July 13, 2022

How To Improve Your Posture When You Have Ankylosing Spondylitis

Ease pain and stay active by keeping your spine in its proper position

Person sitting up straight in chair while checking smartphone.

Good posture is key for spinal health, but it’s especially crucial for people with ankylosing spondylitis (AS), a type of inflammatory arthritis that primarily affects your spine. When you have AS, you’re at risk of developing a hunched back, sometimes known as ankylosing spondylitis posture.


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But you can take steps to prevent it and ease your pain and stiffness. Physical therapist Scott Euype, PT, DPT, MHS, OCS, explains the relationship between AS and posture and provides tips for maintaining a proper stance throughout the day.

Why does ankylosing spondylitis cause postural changes?

AS typically starts with inflammation in your lower back, where your pelvis and spine meet. The swelling in your spine causes stiffness and discomfort. As the condition progresses, new bone forms in your spine and fuses (joins) your vertebrae. That portion of your back becomes immobile.

Over time, people with advanced AS may develop a stooped, question-mark-shaped posture, which limits movement.

Easing ankylosing spondylitis pain

There are several steps you can take to maintain flexibility and relieve AS pain.

  • Exercise: Establish an exercise routine to help maintain your range of motion. Stretching and strengthening your muscles help support your spine and keep it in proper alignment. “Focus on stretching the hamstrings and hip muscles and strengthening the abdominal muscles,” Euype says.
  • Breathe right: Up to 26% of people with advanced AS have difficulty expanding their chest wall, which makes breathing painful. Practice diaphragmatic breathing (deep breathing), a way to exercise your rib cage so that it stays flexible and movable.
  • Align your spine: Stacking your vertebrae in a healthy position reduces AS discomfort, so try to keep your spine in alignment throughout the day.

How to maintain a healthy posture

When you have AS, keeping your spine in proper alignment is essential to avoiding a permanently hunched-over position. But getting into those healthy postures may be painful.


“People with AS have varying degrees of back pain when holding a healthy posture where the lower back naturally curves in,” Euype notes. “Try to find a position as close to the ideal posture as feels good to you.”

Sitting posture for ankylosing spondylitis

Prolonged sitting puts a lot of pressure on your back, so focus on getting your sitting stance right. Here’s what you can do to make sure your spine is in the correct sitting position.

  • Sit in a supportive chair: Look for a chair that has a large backrest with adjustable height, lumbar support and a soft, contoured seat.
  • Use a lumbar cushion: Without lumbar support behind the small of your back, gravity will make you slump. If your chair doesn’t have built-in lumbar support, use a specially designed lumbar cushion or a rolled-up towel. Place it in the natural curve of your back so that if you start to droop forward, you’ll feel the cushion pressing into you. This will remind you to sit up straighter.
  • Get a sit-stand desk: “Rather than sitting or standing all day, a mixture of both can help people with AS,” Euype says. “A desk that goes up and down so you can use it either way allows you to vary your posture.”
  • Keep your head over your neck: It’s common to experience neck pain with AS. Try to keep your shoulders stacked over your pelvis and your head directly over your shoulders. Align your ears with your shoulders, not in front of them.
  • Direct your gaze: Look straight ahead. If you’re looking at a computer, your view should hit the top third of the monitor. Adjust your seat height or monitor height so you’re not looking too far up or down.

Ankylosing spondylitis standing posture

You may not spend much time thinking about how you stand, but you could be holding yourself in an irregular position, especially if you’re compensating for pain.

“Bring your shoulder blades together so you’re standing straighter and more erect,” Euype recommends. Imagine your butt underneath your back, so your spine’s straighter, and you’re not leaning forward.

If you frequently read and send text messages, take breaks to look up. Realign your head and neck over your shoulders. If necessary, set reminders on your computer or fitness tracker. When it buzzes, get up and move around or correct your posture, so you’re not stooped over your phone.


Best sleeping posture for ankylosing spondylitis

If you’ve ever woken up with a sore back, you know your sleeping position can affect how you feel in the morning. Here’s how you can keep your spine in healthy alignment while you slumber.

  • Back position: This is the best sleeping position for your spine, especially if you add a pillow under your knees, so they’re slightly bent. The pillow helps relax back muscles and allows your spine to stay in a neutral position.
  • Side position: Putting a pillow between your knees is helpful if you sleep on your side. It takes the tension off your hips and lower back.
  • Abdominal position: Lying on your belly is the worst position for your spine. But if you can’t sleep otherwise, Euype recommends placing a pillow underneath your abdomen across your pelvis. This reduces the arch in your back when you sleep face down.
  • Pillow: The height of your pillow should fit with your sleeping position and body shape — aim to keep your neck straight, not extending it up or down too much. If you have neck pain, consider rolling up a towel, sticking it in a pillowcase and putting it under your neck for support.

Use postural changes to relieve symptoms of ankylosing spondylitis

Focusing on your posture promotes better movement and eases AS pain now — which can help you stay active with minimal pain in the future. It may not be possible to hold your spine in perfect alignment all the time. But the more you do it throughout the day, the healthier your spine will be.

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