Ankylosing Spondylitis
Ankylosing spondylitis is a chronic inflammatory arthritis primarily affecting the spine and the joints between the spine and the pelvis. A rare condition, with UK prevalence estimated to be around 0.3%, the onset of ankylosing spondylitis peaks from ages 20-30, with only 5% of those affected experiencing the onset of their symptoms after the age of 45. Ankylosing spondylitis is characterised by inflammation at areas of the bone known as entheses – the sites where tendons and ligaments attach to the bone. This inflammation can lead to calcification, or hardening, of ligaments and cause areas of fusion between vertebrae that can markedly impact a person’s mobility and cause severe pain.
For people affected with ankylosing spondylitis, the relationship between work and managing their condition is really important, and trying to reduce the amount of flare-ups they experience can have a huge impact on their quality of life. Classical symptoms of the condition include:
- Chronic lower back pain lasting more than 3 months.
- Morning stiffness lasting ≥30 minutes, improved by movement.
- Night pain: often wakes patients during the second half of the night.
- No relief with rest; paradoxically worsens with inactivity (e.g., prolonged sitting).
- Improvement with exercise and movement
- Postural issues: risk of kyphosis (forward flexion of spine) if not managed.
- Chest pain and peripheral joint involvement may be present.
- Reduced spinal mobility impacts seated posture and comfort in office settings.
Every office worker should be aware of the importance of movement, and research shows that, in AS, regular movement is crucial for slowing disease progress and reducing the risk of flare-ups. In the office setting, it is important for those with AS to be able to freely discuss management strategies with their employer, alongside a full assessment of their workspace by a specialised ergonomist or physiotherapist. Through these discussions, we aim to look at the workstation environment as a whole to create a personalised solution to the limitations that a standard workstation can have on a client with AS:
– Workspace Adaptation
- Sit-stand desks to promote frequent posture changes and reduce time in spinal flexion.
- Ergonomic chairs with lumbar support to encourage spinal extension.
- Use firm seating surfaces to maintain a neutral pelvis and spinal alignment.
- Avoid soft, slouched seating that encourages spinal flexion.
– Movement and Activity
- Frequent microbreaks (every 20–30 minutes) to stretch and change posture.
- Reminders or apps to prompt standing/walking/stretching.
- Incorporate daily spinal extension exercises (e.g., prone press-ups).
- Encourage walking meetings or standing during phone calls.
- Working together to find ways to keep as active as possible in and out of the office.
– Postural Training
- Avoid flexed positions for prolonged periods.
- Sleep supine on a firm mattress, avoid pillows under head/knees.
- Focus on spinal extension and deep breathing exercises to maintain chest wall mobility.
At Inspired, we understand that effectively managing chronic conditions such as ankylosing spondylitis takes the work of a team – and ensuring those with AS are under the care of a rheumatologist is hugely important. We also understand the importance of connecting people with charities – such as the The National Axial Spondyloarthritis Society – who can provide them with helpful resources and services such specialist rheumatology physiotherapists that may not be available to them otherwise.
As with many inflammatory joint conditions, the inflammation seen in ankylosing spondylitis is not limited to the joints. Inflammation of the eyes, also known as uveitis, is a characteristic feature of the condition. For those affected, the importance of maintaining good eye health cannot be overstated. In the office, minimising visual fatigue is key to maintaining good eye health, and adopting strategies such as the 20:20:20 rule is one of the easiest ways to do that.
If you have ankylosing spondylitis and would like to find out more about how to manage at work, you can visit the NASS website at https://nass.co.uk/, or take a look at their guidance on managing AS at work.
