What is Spondylitis?
Arthritis of the spine is called Spondylitis. Pain and stiffness that starts from the neck and continues up to the lower back is called spondylitis. It may also result in deformity of the spine leading to a stooped posture. Spondylitis is a condition that is debilitating and prevents one from performing the normal day to day activities.
Spondylitis affects a number of people irrespective of age or gender. Besides the pain, stiffness, bony growths on the spine, pain in ligament and tendons, a person may suffer from other conditions like fatigue, fever, loss of appetite, redness of eyes.
Complications that arise out of spondylitis include uvetis, compression fractures and heart problems. Uvetis is a condition where there is eye pain due to spondylitis, along with decreased vision, blurring, redness and light sensitivity. Compression fractures happen in the vertebrae and they crumble causing difficulty breathing. Heart problems are caused due to spondylitis affecting the aorta or the largest artery in the body and this can affect the aortic valve in the heart.
The cause of spondylitis has not yet been discovered. Yet there is a strong genetic link with the gene HLA – B27. People who have defect in this gene suffer from spondylitis. However, people without any malfunction in the gene also suffer from this condition.
Persons who are suffering from spondylitis can visit an orthopaedic for relief from this condition. Doctors will perform various tests to diagnose the condition. Some of the tests conducted are lab tests, measurement of chest, x-ray of chest and physical examination.
Treatment for spondylitis does not exist, it can only be managed. Patients are prescribed medicines to relieve the pain in the joints and the spine. They are also provided treatment to avoid deformity of the spine, stiffness, and maintain the ability to do day to day activities.
Physical and occupational therapy is provided to patients in the early stages of spondylitis. Exercise is also recommended for patients to remove the stiffness and strengthen the muscles. Swimming is the best form of exercise for spondylitis patients.
Spondylitis is a disabling condition that needs advanced treatment and medications. Proper diagnosis is necessary to identify the condition and provide relief to the patient as he suffers from pain day in and day out.
The bones and joints orchestrate very well with each other for smooth movements of various joints and the spine. However, due to various reasons, some identified and others unknown, there could be inflammation of the areas where the bones join the muscles leading to impaired movement. The range of motion could be reduced or it could be painful, thereby, limiting movement. Spondyloarthritis includes a group of inflammatory diseases that involves the bones and joints and enthuses which are areas where the ligaments and tendons attach to the bones. This causes conditions like plantar fasciitis, ankylosing spondylitis, psoriatic arthritis and reactive arthritis. The term spondyloarthritis is a blanket term to describe any of the above-mentioned conditions.
Read on to know a little more in detail about it:
Causes: While the exact etiology is not identified for sure, most patients with spondyloarthritis have an autosomal dominant gene (HLA-B27). Chronic infections could trigger the onset of the disease too.
1. In all forms of spondyloarthritis, there is always inflammation of the spine, joints and entheses. If the fingers or toes are involved, there could be swelling leading to what are typically known as 'sausage digits'.
2. There is sacroiliitis which is inflammation of the joint between the pelvis and the spine, and spondylitis which is inflammation of the joints between the spines. 3. Family history and autosomal dominant gene.
A detailed medical history and physical examination form the cornerstone of a confirmed diagnosis. In addition, radiographic examination and diagnostic blood tests also could be done to confirm the diagnosis. Radiographs, especially, of the spine and the low back show typical changes including sacroilitis in suspected cases of spondyloarthritis. If the spine does not show these changes, but there is a high likelihood of spondyloarthritis, then MRI (magnetic resonance imaging) can be used to confirm the diagnosis.
As a final step, a blood test for the HLA-B27 gene can also be confirmatory. However, it is not true that a person with the gene will definitely develop the disease.
