Ankylosing Spondylitis Treatment

Ankylosing Spondylitis Treatment include:-
• Drug Therapy .
• Surgical Management.
• Physiotherapy Management.


Drugs utilized in Ankylosing Spondylitis Treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen (Naprosyn) or indomethacin (Indocin) are utilized to relieve pain and stiffness. In severe cases, sulfasalazine (Azulfidine), another drug to lessen inflammation, or methotrexate (Rheumatrex), an immune-suppressing drug, is usually recommended.
In cases where chronic treatments are needed, potential drug negative effects must be taken into consideration. Corticosteroid medicine is effective in relieving symptoms, but they are usually reserved for severe cases that don't improve when NSAIDs are utilized. To avoid potential negative effects, treatment with corticosteroids is generally limited to a short period of time with a gradual weaning in the drug.
Corticosteroid therapy or medications to suppress the defense mechanisms may be prescribed to manage various symptoms. Some medical professionals use cytotoxic drugs (drugs that block cell growth) in individuals who do not respond well to corticosteroids or who're dependent on high doses of corticosteroids.
Drugs called TNF-inhibitors have shown to improve the symptoms of ankylosing spondylitis.
Surgery like a Ankylosing Spondylitis Treatment
Surgery might be performed if pain or joint damage is severe.
Surgery plays a really small part within the management of this condition. About 6% of individuals with AS must have a hip replaced. This can successfully restore mobility and eliminate pain from the damaged joint. In rare cases surgical treatment is used to restore a straighter posture from the spine and neck to individuals who have become severely stooped.


Physiotherapy Management of Ankylosing Spondylitis 
The physiotherapy management includes the physical examination or assessment from the patient and the physiotherapy methods employed for Ankylosing Spondylitis Treatment.
A) PHYSICAL EXAMINATION:
i) Sacroiliac Joint: There are specific simple tests, which can be positive if the SI joint is affected.
• SI joint tenderness and paraspinal muscle spasm.
• Lateral compression from the pelvis with the examiner's hand will elicit pain.
• Gaenslen sign- Instruct the individual to lie supine around the edge of the examining table with knee flexed with one buttock within the edge. Ask the individual to drop the unsupported leg from the table, this procedure will elicit pain within the contralateral SI joint by stretching it.
• SLR test (straight leg raising test)- The individual is in supine lying position after which asked to lift the lower limb upwards with his knee extended. With this, pain is felt around the affected side in the SI joint.
• Pump Handle Test- The individual is in supine lying after which, do the flexion of the hip and knee after which give some extra pressure regarding touch the knee towards the opposite side from the shoulder. By this procedure, the pain sensation is felt on affected side.
ii) Spine: Lack of spinal motion could be detected quite at the start of most cases. As mentioned before early diagnosis is essential in order to start on the Ankylosing Spondylitis treatment plan.
cervical spine
• The cervical spine also become stiff and flexion deformity develops. The measurement is performed by goniometry.
• Tragus to wall test- For that flexion deformity, measurement can be created from the wall behind and also the tragus of the ear.
• Fleche Test- This test detects an earlier involvement of the cervical spine. Ask the individual to stand on the heel and back discussed the wall after which ask the patient to the touch his back from the head to the wall and also at the same time the chin isn't moved upward. When the patient can't do that, shows the involvement from the cervical spine.
• Thoraco-lumbar flexion extension.
• Lumbar or spinal forward flexion (Schobere test).
• Lateral spinal flexion.
• Combined hip and spinal flexion.
iii) Study of peripheral joint movements: All of the joints are measured for active and passive flexibility, done with the help of goniometer. Commonly involved joints are temporomandibular , hip, knee and shoulder.
iv) Breathing Test: Early involvement from the costo-vertebral joints in the disease process makes careful spirometry and measurement of chest cage movement essential. Under 5cm of chest expansion during inspiration within an adult is considered to be reduced.
v) Measurement of Postural Deformity: Within this, loss of secondary spinal curve occurs, first the lumbar lordosis sheds and then the cervical lordosis and increase of thoracic curve develops. Therefore the patients spine become rounded. You should make objective measurement of those. In physiotherapy department using spondylometer works well for measurement of postural deformity.


