September 15, 2022/Rheumatology & Immunology

Best Types of Exercises for Ankylosing Spondylitis

Pilates, stretching and hydrotherapy can support your spine and maintain a wide range of motion

Person doing yoga plank on floor mat.

The last thing you want to do when you’re feeling stiff and painful is move. But exercise is exactly what will help you feel better when you have ankylosing spondylitis (AS), an inflammatory arthritis affecting your spine and joints.


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Regularly working out is a key part of AS treatment, says rheumatologist and sports medicine expert Ahmed Elghawy, DO. It prevents lower back pain and stiffness. It also helps maintain your range of motion, so AS doesn’t limit your ability to do everyday activities.

Dr. Elghawy shares the best exercises for ankylosing spondylitis and what to do when you’re having an AS flare.

How can exercise help people with ankylosing spondylitis?

Exercise is a cornerstone of AS treatment and has several benefits. Try to include a variety of exercises to improve your:

  • Core strength. The muscles in your torso (or core area) help keep the spine aligned. A strong core can reduce lower back pain, too, says Dr. Elghawy. “The rib cage stabilizes the upper back, but the lower back doesn’t have that support. And that’s often where people feel the most pain.” Focus on strengthening your abdominal muscles to provide more stability to your lower back.
  • Spinal flexibility. If AS progresses, joints in your lower back may join or fuse together. When this happens, it limits your movement. Stretching exercises help maintain your spine’s flexibility and help give you good posture.
  • Balance. Some people with AS take steroid medications long-term. This increases your chance of osteoporosis or weakening of the bones, which can lead to a fracture. Working on your balance helps you avoid bone-breaking falls.
  • Heart health. Autoimmune conditions like AS cause ongoing inflammation. Inflammation increases your risk of developing heart disease. To counteract that, incorporate aerobic exercise into your workout routine. It boosts heart and lung function. The bonus? It can reduce pain and improve your mood, too.

What exercises are good for ankylosing spondylitis?

The best exercise for AS is the one you enjoy. Because there are so many options, you don’t have to commit to something that bores you.

For instance, walking is easy and free, and you can do it in a variety of settings. You can choose to exercise on your own, in a group class or with a friend or neighbor — whatever makes you happiest.


“Find an exercise regimen that you like so it’ll be easier to stick with it,” advises Dr. Elghawy. “Try a few different activities to see what you like most.”

Here are some options that are especially beneficial for AS:

Physiotherapy exercises

Healthcare providers often recommend physical therapy for ankylosing spondylitis relief. A physical therapist supervises you while you do specific exercises.

Movements may target your chest wall in addition to your spine. AS can sometimes stiffen your rib cage, making it difficult to take deep breaths. Physical therapy is great for learning stretches that maintain spinal flexibility, chest expansion and healthy lung function, says Dr. Elghawy.


Pilates is a form of exercise that focuses on building body strength in a slow and controlled way.

“It combines many types of exercise into one routine,” notes Dr. Elghawy. “It’s a good mix of flexibility training, working your core and postural exercises. And Pilates exercise is good for AS because it’s low impact, so it’s safe for joints.”

Other low-impact, muscle-building activities include yoga, tai chi and weight training.

Stretching exercises

Make sure your workout includes stretching exercises to help AS, says Dr. Elghawy. For instance, you can practice exercises you learned at physical therapy or do slow-flow yoga, where you hold postures for longer. Another option? Traditional stretches that target your neck and back.

Neck exercises

The goal with neck exercises for AS is to increase your range of motion, Dr. Elghawy says. Try these moves to gently stretch your neck:

  • Tuck your chin to your chest.
  • Move your ear toward your shoulder.
  • Slowly rotate your head.

Back exercises

Strong muscles help you maintain proper posture, which is essential when you have AS. Back and core exercises for AS include:

  • Wall sits. Stand against a wall and then lower into a sitting position.
  • Planks. Get into a position similar to how you start a push-up and hold the position.
  • Bridge. Lie on your back with your knees bent and feet flat on the floor. Starting with your pelvis, slowly lift your lower back upward and hold.


You can do many traditional exercise moves in the water. The advantage of aqua or hydrotherapy for ankylosing spondylitis is that it’s gentle on your joints.

“It’s great for people who don’t have as much strength,” says Dr. Elghawy. “Once the water exercises become easy, then you graduate to doing them on land.”


Can exercise make AS worse?

Exercise is a must to reduce AS symptoms and maintain mobility. But the physical activity you can handle depends on your stage of AS and overall health.

“You can expect some soreness when you exercise,” says Dr. Elghawy. “But pain is a signal to stop and could be a sign of an AS flare when the disease goes into an active phase and symptoms worsen. Hold off on the activity until you see your healthcare provider. Explain the pain you’re having. Together, you can determine if you can safely do that exercise.”

What movements should you avoid with AS?

If you have AS, avoid intense, fast-moving, high-impact exercises like martial arts and contact sports. Also, consider how the disease has affected your mobility and balance before trying a new physical activity that’s particularly challenging.

Exercise can complement your medical AS treatment. It’s a natural way to relieve AS symptoms like pain, stiffness and fatigue. It helps your body stay strong and flexible, too. And it may even prevent inflammation, which makes the disease worse.

The bottom line: You can’t afford to be a couch potato when you have AS. And once you get moving and feel the benefits, you won’t want to quit.


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