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AxSpA and Ankylosing Spondylitis

A lot of lower back pain can be categorised as “non specific“. Although it sounds like a non-diagnosis, it is an umbrella term to cover more simple things like joint, muscle, or ligament problems. Sometimes conditions can appear to be straightforward like this, but might actually be something completely different. AxSpA is an example of this.

Ankylosing Spondylitis

What is AxSpA?

AxSpA is short for Axial SpondyloArthritis. It refers to arthritis in the spine and elsewhere. The form of arthritis in question is inflammatory and autoimmune, not the same as “wear and tear” osteoarthritis. The way the disease progresses is completely different, which is why it is so important that it is diagnosed. Unfortunately, it takes an average of 8.5 years to receive an accurate diagnosis.


The early stages may seem like the normal kind of lower back pain that can resolve on its own. They might even appear to have been brought on by a minor injury, but they don’t disappear like you would expect them to. Lower back pain is the most common symptom, but there may also be pain at the entheses: where tendons meet bone. One enthesis that is commonly affected is the heel at the Achilles tendon.

Symptoms usually begin before the age of 40, and will fluctuate as inflammatory episodes come and go. The hallmark of increasing stiffness with every passing episode is a big red flag for lower back pain. Swelling in the fingers, and inflammation within the eye are other potential signs. There is higher incidence in people who have a personal or family history of other autoimmune conditions.

Disease Process

One reason we want to get a diagnosis as soon as possible is that the disease is destructive. Like with rheumatoid arthritis, the body goes through phases of inflammation, where it attacks its own joints. With AxSpA, this is mostly around the back of the pelvis and the lower back. When the inflammation passes, repair can begin. But in this case, the body lays new bone down in the wrong place, covering the whole joint with time.

Ankylosing Spondylitis (AS) is a form of AxSpA where the disease has progressed enough to see the changes on x-ray. Before we knew much about the condition, there was a misconception that AS could only be diagnosed by the late stage signs of the disease. The “?” posture as illustrated above is a sign that the joints have been significantly deformed. We need to recognise the earlier signs so that the correct treatment plan can prevent the disease progress.

Managing AxSpA

Osteopaths can help with managing the symptoms of rheumatic pains. However, we will need you to be under the care of a rheumatologist alongside osteopathic treatment. We can help support your referral to rheumatology using resources like the SPADE Tool. Only a rheumatologist can diagnose AxSpA or AS, or prescribe the appropriate medication. Strong medications to prevent the damage caused by inflammatory episodes are the best form of treatment. There may still be symptoms despite this, and this is where we may be able to help.

As an inflammatory condition, there is a fine line of comfort between excessive exercise and too much rest. We can help you return to sport and develop an exercise plan to help to manage your symptoms. You may find that osteopathic treatment can offer relief on particularly painful days, or help the rest of your body move better to accommodate the changes caused by AxSpA. Your osteopath cannot cure AxSpA or AS.


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