Strategies for Coping With Ankylosing Spondylitis

Managing the chronic pain of this autoimmune condition is important

Ankylosing spondylitis sleep positions

You’ve been experiencing lower back pain. And your doctor has just diagnosed you with ankylosing spondylitis (AS). Your head is swimming with worries and plenty of questions.


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Now what?

First, it’s important to understand what AS is.

“Ankylosing spondylitis is an autoimmune condition that primarily attacks the spine,” says rheumatologist Ahmed Elghawy, DO. “It can affect other parts of the body like the hips, the hands and the feet, but it’s primarily attacking the lower back and sacroiliac joints located between the base of the spine and the pelvis.”

AS is a chronic condition that can affect how you live your life. You may experience fatigue and pain that can take its toll on your personal and professional life.

But there are steps you can take to manage pain and focus on your mental health.

Dr. Elghawy discusses what symptoms you may experience and how to cope with AS.

Tips for managing chronic pain

The pain you experience with AS can be debilitating, but there are ways you can manage chronic pain.

Stay flexible

Whether it’s through physical therapy or on your own, dedicating time to stretching is key.

“We recommend making sure that you maintain your flexibility,” says Dr. Elghawy. “And so doing with physical therapy or flexibility exercises on your own for your low back can provide a lot of relief.”

Maintain good posture

Your lower back pain may cause you to shift how you sit and stand causing poor posture.

But it’s important to pay attention to how you’re positioned.

“Whether you’re sitting or standing, do this to make sure that your muscles and low back stay strong,” says Dr. Elghawy.

Take a hot shower

Heat can help alleviate pain and stiffness. So, don’t overlook the benefits of taking a hot shower.


“It can help loosen up your muscles and improve your flexibility as well,” notes Dr. Elghawy.

Focus on sleep

Sleep can heal and so making sure that you’re well-rested in a comfortable position can also help your muscles relax,” says Dr. Elghawy.

If you’re a back sleeper, use a supportive neck pillow that’s made for back sleepers. You can also place a pillow underneath your legs to help keep your back straight.

If you sleep on your side, opt for a pillow that may be a little bit higher. Also, use a pillow between your legs.

“I would generally avoid sleeping on your stomach because it can cause excessive stress on the lower back,” Dr. Elghawy adds.

Wear comfortable shoes

As AS can cause ankle pain, it’s important that you find supportive shoes. Look for ones that offer a cushioned base and support near your ankle.

“Make sure you have a wide toe box in the front of the shoe as well,” says Dr. Elghawy.

Lifestyle tips

You may also want to consider some lifestyle changes, too. By making these changes, you can help reduce inflammation and pain.

Focus on your gut health

“The gut is intimately related with the immune system,” explains Dr. Elghawy. “By focusing on having good gut health, it can help prevent some of your arthritic symptoms.”

He suggests staying away from processed or sugary foods.

“We found that more of an anti-inflammatory or Mediterranean diet seems to give those with AS the most relief,” he adds. “And also making sure that you stay very well-hydrated can give you a lot of relief.”

Limit alcohol consumption

Depending on what kind of treatment your doctor prescribes, you may need to watch how much alcohol you drink.

“Some of the therapies that we use for AS can be immunosuppressive, and alcohol itself is also immunosuppressive,” says Dr. Elghawy. “It’s recommended that you limit your alcohol intake if you’re on those.”


Drinking alcohol can also upset your gut health as well.

“It’s not necessarily that you need to avoid alcohol altogether, but you may need to monitor how much you drink,” he continues. “And if you do drink more than what the typical person drinks, you may need to cut down.”

Mental health tips

Being diagnosed with an autoimmune condition like AS can have an impact on your mental well-being. You may experience depression or anxiety.

“Mental health is really important in autoimmune conditions because anything that really stresses the body, whether it’s physically, mentally or emotionally can be a trigger for flares,” says Dr. Elghawy.

To help manage stress, consider joining an AS support group.

“These groups are full of people who share their own experiences, the treatments that they’re on and how they’re doing on these things,” he says. “And I think that it’s important because it can make you feel like even though these diagnoses are not very common, it lets you know that they’re not alone in this diagnosis.”

And activities like yoga, Pilates and massage therapy not only help with your flexibility and pain, but can also benefit your mental health.

Treatment for ankylosing spondylitis

There aren’t any cures for ankylosing spondylitis, but treatments can help reduce joint pain and damage and prevent long-term complications.

Treatments can include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Either an over-the-counter or prescription NSAID can work as an anti-inflammatory and help with other symptoms as well.
  • Disease-modifying antirheumatic drugs (DMARDs). “This type of drug can also help quell the overactive immune system and help with symptoms,” says Dr. Elghawy.
  • Corticosteroids. To help temporarily ease joint pain and inflammation, your doctor may recommend an injection of corticosteroids.

By following any prescribed treatment, taking steps to manage your pain and consulting with your doctor, people with AS can live a healthy life often without any restrictions. But at first, it can be scary to learn about your diagnosis and what it may all mean.

“This can be a stressful situation because you’re being given a diagnosis that a lot of times, is a lifelong diagnosis,” says Dr. Elghawy. “So, being able to cope with AS is really important.”

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