In recognition of World Ankylosing Spondylitis Day on Saturday 6 May, Andrew Zhang, a rheumatology physiotherapist, has written this blog.

My name’s Andrew, and I work at a large tertiary hospital in Sydney. I have the privilege of working with some amazing rheumatologists in the management of people living with ankylosing spondylitis (AS).

Ankylosing spondylitis is an uncommon disease that isn’t well recognised. Even some health professionals struggle to identify it early on. It’s frequently mistaken as common back pain, with the average time to be accurately diagnosed for many people being around 5-9 years!

AS is an autoimmune inflammatory arthritis. That means the body attacks its own joints, tendons and ligaments, mainly in the spine, resulting in pain and stiffness. Over time, this inflammation can lead to fusion (ankylosis) of the spine and ribcage. If AS is not well managed, it can result in permanent changes to the spine and a hunched posture. The back is also susceptible to fractures, and breathing may be more difficult due to restricted movements.

We don’t know why, but it’s speculated that genetic and environmental factors are involved in developing the disease, including a strong family history and correlation with the HLA-B27 gene – but not with everyone. It’s quite common for people to notice symptoms from early adulthood.

People with ankylosing spondylitis commonly experience acute flares of back or buttock pain and tend to feel stiff in the mornings when they wake. They may also feel pain in areas other than the spine – commonly the back of the heel, underneath the foot, chest wall and eyes.

In addition, people with AS may also experience high levels of fatigue and other inflammatory conditions such as uveitis, inflammatory bowel disease and psoriasis.

Early recognition and referral to a rheumatologist, specialist doctors who diagnose and manage musculoskeletal conditions and autoimmune diseases, is crucial for this progressive disease.

Diagnosis is based on a thorough history and physical examination, as well as blood tests and imaging which are usually requested to look for evidence of active inflammation. Nonetheless, someone can still have ankylosing spondylitis with these results being completely normal!

Rheumatologists treat ankylosing spondylitis patients with medications that reduce inflammation. This can include non-steroidal anti-inflammatory drugs and/or biological disease-modifying anti-rheumatic drugs (biologics). Biologics dampen the immune system to reduce disease activity; however, this immunosuppression may increase the risk of infections and illnesses.

Physiotherapy is also important to help manage AS. The aim is to reduce pain, stiffness, and joint damage and increase physical function and quality of life. This should always involve a personalised exercise program consisting of movements and stretches to maintain flexibility and strength, as well as aerobic exercises to improve cardiovascular fitness and chest expansion. Hydrotherapy (exercise in warm water) also has a positive effect. Physiotherapists should also be great health educators highlighting the importance of regular exercise, back care and posture, and a healthy and active lifestyle!

Many patients I see with ankylosing spondylitis have bounced between many health professionals before their eventual diagnosis; which for them can both be a relief and overwhelming. That’s why working closely with my patients as a health educator and treating the whole person is essential. It’s also very rewarding work.

With the advancements in modern medicine, most people living with ankylosing spondylitis can go about their usual activities without limitations if it’s diagnosed early and well-managed with medication and physiotherapy.

So join me and help spread the word about AS on World Ankylosing Spondylitis Day!

Andrew Zhang

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Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email ( or via Messenger.


This is the first of a series of blogs that will explore the different groups of health professionals and therapists who’ll help you live well with a musculoskeletal condition. For ease of reading, we’ll be referring to them all as practitioners.

Managing a chronic musculoskeletal condition – or multiple conditions – can be complicated. To help you get the best health outcomes and maintain (or improve) your quality of life, you’ll probably see a variety of different health professionals and therapists.

Who you see and how often will depend on your condition/s, symptoms and how they affect your life.

Physical or manual therapies

These therapies provide a hands-on approach to help relieve your pain and stiffness and improve your mobility, movement and joint function.

