Ankylosing Spondylitis – Early Signs, Pain Management & Mobility Tips

At AskDoctor.ai, we have created this content to provide you with valuable knowledge about Ankylosing spondylitis – a chronic and rare condition. Our goal is to offer both information and inspiration—helping you understand the condition while giving you hope and practical insights on how to manage and cope with it. You are not alone; through knowledge and community, we believe you can confidently navigate this journey.

If you’ve ever woken up with a stiff back that just wouldn’t ease up, or if you feel like your spine is constantly aching, you might brush it off as poor posture or a bad mattress. But sometimes, chronic back pain is more than just an inconvenience—it could be a sign of something deeper, like Ankylosing Spondylitis (AS).

In this blog, we’re diving deep into what AS is, how to spot the early signs, ways to manage the pain, and most importantly, how to stay mobile and lead a fulfilling life even with this condition.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis is a chronic inflammatory arthritis that primarily affects the spine and sacroiliac joints (where your spine connects to your pelvis). Over time, it can cause some of the vertebrae (the bones in your spine) to fuse, leading to a loss of flexibility and a hunched posture. It is a relatively rare disorder affecting 0.1 to 0.4 percent of the global population. 

The name might sound intimidating—and to be honest, AS is no walk in the park—but understanding it can make a huge difference in managing it effectively.

Who Gets Ankylosing Spondylitis?

AS typically starts in late adolescence or early adulthood, often between the ages of 17 and 35. It’s more common in men than women, although women can also develop it. Genetics plays a major role too—if someone in your family has AS, your chances of getting it are higher.

One gene in particular, HLA-B27, is commonly associated with the disease. However, having the gene doesn’t guarantee you’ll get AS—it just means you’re more likely to.

Early Signs of Ankylosing Spondylitis

Early detection is key when it comes to managing AS. Unfortunately, the early symptoms are often mistaken for common back problems or simple fatigue. Here’s what to look out for:

1. Chronic Lower Back Pain

This is often the first and most persistent sign. The pain usually starts gradually and can be worse in the morning or after periods of inactivity. Unlike regular back pain, this gets better with movement.

2. Morning Stiffness

If you wake up feeling stiff and it takes a while to get moving, that could be a red flag. Morning stiffness that lasts more than 30 minutes is a common early symptom of AS.

3. Pain in the Hips, Buttocks, or Shoulders

AS doesn’t just stick to the lower back—it can affect other joints, especially early on. You might feel pain deep in your hips or buttocks, or even in your shoulders and neck. Studies indicate that over 50% of AS patients experience substantial mobility loss within 10 years of disease onset.

4. Fatigue

Chronic inflammation can make you feel tired all the time. This isn’t just “I didn’t sleep well” tired—it’s deep, dragging fatigue that doesn’t go away easily.

5. Reduced Flexibility

Feeling less flexible over time, especially in your spine, can be a subtle sign that AS is progressing.

Getting Diagnosed

If you’re experiencing symptoms, the first step is to see a rheumatologist—a specialist in arthritis and musculoskeletal disorders.

Diagnosis typically involves:

• Medical history and physical exam
  
• Blood tests (especially to check for the HLA-B27 gene and signs of inflammation)
  
• Imaging (like X-rays or MRIs) to look for changes in the spine and joints
  

AS can be tricky to diagnose early on, especially if changes in the spine aren’t visible yet, so persistence and follow-ups are key.

Living with AS: Pain Management Strategies

Let’s talk about what you can do once you have a diagnosis. The good news? There are plenty of ways to manage AS and keep it from taking over your life.

1. Medications

• NSAIDs (Nonsteroidal Anti-inflammatory Drugs) like ibuprofen or naproxen are often the first line of defense. They help reduce pain and inflammation.
  
• DMARDs (Disease-Modifying Anti-Rheumatic Drugs) and biologics (like TNF inhibitors) are used for more severe cases. These target specific parts of the immune system to slow down the disease’s progression.
  
• Pain relievers may be used short-term, especially during flare-ups.
  

Always work with your doctor to find the right combination for you.

2. Physical Therapy

Working with a physiotherapist who understands AS can make a massive difference. They can help with:

• Improving posture
  
• Increasing spine and joint flexibility
  
• Building core strength to support your back
  

You’ll likely be given specific exercises to do at home, which brings us to…

3. Exercise

Staying active is one of the most important things you can do if you have AS. Movement helps ease stiffness, reduce pain, and maintain flexibility. Here are a few great options:

• Stretching and yoga improve flexibility and posture
  
• Swimming – low-impact and great for spine and joint mobility
  
• Walking or light cardio – helps with circulation and overall well-being
  
• Tai Chi – gentle movements that promote balance and coordination
  

Consistency is key—daily movement, even just 10–15 minutes, can help you feel significantly better.

