Exercising with Axial Spondyloarthritis: My Tips for Staying Fit
It’s no secret that consistent exercise can improve the symptoms of ankylosing spondylitis (AS), a form of axial spondyloarthritis (AxSpA), and reduce its progression. However, it’s also no secret that exercise can be painful and difficult with this condition. It’s a catch-22 — we can deal with pain while exercising and reduce future pain or avoid exercise and deal with worse future pain.
It took me a while to figure it all out
Because of this dilemma, it took me a while to figure out how to exercise in a way that best benefits my body. When I first got AS and was unmedicated, exercise was out of the question. Simply bearing weight caused the kind of sharp, jarring pain that screams “do not exercise.” But as the months went on, the pain persisted, and it slowly became clear that this was more than some kind of temporary injury. I realized that if this was going to be long-term, I had to find a way to exercise. I started taking strong painkillers (prescribed to me by doctors who were just as confused as I was) to push through my workouts.
I had to learn how to work with a new body
About 10 months after the onset of my AS, I was diagnosed. I learned that the source of my pain was an autoimmune disease, not an injury. This gave me two pieces of information: 1) The good news: it wasn’t dangerous to exercise, and 2) The bad news: my pain would never be healed. My pre-AS reality of exercising with ease was gone forever. I had to learn to work with a body that was working against me. I also had to stop taking strong painkillers before every workout, because of the long-term side effects.
Luckily, when I started biologic treatment, my pain decreased significantly. This made it easier to exercise, but it was still far from pain-free. I tried to continue the exercises I enjoyed before — like strength training and figure skating — but I had to make adjustments. Through trial and error, I started to learn which movements were okay and which ones were too painful. For example, I learned that regular planks are fine, but side planks put too much strain on my SI joints. I learned that I can still exercise — I just have to put some extra thought into it now.
My tips for exercising with AxSpA
If you are newly diagnosed, you may be adjusting to exercising with AS. Everyone’s body is different, but here are a few guidelines that I follow to stay active with AS:
1. Stay super in-tune with my body
The key to exercising with AS is listening to my body and becoming an expert on my own pain. It’s a lot more complicated than “stop exercising if it hurts too much.” I must factor in the type, intensity, and location of the pain and decide whether or not it can be pushed. Sometimes, it’s best to stop; other times, it’s not. And this changes constantly — so it’s important to stay in-tune with my body. I’ve learned the nuanced difference between “that hurts but moving will make it better” pain and “that hurts and moving will make it worse.” By trying a variety of exercises and stretches, I am learning what helps and what hurts.
2. Avoid repetitive, high-impact movements
Most exercises are good for AS, but some can make it worse, like repetitive jumping and pounding on the joints. This why I avoid running and high-impact activities. Luckily, there are great alternatives that are just as effective for cardiovascular exercise. Like I said before, everyone’s body is different, so some people with AS may be okay with these activities, but for me, it’s usually best to avoid them. It’s okay, I never liked running anyway.
3. Keep a mental inventory of “AS-friendly” exercises to swap in on-the-fly
A big part of exercising with AS is modification. If I’m following a workout video and an exercise that hurts (like a side plank) comes up, I automatically substitute it with a similar exercise that doesn’t hurt (like a regular plank or bicycles). I keep a mental inventory of AS-friendly exercises and it comes in handy all the time. I don’t waste time trying to come up with a modification, so I can keep working out without missing a beat. You can also write down a list of AS-friendly exercises and keep it nearby when you exercise.
4. Focus on consistency, not intensity
For AS, consistent exercise over time to maintain mobility is more important than becoming a bodybuilder. Instead of draining myself with long, intense workouts, I focus on exercising a little bit every day (usually for 30 minutes). This means that my pain is managed consistently and by not committing to dreadful, difficult workouts, I’m more likely to stick to a routine.
5. Be flexible when needed
With AS, it’s important to be flexible physically (by stretching daily), but also mentally. This means staying as consistent as possible with my workout routine but allowing myself to take breaks when I need to. Since chronic pain changes constantly, I can’t stick to an unchanging plan. If I have bad fatigue one morning, I’ll do a lower intensity workout, or if my hips are particularly bad, I’ll do an upper-body workout that won’t bother my hips. I have to modify as I go, and I’m not hard on myself when I have to make these changes. The important thing is knowing when to push myself and when to pull back.
I'm figuring out what works for me
By following these guidelines, I am able to exercise with AS and reap the benefits. To the people with AS — I hope these guidelines help you adjust to an exercise routine. To the people without AS, I hope this article shed some light onto how much thought goes into exercising with chronic pain. It’s not an easy balance to strike. While I miss the ease of exercising pre-AS, I am slowly figuring out what works for me and making every workout count.
Does movement or exercise offer you AxSpA pain relief?
Can you tell when a flare is coming?