B) PHYSIOTHERAPY TREATMENT:
Regular physiotherapy is extremely essential in the control over a patient of AS and just physiotherapist is the individual who can help the patient to battle with the disease.


AIMS OF PHYSIOTHERAPY MANAGEMENT IN ANKYLOSING SPONDYLITIS TREATMENT:-
• Relieve pain.
• Maintain the mobility of joints affected like spine, hip, thorax, shoulder etc.
• Prevent and proper deformity.
• Increase chest expansion and vital capacity.
• Attention to posture.
• To maintain and improve physical endurance.
• Advice to patient.
General instruction to patients:-
• Make the exercise a part of your daily routine.
• Try to do an entire set of exercises at least two times daily at a time easy to you.
• Heat and cold application amy precede exercises to boost relaxation and decrease pain.
• Perform just those exercises given to you because of your physiotherapist.
• Perform exercises on the firm surface.
• Exercise slowly having a smooth motion, don't rush.
• Avoid holding your breath during exercising.
• Modify the exercise regime throughout an acute attack and phone your physical therapist for those who have any complaints or issues with the exercises.
Pain alleviation:-
Pain and muscle spasm are treated through the following modalities and also the relaxation is advised-
• Infra red.
• Hot packs.
• Cryotherapy.
• Steam bath.
• Hydrotherapy.


Exercises for mobilization of joints:-
Maintaining the mobility of joints, by providing mobility exercises to specific joints, which are affected like, spine, hip, shoulder, thoracic cage are crucial in Ankylosing Spondylitis Treatment. Upkeep of the mobility is essential and the basic aim is the fact that all the joints are gone to live in their maximum limit by this, we can delay the entire process of ankylosis.


Hydrotherapy:-
Hydrotherapy, in real sense refers back to the therapeutic use of water. The therapeutic results of water in relation to Ankylosing Spondylitis Treatment-
• The pain relief and muscle spasm.
• The maintenance or rise in range of motion of joints.
• The strengthening of weak muscles as well as an increase in their tolerances to exercise.
• The need for circulation.
• The encouragement of functional activities.
• The maintenance and improvement of balance, co-ordination and posture.


Prevent and proper deformity by giving focus on posture:-
• The spondylitic patient ought to always be conscious of his posture while sitting, standing and walking patient should keep up with the erect posture over these activities. This helps to avoid and correct deformity and therefore help in Ankylosing Spondylitis Treatment.
• Sleeping should take place in prone position or supine on the firm mattress having a thin or no pillow with this, the spine stay in extended position and never in flexion.
• The design of chairs is essential particularly for those who spend the majority of their working hours sitting at desk. Low arm chair ought to be avoided, an upright chair with a few cushioning to support the low lumber spine is much better.
• Adjust the height of the working table and be sure that the patient doesn't stoop on that.
• Avoidance of prolonged immobilisation or bed rest, due to this, the spinal extensors become weak by this the extended position from the spine is not retained.


Increase chest expansion and vital capacity:-
To improve the chest expansion and vital capacity, the breathing workouts are required. Breathing exercises which are used in Ankylosing Spondylitis Treatment:
• Apical breathing exercises.
• Diaphragmatic breathing exercises.
• Lateral costal breathing exercises.
Breathing exercises are encouraged. Ballooning being active is also very useful in Ankylosing Spondylitis Treatment. They boost the vital capacity from the lung. Thoracic mobility exercises.
Improvement of physical endurance in Ankylosing Spondylitis Treatment:-
Endurance is really a quality which develops in reaction to repetitive contraction. Endurance is improved upon by working muscles against light resistance and repetition i.e for extended time.


Group Therapy Classes:-
The audience therapy classes implies that number of patients of the identical disease are collected in one place and physiotherapist can provide treatment simultaneously to any or all the patients. The benefits of group therapy classes in Ankylosing Spondylitis Treatment:
• The patient can provide support to the other person in the class that is another patient.
• Shared problems providing a great medium for patient's education and latest details about the disease process.
• Development of competitiveness and motivational aspects.
• Improvement in health and fitness.