Case Study – Ankylosing Spondylitis

January 19, 2015 | By | Reply READ MORE...

– Dr. Nidhi Gandhi

CASE:

38 years old Hitesh Trivedi (name changed), a businessman whose work involved a lot of travel by air, came to PHYSIOREHAB with complaints of:

  • Pain from his neck to tailbone.
  • His sleep was disturbed. He often found it difficult to then go back to sleep.
  • Marked early morning stiffness.
  • Stiffness used to improve once he started to walk around, this now persisted most of the day.
  • Working in front of the computer for more than 2 hours was making his pain worse.
  • His father did have similar spinal restriction and he seemed to remember that he was quite stooped.
  • In addition to the spinal pain, he had intermittent multi-joint pain at the elbows, wrist, ankles and most recently, buttock pain. At times, there had been swelling of the joints with reduced movement.

EXAMINATION:

  • Posture-obese man, forward head posture, upper back curved forward (kyphosis), low back was flat , knees were slightly bent (to make up for the changed curves in their back). He had a stooped posture.

Ankylosing Spondylitis

  • He had very restricted movements of the neck, the thoracic spine and his lumbar spine.
  • His ability to expand his chest was reduced, which is common in such cases.
  • He was tender at the sacroiliac joints.

INVESTIGATION:

  • He had visited a rheumatologist and was diagnosed a case of ankylosing spondylitis since 8 years
  • The X-ray of his sacroiliac joints did show grade 2 Sacroiliitis on both sides.
  • The genetic test, HLA-B27 was found to be positive and the blood tests also showed raised inflammatory markers.
  • Vitamin D3 and B12 levels were low.

He was advised anti inflammatory medication which improved his spinal movements but remained quite restricted. Currently he was off anti –inflammatory medication.
He required a program which combined a mix of anti inflammation medication, vitamin D and B12 supplements and exercises. It was crucial for him to exercise to improve his spine flexibility, to reduce pain and to improve his posture and general fitness.

PLAN OF CARE:

1. Pain management – ultrasound, taping and myofascial release was done for reducing the inflammation

2. Decompressions Exercises like arm lengtheners for axial elongation of the spine to improve posture.

Ankylosing Spondylitis

3. Scapular Stabilization and Neck Rehab – for upper back strengthening to prevent rounding of shoulders.

Ankylosing Spondylitis

4. Improving the flexibility of the spine (anti-kyphotic exercise) – lying on stomach itself is a very good exercises.

Ankylosing Spondylitis
Ankylosing Spondylitis
Ankylosing Spondylitis
Ankylosing Spondylitis
5. Breathing exercises – chest expansion exercises to prevent rib cage stiffening.

6. Ergonomic advice for office as well as improving the posture. The best exercise is a low-impact type of exercise like walking & swimming.

PATIENT SPEAK:

“After two months of the above rehab plan in which he came twice a week for a month and once a week for a another month he was around 70% better with respect to intensity of pain. Morning stiffness was much less. Spine was more flexible. He could carry out his activity of daily living more comfortably and his sleep was also not disturbed.”

PHYSIO SPEAK:

Ankylosing spondylitis is a type of arthritis that affects the spine. Ankylosing spondylitis symptoms include pain and stiffness from the neck down to the lower back. The spine’s bones (vertebrae) may grow or fuse together, resulting in a rigid spine. Early diagnosis and treatment helps control pain and stiffness and may reduce or prevent significant deformity.
It is a systemic disease, which means symptoms may not be limited to the joints. People with the condition also may have fever, fatigue, and loss of appetite. Eye inflammation (redness and pain) occurs in some people with spondylitis.

ADDITIONAL TIPS:

  • Practicing good posture techniques impacts the way a person with ankylosing spondylitis looks and feels.
  • Try sleeping on a firm, but not hard, bed to maintain a good, non-bent resting posture at night. Some people prefer sun-bed position( inclination at 30 degrees) for sleeping.
  • Use a pillow. Some people find that a small folded towel can take the place of a pillow.
  • Splints, braces, and corsets are generally not advised for spondylitis patients.

At PHYSIOREHAB, an individualized tailor made exercise program helped Mr. Trivedi to be symptom free & resume all his activities at the earliest.

Category: Case Studies

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