Ankylosing Spondylitis. Physiotherapy and Occupational Therapy

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1 Trafford Hospitals Therapy Services Information for Patients Ankylosing Spondylitis Physiotherapy and Occupational Therapy The primary aim of our service at Trafford General Hospital is to help you to self-manage your condition. This booklet provides information on our service and treatment for patients who will be attending here, but we hope it will also be of use to those who do live out of our area and maybe worried about receiving appropriate treatment locally. Physiotherapy and Occupational Therapy The Physiotherapy and Occupational Therapy Teams aim to provide you with techniques and knowledge to enable you to manage your Ankylosing Spondylitis (AS). This will help you to maintain function and the ability to participate in activities of daily living. The key to this will be learning and understanding how to exercise correctly. Being prepared to consider changing the way you do some activities is also important. This does not mean stopping things you enjoy just becoming more aware of how you are doing them. The following information lists some of the options that may help, but treatment will vary depending on your individual health care provider. Not all the treatments listed below will be required by everyone and an assessment by your Physiotherapist or Occupational Therapist will need be to be completed to understand your individual problems and concerns. Treatment will then depend upon the findings of this therapy assessment. Therapy Lead Ankylosing Spondylitis Clinic At Trafford General Hospital we have a Therapy lead AS review clinic which runs alongside the Rheumatology medical team. You will be reviewed by a Therapist and have a thorough assessment including some measurements that will monitor the progression of your condition. We aim to discuss any problems you are having and plan any help that you are assessed as needing any further input. We have very strong links with the consultants. This review will happen dependent on how well you are managing you condition. You will have been referred to this Therapy lead clinic by your consultant. Page 1 of 6

2 Therapy Treatment Techniques Exercise Regular exercise and activity can help control the pain and stiffness associated with AS, as well as reduce or prevent deformity. It is important to keep your muscles strong as lack of movement may weaken them and it can take a long time to build them up again. Cardiovascular exercise can help your chest expansion, fatigue and sleep. Swimming is a great choice and if taken up we would recommend trying to vary your stroke as much as possible. Breast stroke puts more strain on the hips and lower back so it may be better to avoid doing this if it aggravates your symptoms. Regular exercise at a pace you can manage is important. Remember it will be easier to exercise regularly if the exercise is something that you enjoy and is manageable alongside your symptoms. There is a strong emphasis on self-management of this condition. As a result you may be given a home exercise plan to carry out in your own time. These exercises are individually tailored to each patient and may include: Aerobic exercise. Strengthening exercises. Balance and core exercises. Stretching exercises. Your Therapist will advise you on which specific exercises are most suited to you, however the following advice is beneficial to everyone with AS: Try to lie completely flat on your front every day for up to 30 minutes. If you are unable to manage this then start with lying completely flat on your back for up to 30 minutes, as tolerated. We advise you not to take part in contact sports. Relaxation is also important, aim to achieve a balance between activities and rest. Your Physiotherapist can advise and teach you relaxation techniques. Recommended class/exercise Body balance Core stability classes Water aerobics/aquafit Cycling Pilates Swimming Walking Yoga Recommended class/exercise but may need modification Badminton Basketball Netball Step aerobics Page 2 of 6

3 Circuits Football Class/ exercise to be avoided Boxercise Hockey Rugby Tae-bo Tennis Spinning Squash Wrestling Karate Heat Take the time to write down a list of the things that you know make you feel better when your AS is worse and pin it up somewhere in your home. That way you have some helpful pointers ready for if you do have a flare up of symptoms. Some things that people have told us make them feel better include: A long, hot bath. Gently stretching in a long hot shower. Using an electric under-blanket in bed. Use of hot water bottles or wheat bags. Relaxation Techniques Relaxation is important to achieve a balance between activity and rest. There are many different types of relaxation. Some of the things that people have told us make them feel better are: Breathing techniques. Visualisation. Using methods involving contracting and relaxing muscles. Meditation. Mindfulness - This can be discussed further with your Occupational Therapist. Learning to relax properly can help pain, fatigue, concentration, sleep and management of a flare up. Pacing Daily Activities Learning to pace activities can be a difficult skill to learn as it requires some self-discipline, but once mastered can help in managing pain and fatigue. Exercise Page 3 of 6

4 is still the most important way to improve pain and fatigue in the long term and can also be paced so discuss this with your Physiotherapist. Pacing is usually considered alongside the other P s: Prioritising what you need to do. Planning when you will do things. Problem solving how you will do them. Activities can be paced throughout the day, week or month but each individual task may also be paced. Arthritis Research UK (ARUK) produce a booklet called Fatigue & Arthritis which also includes more information on how to pace. The leaflet can be downloaded or ordered from Hydrotherapy This involves exercising/swimming in water. The water temperature in hydrotherapy pools is usually around degrees Celsius - much higher than a swimming pool. This can help with stiffness, pain, poor posture and fatigue. Even if you do not have access to a warm hydrotherapy pool a significant amount of the benefits still apply in a normal pool. Exercising in water helps because: Water supports your body. There is less strain on your joints and this can allow you to build fitness. Water acts as a shock absorber. You do not feel so much pain. Water acts as resistance to help build muscles. It is easier to stay upright because the effect of gravity is less. Exercising in water requires less effort as your body feels lighter. If the water temperature is higher than a normal swimming pool it can help you relax and stretch more effectively. Advice on daily living equipment Using gadgets and labour saving equipment may further help reduce stress to joints or compensate for weak grip. Much of this equipment is available from the high street and is useful even if you do not have joint problems. A few items may need to be purchased from more specialist suppliers such as independent living stores if needed. Page 4 of 6

5 For those with more severe restrictions Social Services can carry out an assessment in your home and advise on any further equipment or adaptations that may be suitable for you. Joint Protection Advice In AS it is important that you protect your joints from further damage in the future. This means teaching ways of doing things without overusing the joints or putting added stress onto joints. In AS we recommend that you do not participate in contact sports or activities that involve prolonged impact on the joints. This helps in reducing the risk of joint problems and flaring up your symptoms. Summary Your condition may impact on your daily life affecting your ability to function at various levels. This often means you will have developed altered movement patterns and postures which become habits. These can then be difficult to change both physically and mentally, but correcting these early on can prevent increased problems later. Living with long term conditions can understandably be stressful at times and may also lower your mood, making it more difficult for you to start managing your condition. Your GP can also refer you for counselling or Cognitive Behavioural Therapy (CBT) often referred to as talking therapy. Evidence has shown this to be of benefit for people with long term pain. The following national services can also help support you in managing your condition. The Expert Patient Program (EPP) A community based peer led program aimed at helping people with a variety of long term conditions improve their quality of life. For further details about EPP courses in your area, and any other general enquiries, contact self management uk Support Groups NASS National Ankylosing Spondylitis Society 4 Albion Court, Hammersmith, W6 0QT UK admin@nass.co.uk Page 5 of 6

6 Trafford Physiotherapy If you feel that you would benefit from physiotherapy in-between your review appointments you can contact Trafford Rheumatology Therapy team and leave a message for the Rheumatology Therapy Team. (0161) Monday Friday, 8.00 am 4.00 pm Any other queries regarding medication please contact the Rheumatology nurses (0161) Monday Friday, 8.00 am 4.00 pm Page 6 of 6