Axial spondyloarthritis · Exercise programme
Regular exercise is one of the most effective things you can do for axial spondyloarthritis. This programme brings together three approaches used in axSpA physiotherapy: postural correction, range-of-motion (mobility) work, and strengthening. A little most days works better than a lot occasionally.
Axial spondyloarthritis can gradually pull posture into a stooped position: a more rounded upper back, a forward head, and a flattened lower-back curve. Working on posture regularly counters that drift and helps protect chest expansion and lung capacity as well as how you stand and move.
Stand with your head, shoulders, and buttocks lightly touching a wall, feet a small step forward. Slide your arms up and down the wall like a snow angel, keeping contact where you can.
Daily, 8 to 10 slow reps
Sitting or standing tall, gently draw your chin straight back, as if making a small double chin, without tipping your head down. Hold briefly, then release.
Daily, 8 to 10 reps, a few times a day
Lie on your back with a rolled towel or foam roller placed across your upper back, knees bent. Let your upper back gently extend over the roll, arms relaxed overhead if comfortable.
Daily, 3 to 5 minutes
Lie on your front, forearms supporting your upper body if that is more comfortable, and relax into a gentle stretch through the front of the hips and lower back.
Daily, build up to 10 to 15 minutes if comfortable
Moving the spine and chest through as much of their available range as possible, every day, is the main defence against stiffness. Move slowly and smoothly through a comfortable range; a mild stretch is expected, sharp pain is not.
Sitting tall with arms crossed over your chest, slowly rotate your upper body to look over one shoulder, then the other.
Daily, 8 to 10 reps each side
Standing or sitting tall, slide one hand down the side of your leg toward the knee, bending sideways, then return to centre and repeat on the other side.
Daily, 8 to 10 reps each side
On hands and knees, gently arch your back up toward the ceiling, then let it gently dip the other way, moving through your full comfortable range.
Daily, 8 to 10 slow reps
Place your hands on the sides of your ribcage. Breathe in deeply through the nose, feeling the ribs expand under your hands, then breathe out fully.
Daily, 5 to 8 deep breaths
Kneel on one knee in a gentle lunge position, back hip tucked slightly under, and lean forward a little until you feel a stretch at the front of the back hip.
Daily, hold 20 to 30 seconds each side
Strengthening the muscles that hold you upright, the spinal extensors, shoulder-blade muscles, core, and glutes, supports the postural work above and helps protect the spine. Give these muscles rest days between sessions.
On hands and knees, extend one arm forward and the opposite leg back, keeping the spine steady and level. Hold briefly, then return and switch sides.
2 to 3 times a week, 6 to 8 reps each side
Lying on your front, gently lift your chest a small amount off the surface, arms out to the sides, then lower with control. Keep the movement small and pain-free.
2 to 3 times a week, 8 to 10 reps
Lying on your back, knees bent, feet flat, lift your hips to make a straight line from knees to shoulders, squeezing the buttocks, then lower with control.
2 to 3 times a week, 8 to 12 reps
Sitting or standing tall, squeeze your shoulder blades gently together and down, as if holding a pencil between them, and hold briefly before releasing.
2 to 3 times a week, 10 reps, hold 3 to 5 seconds
See a physiotherapist for a tailored assessment if you are not sure how to do an exercise safely, if pain is severe or spreading, or if you have spinal fusion or osteoporosis, since your programme may need to be adapted. Contact your team promptly for new numbness, weakness, loss of bladder or bowel control, or a fall or injury to the spine, these need prompt medical attention.
This page draws on the well-established principles behind the NASS Back to Action programme, a free, physiotherapist-designed exercise programme for axial spondyloarthritis from the National Axial Spondyloarthritis Society (UK). It covers mobility, cardiovascular, strength, flexibility, and breathing exercises in more depth, with written and video guides.
Links open in a new tab and point to NASS, a UK charity; some references (such as local services) will not apply in Canada. General guidance only; advice from your own team comes first.