms and keep you moving are good,” says Zachary Long, a physical therapist with Carolina Sports Clinic in Charlotte, North Carolina. Both Kollmann and Long utilize controlled articular rotations (CARs) in people with ankylosing spondylitis. CARs are active rotational movements of joints, which use the whole range of motion of a single joint in a controlled manner. Kollman says these types of stretches are more effective than static stretches — or stretching and holding that position for a period of time. Static stretches don’t have the ability to dive deep within the joint capsule and muscle tissue like CARs can, he says. “When you ask a person who already has joint stiffness and a decreased active range of motion in the morning to perform a series of static stretches, you risk increasing his or her discomfort and pain,” he says. “CARs, however, increase intra-articular fluid and blood flow to the muscles and assist in elongating the soft tissue. It’s motion that we’re looking for in people with ankylosing spondylitis.”

A Morning Stretching Routine for Ankylosing Spondylitis

Kollman suggests trying the following sequence of stretches first thing in the morning to help ease muscle and joint stiffness:

  1. Neck Rotation Start by standing erect with both arms out to your side. Standing with some light tension throughout your body, slowly rotate your head in a clockwise motion for two rotations. Perform two rotations going the opposite direction while still maintaining tension in the body. (Note: The tension in the body helps you focus on the joint that is in motion and create as much joint mobility in that one joint as possible. In the morning session of CARs, the tension held in the body should be on the lighter side. Think 30 to 40 percent of a whole body in an all-out contraction.)
  2. Shoulder Rotations Keeping the 30 to 40 percent tension in your body, stand tall and place your left arm down by your side. Keeping your arm straight, slowly move your arm up in front of you in an arc-like fashion until your arm is outstretched and your hand is in the air. With the arm in the upright position, start rotating the arm back as if you were doing the backstroke. The finished position is with the thumb pointing towards the wall and the backside of the hand on your back pocket. Repeat on your right side.
  3. Spinal Stretch Stand tall and cross your arms over your chest. Bend slightly forward using only the spine, not the hips. Move the chest bone down toward the belly button. While in the forward bend, gently rotate and lateral bend the spine to one side. Perform the flexion, rotation, and lateral bend to the other side in order to complete one repetition. Maintain 30 to 40 percent tension in your body throughout this stretch.
  4. Hip Circles While standing, raise your right knee up into a 90-degree angle. Once in position, maintain the 90-degree position of the knee and move the knee away from your body. From there, bring the foot up towards the ceiling. This is creating internal rotation at the hip joint. As the hip is being internally rotated, bring the leg behind your body and back to the finishing position. A full circle of the hip will be created with each repetition. Remember to maintain full body tension while moving the hip through its full range of motion. Repeat with your left leg. Hold onto the wall or a chair for balance if needed. To make these stretches even more effective, try doing them after your morning shower or bath. According to the National Ankylosing Spondylitis Society, warm water can help relax tight muscles and ease stiffness in joints.