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In the early stages of the disease a flattening of the lumbar curve may occur. Then, with increasing pain and a flexed posture, the thoracic curve can become more accentuated. If unchecked, this can be followed by a loss of cervical curve and a protracted cervical spine develops as an attempt to compensate for the forward flexion. As the hips become more flexed, hip flexion contractures can occur and the knees flex to improve balance and vision. Poor posture results in muscle fatigue, weakness, disability and a poor body image.Good management of the disease should prevent poor posture from occurring,although any fusion may be delayed and not halted. Note especially the knee flexion and hip flexion deformities. The reason for these deformities is that,if the spine is constantly flexed, the patient would fall over forwards. By flexing the knees and hips, the person shifts the line of gravity back within the base to become more stable.
AIMS OF PHYSIOTHERAPY MANAGEMENT:
The overall aims are to minimize deformity and disability and to improve well being, thereby maintaining normal function and improving the person’s quality of life.
Specifically these aims can be achieved by:
Pain may vary from low grade discomfort to intense pain.
Typically, pain is aggravated and is often reduced by exercise. The perception of pain can be influenced by several factors, including fatigue.
Physiotherapy modalities such as ultrasound, dry needling, and transcutanous nerve stimulation, mega pulse and gentle spinal mobilization can be effective, especially for localized pain.
If the person has not exercised recently, exercises will need to be commenced gradually and the person warned that initially they may provoke pain.
Wearing supportive shock-absorbing shoes can decrease the jarring effect of walking on hard surfaces and reduce the likelihood of aggravating the pain. Hot packs can reduce pain.
1.SUPINE WITH FEET TUCKED UNDER THE RAIL
Float supine with the neck and pelvis supported in floats. Keep the back soft hands in the water.
2.SHOULDER ABDUCTORS, ADDUCTORS AND FLEXORS .
Take straight arms out from the sides of the body to above the head,keeping backs of hands in the water.
3.THORACIC AND SHOULDER EXTENSORS
Take the arms out to 90 degrees from the body. Hold bats in both hands and take backs of hands straight down towards the bottom of the pool.
Put floats around the feet and hold the rail with both hands and straight.stretch legs straight out behind, allowing the floats to bring the feet up to the surface of the water. Push feet down in the floats to contract the abdominal muscles and then relax. Repeat at least three times.
Stand straight with back to the wall and arms resting on the rail. Keeping the knees straight, dorsi flex the right and put a float behind the heel. Allow the right foot to float up towards the surface of the water to maximum stretch.Press the heel down into the float a short distance, relax and allow the float to take the heel back up to the surface of the water. Reach down the leg with hands for greater stretch. Repeat to the other side.
Start as for the hamstring exercise above. Take the right leg out to the side with toes pointing forwards. Put a float around the right ankle and allow a full passive stretch. Stay in an upright position.Push down the right leg into the float a short distance, relax and allow the float to take the leg up further abduction.
Stand facing the wall and hold on to the rail. keep the left leg straight and touching the wall. Bend the right knee, put a float around the right ankle and allow the foot to rise in the water. Keep the right thigh against the wall.Push the foot down into the float, relax and allow the foot to rise in the water still further. The right knee may come away the wall from the wall a short distance.
8.PECTORALS AND ABDOMINAL
lean back against the wall with hips flexed and feet a meter away from the wall. Take arms overhead to hold the rail.Arch back and lift the sternum to take the back away from the wall. A float can be placed behind the back at scapula level.
Face the wall with hips bent at 90 degrees and right out straight, holding the rail. Hold a float with the left hand.Twist the trunk and head by taking the float under the right elbow. Following maximum stretch, press the float down into the water a short distance, relax and allow the float to take the hand further up to the surface of water.
Finish a session with a cool down. Stand with back to the wall, knees bent and neck under water. Allow the arms to float up to the surface of the water to encourage relaxation of the shoulders. Do some gentle neck and breathing exercises.
Flexion, extension, lateral flexion and rotation of the cervical, thoracic and lumbar spines can become limited in a person with AS owing to bony changes,fibrosis and calcification of ligaments and muscle tension. Therefore,exercises should be designed to improve these movements.
