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.
Chiropractors use manual therapy and other methods to “adjust” the spine and joints, improve alignment, and relieve pain. But rheumatologists typically don’t recommend chiropractic treatment for people with AS. Read on to learn more about risky chiropractic practices and safe alternatives.
Chiropractic care is a hands-on treatment aimed at improving how the spine and joints work. Chiropractors use manipulation, a technique that involves applying pressure and movements to certain areas of the body. Chiropractors often treat conditions like back pain, neck pain, headaches, and certain joint problems.
Because lower back pain is often the first symptom of ankylosing spondylitis, many people visit a chiropractor for relief before they’re even diagnosed with AS. “In some cases, chiropractors are the first healthcare providers to suspect AS, especially if X-rays show changes in the sacroiliac joints [the joints that connect the lower spine to the pelvis] or signs of inflammation,” says Beth Biggee, MD, a board-certified integrative rheumatologist at Rheumission and a medical reviewer for Everyday Health. This means chiropractors can be helpful in identifying patients who have the condition, she adds.
Catching AS early is important for getting the right treatment.So, if a chiropractor notices signs that point to AS, they should refer that person to a rheumatologist as soon as possible, Dr. Biggee explains.
Like any medical treatment, chiropractic care can have side effects. Most people feel temporary soreness, stiffness, or mild discomfort after a chiropractic adjustment. Some may experience headaches or fatigue, but these effects are usually temporary. Though rare, more serious complications can occur, such as herniated discs, pinched nerves, or stroke.
For people with AS, the risks of chiropractic care are more serious. As AS progresses, the vertebrae (the bones that make up the spine) can begin to grow together and fuse, making the spine stiff and less flexible. These bones can develop osteoporosis, a condition that makes them weak and brittle, explains Biggee. The bones can become so fragile that they break without any obvious cause.
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.
Indeed, guidelines from the American College of Rheumatology, the Spondylitis Association of America, and the Spondylitis Research and Treatment Network advise against spinal manipulation in people with spinal fusion or osteoporosis due to the risk of serious injury.
Research on chiropractic care for ankylosing spondylitis is limited. For example, a review study found that there wasn’t enough research to show whether chiropractic care is helpful for people with AS. Because of these increased risks and the lack of clear evidence that chiropractic care is beneficial for AS, healthcare providers typically don’t recommend it, says Biggee.
If you have AS and are considering chiropractic treatment, talk with your rheumatologist first. They can make recommendations based on your condition.
Not all chiropractic treatments involve manipulation of the neck and spine. Dr. Cohen explains that chiropractors can offer other forms of therapy that may help with AS symptoms, such as:
Transcutaneous electrical nerve stimulation (TENS), a treatment that uses mild electrical currents through pads placed on your skin to reduce pain
Myofascial release, a gentle hands-on technique that helps loosen tight muscles and connective tissue
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.
Chiropractic manipulation may not be the best choice for ankylosing spondylitis. The following are some other evidence-based treatments that can help you stay active and effectively manage pain.
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.
Yoga A study published in the International Journal of Rheumatic Diseases shows that yoga can be as effective as traditional exercises for improving mobility, sleep, and pain in people with AS.Yoga poses can help keep your spine flexible and make the surrounding muscles stronger. Other gentle movement practices, like tai chi, may also help.
Acupuncture Biggee notes that while research is limited, acupuncture carries fewer risks than spinal manipulation for people with AS.
Massage Therapy It can help ease muscle tension and improve circulation, but be sure to work with a therapist who understands AS. Some people find massage helpful, while others may experience increased pain or flare-ups (periods of time when the pain gets worse).
Self-Care Approaches You can use a TENS unit at home for pain relief after learning proper placement from a healthcare provider. Other helpful self-care techniques include:
Gentle stretching and posture awareness
Stress management through meditation or relaxation exercises
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.
