Patient Information

Bones and joints leaflets


Axial SpA advice and exercises


Axial spondyloarthritis is an umbrella term which includes: ankylosing spondylitis  (AS) where changes to the sacroiliac joints or the spine can be seen on x-ray, and non-radiographic axial spondyloarthritis where x-ray changes are not present but inflammation is visible on MRI or you have symptoms.

Axial SpA symptoms start in late teens to early twenties, with the average age of onset being 24.  One in 200 of the adult population in the UK have axial SpA.

It is a painful, progressive form of inflammatory arthritis. It mainly affects the spine but can also affect other joints, tendons and ligaments.  To explain axial SpA it is useful to know a little about how your joints work.  A joint is where two bones meet, such as the vertebrae in your spine.  Ligaments and tendons keep your bones in place, and stop them from moving too much or dislocating.


Image showing a normal spine, early ankylosing spondylitis and advanced ankylosing spondylitis

Effects of ankylosing spondylitis on the spine


In axial SpA, inflammation occurs at the site where ligaments or tendons attach to the bone.  This is followed by some wearing away of the bone at the site of the attachment.  As the inflammation reduces, healing takes place and new bone develops.

Movement becomes restricted when bone replaces the elastic tissue of ligaments or tendons.  Repetition of this inflammatory process leads to further bone formation and the individual bones which make up your backbone (vertebrae) can fuse together.

Typical symptoms include:

  • slow or gradual onset of back pain and stiffness over weeks or months
  • early-morning stiffness and pain, wearing off or reducing during the day with exercise
  • persistence for more than 3 months (as opposed to coming on in short attacks)
  • feeling better after exercise and worse after rest
  • weight loss, especially in the early stages
  • fatigue or tiredness
  • feeling feverish and experiencing night sweats.



There will be times when your axial SpA worsens (often referred to as a flare), and times when it seems more manageable or settledPlanning can often help minimise the impact of these episodes.



The underlying inflammatory process in axial SpA can lead to fatigue.  Other symptoms such as long term pain, sleep disturbance, certain drugs causing drowsiness and/or weakness of the muscles can all contribute to the long term or chronic fatigue experienced by some patients.



Talk to your rheumatologist or GP about how you can adjust your usual medications if your axial SpA flares.  Find out the maximum dose to which you can safely increase your usual medications and which other medications you can safely add.


Discover what helps you

Some things that may make you feel better include:

  • a long, hot bath
  • gently stretching in a long, hot shower
  • using an electric under-blanket in bed
  • watching your favourite DVD or playing your favourite music to help lift your mood when your flares cause you to feel stressed
  • alternating between hot water bottles or wheat bags (only leave a heat pack on for no more than 20 minutes to prevent burning your skin) and ice packs or a packet of frozen peas wrapped in a damp cloth (only leave an ice pack on for no more than 20 minutes to prevent an ice burn developing). Never apply ice to any areas of skin where you have numbness or reduced sensation.


Daily exercise

Exercise is the single most important thing you can do for yourself, as the fitter and more flexible you are the better able you will be to deal with your symptoms.  Benefits of exercise include:

  • increased flexibility
  • increased range of movement
  • improved posture and sleep
  • reduction in feelings of stiffness and pain.

Any exercise you decide to undertake needs to be regular, consistent and kept up over the long term. Therefore, it is important to choose something you enjoy.



The role of physiotherapy is to help improve your mobility and flexibility through educating you on how to minimise the effects axial SpA has on your life, teaching you how to check your posture and working with you to identify daily exercises. Physiotherapy can help with your range of movement, strength and overall mobility.  A key emphasis will be on maintaining a posture that is good for you.

Typical exercises may include:

Exercise 1

Stand a short distance from a wall with your back towards it. With your arms above your head, stretch back and try to touch the wall with your hands. Repeat this 10-15 times.

Illustration of exercise 1


Exercise 2

Standing with your back against a wall, slide your right hand down your right leg. Repeat this 10-15 times. Slide your left hand down your left leg. Repeat this 10-15 times.

Illustration of exercise 2

Exercise 3

Kneeling on all fours, stretch your left leg out behind you, hold it there for four seconds and then lower your leg. Repeat this 10 times. Then repeat this exercise with your right leg.

Illustration of exercise 3

Exercise 4

Lie on your back with your knees bent. Tighten your lower stomach muscles by pulling your tummy button down towards your spine. Hold this for four seconds and then relax. Repeat this five times.

Illustration of exercise 4

Your physiotherapist will also be able to answer any questions you have about axial SpA.



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