Ankylosing Spondylitis Chiropractic Care: Risks and Alternatives

For people with ankylosing spondylitis (AS), back pain and stiffness can be an ongoing challenge. If you're not getting enough relief from your current treatment plan, you might wonder if seeing a chiropractor could help.

Even heavy massage for someone with advanced AS can cause the bones to break or slip out of place, potentially leading to nerve damage, says Biggee.

“If chiropractors are not familiar with the anatomy that goes along with the chronic changes of AS, any manipulation that’s not done carefully or even done without knowledge could really be harmful,” says Aly Cohen, MD, a rheumatologist and integrative medicine practitioner based in New Jersey, and the author of Detoxify: The Everyday Toxins Harming Your Immune System and How to Defend Against Them.

If you have AS and are considering chiropractic treatment, talk with your rheumatologist first. They can make recommendations based on your condition.

• Transcutaneous electrical nerve stimulation (TENS), a treatment that uses mild electrical currents through pads placed on your skin to reduce pain

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• Myofascial release, a gentle hands-on technique that helps loosen tight muscles and connective tissue

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• Massage
• Advice on daily movements, like how to move from sitting to standing
• Muscle conditioning exercises

“If a chiropractor focuses on treatments like TENS therapy, muscle conditioning, and guidance on daily movements, similar to what physical therapists do, these can be really helpful,” says Cohen.

Biggee agrees that non-manipulative chiropractic therapies can improve AS symptoms. But they need to be done carefully. “We typically refer people with AS to physical therapists because they can teach safe, gentle techniques that patients can continue at home,” she says. “Some forms of massage can be too aggressive, so patients and therapists should be aware of that.”

As with any treatment, it’s always best to check with your rheumatologist first, even for non-manipulative chiropractic therapies.

Physical Therapy Physical therapists can design a customized exercise program and teach you safe movements and stretches you can do at home to help maintain flexibility and reduce pain.

Exercise Staying active is especially helpful for people with AS as it can reduce inflammation and improve flexibility. Low-impact activities like swimming and walking can all help manage AS symptoms. Understand the dos and don’ts of exercising with AS and choose activities that feel comfortable for you.

• Gentle stretching and posture awareness
• Stress management through meditation or relaxation exercises
• Hot and cold therapy
• Journaling
• Soothing activities like music therapy

AS management often involves combining several approaches, says Cohen. Besides appropriate exercise, people with AS might benefit from things like acupressure, topical pain relievers, cognitive therapy, or even time in a sauna, she adds.

• Rheumatologists typically don’t recommend chiropractic manipulation for people with ankylosing spondylitis (AS) because of the risk of complications and lack of evidence that it helps.
• AS can cause the bones in your spine to become rigid and brittle over time. Both gentle chiropractic manipulation and aggressive massage can increase the risk of fractures and nerve damage.
• Chiropractors may offer non-manipulative treatments, such as muscle conditioning, stretching, and guidance on daily movements to manage AS symptoms. But always check with your rheumatologist first.
• Safe alternatives to chiropractic manipulation include physical therapy, yoga, transcutaneous electrical nerve stimulation (TENS), acupuncture, and gentle exercise programs.