Mobility exercise should put a joint through the full range of available movement.
A variety of equipment can be used to make the exercises more interesting, such as a gymnastic ball. When exercising in supine, support the patient’s head with the minimum number of pillows-just enough to prevent the head from tilting back.
The physiotherapist should always be prepared to modify an exercise.
Lumbar and thoracic spine flexion and extension Hold the rail with both hands straight out in front and the elbow extended.Stand two paces back facing the pool rail and with the buttocks back as far as possible. The feet should be slightly apart.
1. Push the hips forward towards the wall (into the extension) and then back out to the starting position. Keep elbows and knees straight.
2. With the same starting position as above, bring one foot up towards the wall with an extended knee. Leading with the heel and keeping the knee straight, take the heel backwards as high as possible. Repeat on the other side.
B.THORACIC AND CERVICAL ROTATION
1. Use the same starting position as above but with legs astride. Bend theleft elbow and twist to the left to look under the elbow. Repeat to the otherside.
2. Face the wall and rest the arms on the bar. Bend the knees to 90 degrees and keep the trunk, pelvis and thighs against the wall. Keep the knees together. Fix shoulders by holding on the pool rail with hands and forearms.Swing both the knees up to the right as far as possible until the outside to the left thigh is on the wall. Repeat to the other side.
C.FUN AND GAMES
Take care to match patients equally and ensure safety in the pool at all times.
1. Race each other across pool forwards, backwards and sideways.
2. Two opponents face each other prone with a ring or a woggle held at arms length between them. Using any swimming kick, the winner is the person who pushes the ring over to the partner’s side.
3. As a race, pass a large ring over the body starting at either the head or feet.
4. Sit with a woggle between the legs. Use the legs in a cycling action to race across pool
A typical forty-minute group hydrotherapy session may include:·
Hydrotherapy is an effective way of treating AS as it provides heat whilst
The warmth of water can relieve pain and muscle pain and
muscle spasm and promote relaxation. Dry-land exercises are most effective
directly after hydrotherapy.
B.CARDIOVASCULAR FITNESS, STAMINA AND MUSCLE ENDURANCE
Physical fitness can be improved by cardiovascular exercise that increases the muscle strength and endurance as well as exercising the heart and lungs.This form of exercise can improve stamina, and enables people to pursue their work and hobbies with greater ease.Circuits in the gym should include a variety of strengthening and stretching exercises interspersed with low-impact cardio-vascular exercises such as the rowing machine and static bike. High-impact activities such as jogging and step-ups can aggravate the weight-bearing joints. Low-impact cardiovascular activities such as swimming, aquarobics, cycling and walking increase stamina and muscle endurance without aggravating the joints.
Cardiovascular exercise can also be undertaken in the hydrotherapy pool.Contact sports such as rugby and football are best avoided as the joints can be aggravated and a fused spine can be at risk from contact with other players.With increased respiratory excursion, cardiovascular exercise helps to mobilize the thoracic joints and maintain or improve chest expansion and vital capacity.Regular cardiovascular exercise has other benefits, including body weight reduction, and protection from heart disease and diabetes. It also can improve sleep, relaxation and well being.
Keep the neck and shoulders under water as much as possible by standing in the correct depth of water. If necessary, bend knees and hips. The faster the movement is performed, the more the turbulence and therefore the greater the resistance.
Count out loud and perform the activity at least 10 times to increase the CV content and respiratory excursion still further.
1. Walk with big strides forwards, backwards or sideways around the edge of the pool. Exaggerate the arm swing and trunk movements. Change direction quickly into the turbulence created.
2. Clasp the hands together under the water straight out in front and swish the arms as far round as possible to right and left.
3. Bend the right knee and reach down to the outside of the right heel with the right hand. Repeat to other side.
4. Hop, touching the right elbow to a bent left knee. repeat to the other side.
5. Lump, punching the right arm forwards and the left leg backwards. Repeat to the other side.