Q: Doctor please guide about Ankylosing Spondylitis. My brother has been diagnosed about two weeks ago. Can physiotherapy help? He has stiffness and pain in his back.
A: Radiographic axial spondyloarthritis is also known as ankylosing spondylitis (AS). Axial spondyloarthritis predominantly affects the spine, with inflammatory changes causing pain, stiffness and a loss of motion in the back. It causes characteristic , resulting in structural and functional impairments and a reduction in quality of life. Affected joints progressively become stiff and sensitive due to a bone formation at the level of the joint capsule and cartilage. It causes a decreased range of motion and, in its advanced stages, can give the spine an appearance similar to bamboo, hence the alternative name "bamboo spine".

Although not often recognised, axial spondyloarthritis can also cause peripheral joint pain, particularly in the hips, knees, ankles, and shoulders and neck. It involves synovial and cartilaginous joints, as well as sites of tendon and ligamentous attachment. Early diagnosis and treatment help to control the pain and stiffness and may reduce or prevent significant deformity.

Physiotherapy is an essential part of the treatment of AS. It aims to alleviate pain, increase spinal mobility and functional capacity, reduce morning stiffness, correct postural deformities, increase mobility and improve the psychosocial status of the patients. The main aspects of rehabilitation include education, a program of personalised exercises and outline of physical activities to be completed at home or in a group based environment.

The initial phase of AS is characterised by morning stiffness and pain in the spine. The aims of physical therapy include control of the diffuse and intense pain secondary to joint stiffness, recovery of proprioception, joint stability, restoring normal postural patterns and reduction of pain, maintaining the elasticity of the pelvis and spine to enable good respiratory function. Short term goals include the improvement of body function and reduction of pain, Long-term goals include pain control, improvement in activities of daily living, general function and quality of life.

Fatigue is a common complaint in rheumatological conditions. It can be managed by taking regular micro breaks, avoiding sitting in the same position for long periods, maintaining physical activity and having good sleep hygiene. AS patients can suffer from flare-ups of increased disease activity, which can last from days to weeks. During the flare-up the patient may benefit from gentle stretching exercise, taking breaks and medications. Educating the patient about his condition and how to manage it, besides having a patient-provider relationship are important for patients’ self managing. ADL activities can be made easier using assistive devices and alternative techniques. For example, managing shoes; slip-on shoes can be used or the patient can raise their leg on a stool or place it on the opposite knee. Driving can be difficult due to neck pain and stiffness, advice for driving can include taking breaks on long journeys and using a small pillow behind their back or under their buttock to promote better.

Q: Kindly guide about Piriformis Syndrome. Is sciatica the same thing?
A: Piriformis syndrome (PS) is a painful musculoskeletal condition, characterised by a combination of symptoms including buttock or hip pian. In several articles, piriformis syndrome is defined as a peripheral neuritis of the branches of the caused by an abnormal condition of the (PM), such as an injured or irritated muscle. The sciatic nerve generally exits the pelvis below the belly of the muscle, however many congenital variations may exist.

Patients with piriformis syndrome have many symptoms that typically include persistent and radiating low back pain, (chronic) buttock pain, numbness, paraesthesia, and difficulty with walking and other functional activities such as pain with sitting, squatting, standing, bowel movements and dyspareunia in women.

A complete neurological history and physical assessment of the patient is essential for an accurate diagnosis. Avoid sitting for a long period; stand and walk every 20 minutes, and make frequent stops when driving to stand and stretch. Prevent trauma to the gluteal region and avoid further offending activities. Daily stretching is recommended to avoid the recurrence of the piriformis syndrome.

The patient can also perform several exercises and treatments at home including: Rolling side to side with flexion and extension of the knees while lying on each side, Rotate side to side while standing with the arms relaxed for 1 minute every few hours, Take a warm bath, Lie flat on the back and raise the hips with your hands and pedal with the legs like you are riding a bicycle, Knee bends, with as many as 6 repetitions every few hours.