Mobility Tips for Daily Life

AS can affect your day-to-day, especially when it comes to mobility. Here are some practical tips to keep you moving and reduce discomfort:

1. Ergonomic Adjustments

• Use chairs with good lumbar support.
  
• Set up a standing desk or alternate between sitting and standing.
  
• Place a rolled towel or small pillow behind your lower back when sitting for long periods.
  

2. Posture Awareness

Poor posture can accelerate fusion in your spine, so focus on maintaining a straight, aligned posture throughout the day. A mirror or posture app can help keep you aware.

3. Heat and Cold Therapy

• Use heating pads or warm baths to ease muscle stiffness.
  
• Cold packs can help reduce inflammation during flare-ups.
  

4. Proper Sleep Setup

• Use a firm mattress that supports your spine.
  
• Avoid overly soft pillows that push your neck forward.
  
• Try sleeping on your back if possible to maintain spinal alignment.
  

5. Plan Rest Breaks

If you’re on your feet a lot or doing physical work, schedule in short rest breaks to avoid fatigue and prevent flare-ups.

Mental Health Matters Too

Chronic pain and reduced mobility can take a toll on your mental health. It’s okay to feel frustrated or anxious—that’s normal. What helps:

• Talking to a therapist or joining a support group
  
• Mindfulness and relaxation techniques, like meditation or deep breathing
  
• Keeping a journal to track symptoms and emotions
  

You’re not alone. Connecting with others who understand AS can make a huge difference in how you cope.

Diet and Lifestyle

While no diet can cure AS, some people find that certain foods help reduce inflammation. Here’s what might help:

• Anti-inflammatory foods: leafy greens, berries, fatty fish (like salmon), nuts, olive oil
  
• Avoiding trigger foods: Some people find relief by limiting sugar, processed foods, and dairy
  
• Hydration: staying well-hydrated helps with joint health
  `
• Quit smoking: it worsens symptoms and reduces medication effectiveness
  
• Limit alcohol: it can interact with medications and increase inflammation
  

It’s always a good idea to work with a nutritionist if you’re exploring dietary changes.

When to Seek Help

Living with AS means listening to your body and knowing when something isn’t right. Call your doctor if:

• Your pain suddenly worsens or changes
  
• You experience new symptoms like vision problems (which could signal uveitis)
  
• Medications stop working
  
• You’re feeling overwhelmed or depressed
  

There’s no shame in asking for help—getting support early can prevent things from getting worse.

Humira: A Life-Changing Medication

Reddit User Guru was diagnosed with ankylosing spondylitis (AS) at 18 years old, six years ago, and experienced severe hip and sacroiliac joint pain that caused them to walk with a waddling gait. However, after starting Humira, they saw a complete improvement within a month. They are now able to run, lift weights, cycle, and hike with a 40-pound pack with minimal pain. Occasionally, they experience slight back pain, but it is manageable, and they often forget they have AS.

They report no noticeable side effects from Humira and experience sickness about three times a year, which is consistent with their health before starting the medication. They believe that many individuals may falsely attribute their symptoms to Humira, especially those with generally poor health. While acknowledging that some people do experience real side effects, they feel the risk/benefit profile of Humira is favourable when considering research studies.

Medications Make A Difference

MintSplints from Reddit said that after being diagnosed with axial spondyloarthritis (axSpA), their rheumatologist prescribed Imraldi, a biosimilar to adalimumab. Within about a week of the first dose, they experienced life-changing results, going from struggling with severe sacroiliac joint pain and a waddling gait to almost no pain and regained flexibility. Having been on Imraldi for approximately 1.5 years, they have not experienced any flare-ups and do not regret starting the treatment.

Living With Ankylosing Spondylitis: Michael’s Story

In this moving and inspiring video, Michael shares his journey of living with and triumphing over Ankylosing spondylitis. 

Ankylosing Spondylitis: A Difficult Journey But Not Impossible

Ankylosing Spondylitis may be a lifelong condition, but it doesn’t have to control your life. With the right tools—early detection, proper medication, consistent exercise, and a supportive care team—you can manage your symptoms and maintain a good quality of life.

Remember, every person’s journey with AS is different. It might take time to find the right routine or treatment plan, and that’s okay. Be patient with yourself, stay active, and keep the communication open with your healthcare providers.

And above all—know that you’re not alone. Whether you’re newly diagnosed or have been living with AS for years, there’s a whole community out here cheering you on.

References

National Library of Medicine
Arthitis Irland – Michael Fennelly’s story
Ankylosing Spondylitis Reddit Community