Ankylosing spondylitis is a chronic inflammatory rheumatic disease that causes pain and stiffness and is often accompanied by poor sleep, fatigue, stress, anxiety, and depression. While drug treatment is an important component of relieving AS symptoms, exercise, including mind-body interventions like yoga, is also an important part of the treatment picture. Regular physical movement helps you maintain fitness, flexibility, and good posture while decreasing joint pain.
Yoga, an ancient Indian system of well-being that has become extremely popular in Western countries, may be particularly helpful for people with AS. The practice of yoga encompasses physical poses, breathing exercises, and meditation that, done regularly, help many people gain physical strength and flexibility, improve their balance, and also feel more relaxed and better able to manage stress and anxiety.
While yoga is safe for most healthy individuals, some poses are better avoided by those with osteoporosis, a common complication of ankylosing spondylitis. Certain eye conditions, severe balance problems, and uncontrolled high blood pressure also make certain yoga poses unsafe.
To make sure your yoga practice helps and doesn’t harm your body, speak to your doctor before you start about any limitations you may need to observe.
How to Get Started With Yoga
There are hundreds, possibly thousands, of yoga poses and infinite ways to combine them. But you can start reaping the benefits of a yoga practice by learning to do just a few poses properly, and listening to your body as you do them.
You will likely find that some poses feel better than others. If a yoga pose causes pain or other significant discomfort, stop doing it. You may want to try it again at a later date, or you might just decide that pose isn’t for you.
The following yoga poses have been selected because they target areas of stiffness commonly encountered by those with ankylosing spondylitis. Be sure to read the description and watch the accompanying videos, narrated by physical therapist Cara Ann Senicola of the Hospital for Special Surgery in New York City, to understand how to do each pose.
Diaphragmatic Breathing
Taking a deep breath is difficult for many people with ankylosing spondylitis. This diaphragmatic breathing pose may help with that. A study published in September 2018 in the journal Rheumatology International confirms that inspiratory muscle training has a positive effect on both respiratory muscles and functional exercise capacity.
Deep, slow breathing also activates the parasympathetic nervous system, which has a relaxing effect.
To practice diaphragmatic breathing, place a yoga belt or just a regular belt around your rib cage. Make sure you can insert two fingers between the belt and your torso to allow room for a deep inhalation.
Lie on the floor on your back with your lower legs up on a chair or couch. You may wish to place a folded blanket or small pillow under your head for comfort.
As you inhale, think about breathing into the sides of your rib cage. Try to inhale and exhale to a count of 4.
Do the diaphragmatic breathing pose for one to five minutes, or until you feel relaxed or fall asleep.
Side Breathing
Practicing side breathing can also help you learn to breathe deeper.
Start by placing a belt around your rib cage, with two fingers’ worth of space to breathe into. Then lie on your side over a bolster or firm pillow. The bottom edge of the bolster should touch the top of your hip, and the top edge should hit somewhere along your rib cage.
Your legs should be comfortably bent, and your hips, knees, and ankles should be stacked, one on top of the other. Rest your head on a folded blanket or pillow.
Breathe into the side of your chest that’s not on the bolster. To deepen the stretch, extend your top arm over your head; for even more of a stretch, straighten your top leg. Repeat on the other side.
Reclining Pectoral Stretch
This yoga pose focuses on stretching the front of your chest, or pectoral muscles. In ankylosing spondylitis, this particular area can get stiff and tight, making it difficult to breathe deeply.
Lie on your back on top of a bolster or a rolled-up blanket so your spine is supported from your hips to your shoulders. Place a yoga block or similar support under your head. Bring your arms out to a T and simply relax in this position. Avoid allowing your back to arch.
Thoracic Rotation
In people with ankylosing spondylitis, the thoracic spine — the part of the spine that attaches to the ribs — is often tight, with limited movement. This pose can help stretch the area.
