Ankylosing spondylitis often involves lower back pain and stiffness, so it might seem logical that spinal manipulation done by a chiropractor could help your symptoms. But doctors say the opposite is true: Because the spine can fuse in people with ankylosing spondylitis, traditional chiropractic adjustments are not recommended. Ankylosing spondylitis treatment guidelines from the American College of Rheumatology published in February 2016 in the journal Arthritis & Rheumatology recommend against the use of spinal manipulation. But because people with low back pain might first go to a chiropractor, these providers can play a role in getting people with ankylosing spondylitis into medical treatment. An analysis of data from 3,336 people with ankylosing spondylitis published in July 2016 in the journal Clinical Rheumatology found that up to 7 percent of people who were ultimately diagnosed by a rheumatologist first saw a chiropractor.
Why Doctors Caution Against Chiropractic Care
The Spondylitis Association of America (SAA) specifically advises against back and neck manipulation by a chiropractor — or even a massage therapist — because it might injure the spine of someone who has ankylosing spondylitis or spinal fusion. “Chiropractic therapy is often useful for low back pain, but I wouldn’t suggest it for a person with ankylosing spondylitis,” says David Alan Fox, MD, a rheumatologist, professor of internal medicine, and chief of the division of rheumatology at the University of Michigan in Ann Arbor. The traditional hands-on manipulations used in chiropractic care involve moving the joints around in order to achieve therapeutic goals, such as easing pain and correcting alignment problems. People with ankylosing spondylitis may have joint damage that can become worse or result in fracture with such forceful pressure, according to the SAA.
Safer Chiropractic Approaches for Ankylosing Spondylitis
In a person who has ankylosing spondylitis, the spine may have become fused, and this makes it more susceptible to injury, Dr. Fox says. That’s why people with the condition who are interested in chiropractic care should find a chiropractor who has experience specifically with ankylosing spondylitis and using gentler techniques, according to Karen Erickson, DC, a spokeswoman for the American Chiropractic Association and a chiropractor in private practice in New York City who has worked with people with ankylosing spondylitis. “A skilled chiropractor can use non-forceful techniques that are respectful of the spine and other joints,” she says. Instead of forcibly adjusting joints, Erickson says that, for people with ankylosing spondylitis, she focuses on keeping soft tissues around a joint mobile and on helping people learn exercises that get them moving more smoothly when they get out of bed in the morning. As an example of a non-forceful approach to keeping the pelvis in line, Erickson explains that instead of directly pushing the bones and joints, she uses the body’s own weight and the placement of specialized blocks to ease alignment. Although chiropractors are best known for their bodywork, Erickson adds that the goal of chiropractic therapy is to address the whole person. For instance, chiropractors might also suggest diet changes and identify specific nutritional deficiencies. But research about diet and inflammatory diseases such as ankylosing spondylitis is still limited, so suggestions for such changes shouldn’t be considered as proven medical advice for ankylosing spondylitis treatment. The SAA currently recommends keeping a healthy weight and eating a nutritious and varied diet that includes plenty of vegetables, fruits, and whole grains. And a study published in February 2019 in the journal Advances in Rheumatology found that a high-fat diet resulted in worse disease outcomes for patients with ankylosing spondylitis. A chiropractor familiar with ankylosing spondylitis might also encourage a person with the condition to step up traditional medical treatment when necessary, such as if a person has signs of disease progression, Erickson says. If you’re interested in trying chiropractic care to help manage your ankylosing spondylitis symptoms, first talk to your doctor about whether this treatment is right for you. Then look for a chiropractor who has experience with ankylosing spondylitis and let them know you have the condition. At your first visit, your chiropractor should take your medical history and perform a physical exam of all your joints to determine which approaches are best for you, according to the Arthritis Foundation. Be sure to keep your doctor informed of the techniques you’re trying so he or she can factor this into your overall treatment plan. You should avoid going to the chiropractor during a flare or if your joints are swollen or inflamed. And if your ankylosing spondylitis-related pain gets worse, stop chiropractic care and see your doctor about adjusting your treatment plan.
