One of the most frustrating things about ankylosing spondylitis (AS) is experiencing pain not from exertion, but from doing nothing more than trying to get a good night's sleep.
Back pain — the most common symptom of AS — and stiffness get worse with rest, so you're probably at your worst in the morning, just when you want to get your day started. You might also have pain and stiffness in other areas of your body, such as your neck, shoulders, hips, or feet.
While it's important to work with your doctor to find the best medications for AS, there are also some natural pain-relief strategies to help manage back pain and other symptoms, and you can use many of them every day:
1. Exercise and stretching. “If you have ankylosing spondylitis, you need to stay active to maintain your flexibility," advises Rochella Ostrowski, MD, an assistant professor of rheumatology at the Loyola University Health System in Maywood, Ill. "The best exercises are those that avoid high impact." She suggests working with a physical therapist or a personal trainer to get started. A fitness professional can design the right exercise and stretching program for you, including when to work out. Later in the day when you're less stiff may be the best time.
2. Good posture. “Check your posture frequently at home and at work," Dr. Ostrowski says. "Make sure you’re well-aligned and that you do gentle range-of-motion exercises often to avoid long periods of immobility." Reinforce good posture by regularly checking your alignment against a wall. You don’t want your spine to stiffen into a bent position, so aim for tall and straight.
3. Good posture in bed. “Sleep posture is also important," Ostrowski says. "You need a firm bed and a pillow that supports your neck properly. Avoid a pillow that’s too high. Sleeping on your belly is best for your posture, but some people can only sleep on their side or back.” If you're in that group, try spending a few minutes of your awake time lying facedown on your bed. For comfort, you can turn your head from side to side. This exercise helps promote better daily posture. Work up to 20-minute sessions to help with back pain relief.
4. Warm soaks. “A warm bath or shower is a natural way to relieve the pain and stiffness of ankylosing spondylitis," Ostrowski says. "Stretching to relieve pain and stiffness is also better after a warm shower. Stretching with cold joints and muscles isn’t best." Alternating hot and cold compresses on painful spots is another natural pain-relief strategy you can try.
5. Acupuncture. This ancient technique that involves inserting thin needles through the skin may stimulate your body’s natural pain relievers. “Studies on acupuncture for back pain relief have had mixed results," Ostrowski says. "I don’t discourage it, and it’s helped some people with back pain.” According to the Spondylitis Association of America (SAA), there's enough research supporting acupuncture for chronic pain relief to try it. There is a caveat, though: You must go to a trained and licensed acupuncture professional.
6. Massage. “Massage therapy, when performed by a therapist accustomed to working with ankylosing spondylitis, may be helpful,” Ostrowski says. Massage may not only help relieve the pain and stiffness of AS but also ease the stress commonly brought on by having a chronic condition.
7. Yoga. “Yoga is a great natural pain reliever for ankylosing spondylitis,” Ostrowski says. "You need to start with very basic poses and be patient, but if you work with an instructor who can modify the yoga positions for you, you can really benefit from this form of exercise." A 2013 review of yoga for low-back pain published in The Clinical Journal of Pain looked at 10 controlled trials involving 967 people. The conclusion: There was strong evidence for short-term and moderate evidence for long-term back pain relief from yoga.
8. Transcutaneous electrical nerve stimulation (TENS): TENS involves passing an electric current through the skin. It may work on the same principle as acupuncture — by bringing about the release of the body’s natural pain relievers. Although there have been some studies on TENS for back pain, results are mixed. Ostrowski says that TENS may be an option physical therapists use for pain that’s not responding to exercise and stretching.
Other Tips for Ankylosing Spondylitis Pain Relief
While some people with ankylosing spondylitis benefit from chiropractic sessions, according to the SAA, chiropractic treatment is not recommended for AS. “Chiropractic care isn’t advised for this type of back pain because changes from ankylosing spondylitis may increase the risk of injury during manipulation,” Ostrowski says.
But there are a few other small steps you can take to help manage AS pain naturally. “I also recommend lots of deep breathing to keep your rib cage flexible, and I strongly advise against smoking," Ostrowski says. "Avoid physical and emotional stress as much as possible, have a good support system, and make sure to get enough rest. Sometimes with ankylosing spondylitis, you just need to take life a little slower.”