They’re often referred to as physical, manual, manipulative or hands-on therapies. The most common are:

  • Chiropractic – this involves manipulation and manual adjustment of your spine. It’s based on the premise that if your body, especially the spine, is out of alignment, it can affect the health and function of other parts of your body.
  • Massage – involves rubbing and manipulating the soft tissues of your body, especially your muscles. Massage can improve blood circulation, ease muscle tension and help you feel more relaxed. There are a variety of different types of massage available.
  • Myotherapy – involves assessing, treating, and managing the pain associated with soft tissue injury and restricted joint movement caused by problems with your muscles and the tissue surrounding your muscles (the fascia).
  • Occupational therapy – helps you learn better ways to do everyday activities such as bathing, dressing, cooking, working, eating or driving. An occupational therapist can also provide information on aids and equipment to make everyday jobs easier.
  • Osteopathy – is based on the premise that your body’s wellbeing depends on your bones, muscles and other soft tissues functioning smoothly together and correctly aligned. It uses physical manipulation, massage and stretching.
  • Physiotherapy – uses physical means (e.g., exercise, massage, heat and cold) as well as education and advice to help keep you moving and functioning as well as possible. Physiotherapists can also show you pain relief techniques and design an individual exercise program for you.
  • Reflexology – involves pressure applied to specific points of your feet or hands. These points are believed to match up with other parts of your body.

All of these therapies will provide additional support apart from the hands-on treatment. This may include specific exercises for you to do at home, relaxation techniques and pain management strategies. Some practitioners (e.g., chiropractors, physiotherapists and myotherapists) may also use medical devices such as ultrasound, transcutaneous electrical nerve stimulation (TENS) or dry needling alongside their hands-on treatment.

Talk with your GP and/or specialist

Before seeing any new practitioner, it’s best to discuss the treatment with your GP and/or specialist (e.g. rheumatologist). They may have some cautions about a treatment as it relates to your specific health condition/s. For example, they may recommend that you not get a treatment if you’re going through a flare or have active inflammation. Or, if you have fused joints or osteoporosis, they will likely advise against treatments that manipulate or adjust your joints or spine.

On the flip side, they may also provide you with recommendations of practitioners they’ve worked with or who have a particular interest in your condition.

Do your research

When making enquiries about a potential practitioner, ask lots of questions. For example:

  • How does the treatment work?
  • What are the possible side effects or risks?
  • Have you treated other people with my condition or health issues?
  • Do you need to see any of my recent medical tests (e.g., x-rays)?
  • How long does it take for this treatment to work?
  • How will I know if it’s working?
  • What can I expect during a treatment session?
  • How often will I need to see you?
  • How much does it cost?
  • Can I claim this treatment on my private health insurance?
  • What are your qualifications?
  • Do you receive regular training and updates?
  • Are you a member of the professional association for this treatment/practice?

You can also contact the professional association and check their list of members to ensure the practitioner is registered. Or visit the Australian Health Practitioner Regulation Agency website and search for the practitioner.

What to expect at your first appointment

Regardless of the type of practitioner, you can expect to have a detailed discussion about your musculoskeletal condition and medical history, symptoms and what you hope to get out of the treatment.

Be wary of any practitioner that doesn’t give you this time and attention to understand your situation and your needs. There’s no ‘one-size-fits-all’ when it comes to healthcare.

Keep track of your progress

It can be helpful to keep a daily diary tracking your symptoms so you can see if the therapy is working for you. Write down any changes in your pain levels, fatigue and other symptoms for a period (e.g., a month). Also include any changes to your medications, exercise routine, the amount of sleep you’re getting and anything else that could affect your symptoms. After a month of tracking, you’ll have a clearer picture of whether or not the therapy is working.

And keep your GP and/or specialist informed about how you’re going with the physical therapy.

Be careful

All treatments – from hands-on physical therapies to medications and vaccines – have benefits and risks. You need to weigh these up to make an informed decision as to whether or not the benefits outweigh the risks for you.

And if you have conditions such as osteoporosis or inflammatory arthritis, you should avoid manipulative treatments such as chiropractic and osteopathy.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email ( or via Messenger.

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