Ankylosing Spondylitis and Yoga (Not Yoga for Ankylosing Spondylitis)

by Shelly Prosko, PT, PYT, CPI

Sunflower in Bouquet

I recently had a physical therapist colleague ask me for some advice for some yoga poses that might help her client who has ankylosing spondylitis (AS). I explained that there are certainly some poses I would share with her that could potentially address some of the general commonalities of the symptoms of AS and how people with AS may present in similar ways, but I also explained I thought it was important for her and her client to understand that: 

1. Therapeutic yoga is so much more than prescribing poses for a particular dysfunction or special population.
2. The phrase "yoga for ankylosing spondylitis" (or any diagnosis) tends to suggest, in my opinion, that we are using a reductionist approach and falling into the trap of treating/addressing a diagnosis instead of a person who is a living, breathing, moving, thinking, feeling and reacting being, who is connected to and affected by the surrounding environment. Every being consists of complex systems and layers, each one influencing the other, including the nervous system, digestive system, musculoskeletal system, hormonal system, immune system, integumentary system, and emotional, social and spiritual layers, just to name a few.

That being said, there are certainly some common physiotherapy exercises and yoga methods that can be used for people looking to optimize spinal and rib mobility and alignment, maximize breath patterns, improve pain management, and/or calm the nervous system. But I suppose that would be a really long title for this article.  

I can appreciate how it's easier to simply say "Yoga For ( diagnosis )"; and I would assume we all understand that we're making generalizations that aren't to be used as prescriptions or individual therapies, but simply outlining some potentially valuable guidelines in order to help people. So, for the record, this article is not meant to be interpreted as “Yoga for Ankylosing Spondylitis.” I want to be clear that I strongly believe in “Yoga For the Individual Person” and his or her unique physical, mental, emotional, energetic, and spiritual states, which are constantly changing and responding.

Keeping this in mind, I'd like to share the response to my colleague's request. One of my yoga students, who happens to also have AS, was willing to demonstrate some physio and yoga techniques that I chose for this case. A short interview with him is also included at the end of the video about how yoga has helped him manage his AS symptoms. I hope you find the video valuable and perhaps even worth sharing with someone who you think may benefit from it: 

About Ankylosing Spondylitis

AS is a chronic inflammation of the joints of the spine and is considered to be an autoimmune disease. For reasons we do not know (although, there is speculation and theories presented) the body receives a trigger that tells it to “attack” itself. The body can potentially then go into repair mode, causing excess bone formation, which explains the fusion of joints that is sometimes seen in advanced AS.

Some of the symptoms and complications of AS are:

• pain experienced in the areas of SI joint, spine, hips, shoulders, knees, ankles 
• stiffness/reduced mobility of spine
• reduced chest/rib mobility or expansion, resulting in decreased efficient breathing patterns
• fatigue
• osteopenia/osteoporosis
• digestion problems (IBS)

Some of the intentions of PhysioYoga therapy in this case are to:

• reduce the chances or severity of secondary complications as above
• help improve management of symptoms as above
• maintain and optimize joint mobility and alignment
• optimize muscle health and function
• maximize efficient breathing patterns (which can help improve movement)
• improve self management of pain
• increase self-efficacy
• optimize feelings of joy, pleasure, and gratitude
• maximize functional capacity and quality of life

Certain yoga poses, movements and breathing methods can help address posture, alignment, mobility, and stability as well as potentially address the energetic layer (combat fatigue, improve sleep) or produce a calming effect on the nervous system, which can help with such problems as pain management. Mindfulness or meditation practices, such as awareness, visualization or other methods of focus, can also potentially help with pain management, change the pain experience, and perhaps even reduce the chance that the genes associated with inflammation are expressed. Ram's previous posts "Chronic Inflammation and Yoga" and "Meditation: Effects on Gene Expression" shed further light on these topics.

There is currently no formal test to actually diagnose AS. The Arthritis Society states that although most people who have AS carry the HLA-B27 gene, most people with the HLA-B27 gene do not get AS. So, just because you have the gene, it doesn't mean you will get AS. The Arthritis Society states, "in fact, only a very small number of people with this gene will ever develop AS."

If your physician suspects you have AS, it is a good idea to get a referral to a rheumatologist to help guide and manage your care. PhysioYoga can be used as a valuable and beneficial complementary therapy to your current medical treatment. I highly recommend following and continuing with your medical treatment plan, in addition to finding a physical therapist or health care professional in your area who is trained in integrating yoga therapy and nutritional therapy into his or her treatment sessions (online directories of practitioners across North America are here and here). Or perhaps a yoga therapist or teacher in your community can work together with your physical therapist and health care team for optimal success and safety.

With education, supportive treatment as needed, and guidance, people with AS can have active, meaningful, happy lives and relationships filled with vitality and longevity. 

Disclaimer: This article and video is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities.

Shelly Prosko is a Physical Therapist, Yoga Therapist and a Certified Pilates Instructor. She received her Physical Therapy degree at the University of Saskatchewan, Canada in 1998, her Yoga Therapist training through Professional Yoga Therapy Studies in North Carolina and her Pilates certification through Professional Health and Fitness Institute in Maryland. 

Since 1998, Shelly has been integrating yoga principles and methods into her physical therapy treatments. She has treated a wide variety of musculoskeletal, neurological and cardiorespiratory  conditions while working in private orthopaedic clinics and long term care facilities across Canada and the United States.


Currently, Shelly resides in Sylvan Lake, AB and travels across Canada and the United States offering specialty Physio-Yoga Therapy workshops, classes, private sessions, lecturing at University and College programs as adjunct faculty of Professional Yoga Therapy Studies, teaching at YTT’s and actively promoting the integration of medical therapeutic yoga into our current healthcare system. She believes that bridging the gap between Western and Eastern healthcare philosophies is essential in order to achieve optimal health. Her treatments are individually based and are a unique blend of both approaches. Please visit www.physioyoga.ca for more information about Shelly’s mission and services, and to read a variety of testimonials of how PYT has profoundly influenced many people’s lives.

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