To do the pose, lie on your side with your head on a folded blanket or small pillow and your arms extended in front of you. Keep both legs comfortably bent at the knees, or if it’s comfortable, extend your bottom leg on the floor and hook the toes of your top foot behind your bottom knee, letting your top knee fall toward the floor.
Lift your top arm toward the ceiling, rotating your chest upward at the same time. Watch your hand as it lifts and allow your head to turn along with your arm. You can let your arm fall slightly behind you, if comfortable, but once your chest stops rotating, don’t go any further with your arm. Doing so can cause stress in the shoulder and won’t benefit your thoracic spine.
Repeat the arm lift and chest rotation several times on each side.
Cat-Cow Pose
Alternating between Cat and Cow poses can help improve spinal flexibility and relieve tension. This is a great pose series to do at the start of your day.
Start on your hands and knees, with your hands directly under your shoulders and your knees under your hips. Your back should be relatively flat, not arched up or down. If putting weight on your knees is painful, put a folded blanket or towel under your knees.
You can also place a rolled-up towel under the fronts of your ankles to keep your Achilles tendon more extended, if that’s more comfortable.
Start the stretch by lifting your pelvis and allowing your belly to arch toward the floor. Continue to arch your spine, vertebra by vertebra, all the way from your pelvis to your neck, keeping your shoulders wide and not hunched. This is the Cow pose.
To go from Cow to Cat, again start the movement at your pelvis, tucking it as your raise your spine toward the ceiling. Your head should relax down toward the floor. Continue moving from Cat to Cow several times.
Bird-Dog Pose
The Bird-Dog pose can help improve your control over and the stability of your postural muscles. In this pose, you’ll work your transverse abdominis, a muscle that helps activate your core muscles and stabilize your lower spine.
Start this pose on your hands and knees, then engage your abdominal muscles, as if you intended to bring your belly button up toward your spine. At the same time, press into your hands and imagine pressing your upper back toward the ceiling — without actually rounding your back.
When you feel stable on your hands and knees, lift one arm up and out in front of you, focusing all the while on keeping your abdominal muscles engaged. Draw that arm back in, then extend the other and draw it back in.
Next, extend one leg out behind you, keeping your toes on the floor and your torso stable. Draw that leg back in and extend the other one.
A more advanced version of this pose is to extend one arm and one leg, on opposite sides, at the same time, then draw them back in. Repeat with the other arm and leg.
Over time, build up the number of times you repeat these movements.
Sphinx Pose
This pose helps stretch your hip flexors, the muscles along the fronts of your hips that allow you to draw your legs up toward your belly.
Start by lying on your stomach, with your head resting on the backs of your hands. If your back is tight, place a bolster or firm pillow under your hips.
Place your elbows and palms on the floor and push your head, shoulders, and chest up, positioning your shoulders directly over your elbows. This position should help extend your thoracic (upper) spine without putting pressure on your lumbar spine, or low-back area.
Half-Kneeling Thoracic Twist
This exercise focuses on improving balance and stability. Start by kneeling on both knees, then step forward with your right foot, so you’re balanced on your left knee and right foot. Both knees should be bent at 90-degree angles. If balancing is hard, step your right foot further to the right.
Next, place your left hand on your right knee and your right hand on your right hip.
Gently rotate your rib cage to the right, keeping your spine erect. Your hips should remain facing forward, and your head should rotate with your torso so your face and sternum are moving together.
Hold the twist for a few breaths, then repeat the exercise while balanced on your right knee and left foot.
If you notice pain or stiffness when twisting, stop the exercise and try it again another time.
Yoga Flow
A sequence of yoga poses is sometimes called a yoga flow. You can combine some or all of the poses presented here into a flow.
As you move through the poses, always listen to your body. If a pose doesn’t feel good, don’t do it. Wait until another time. If you find the transitions between poses challenging, use a wall or other stable object for support.
The yoga flow video that follows includes some of the poses previously described as well as a couple of new ones.