Better Posture With Ankylosing Spondylitis

For people with AS, good spinal positioning can be hard to maintain. We asked experts to share some tricks for making it a habit.

Maintaining proper posture throughout the day is a struggle for anyone, especially anyone who’s been working from home with a less-than-ideal setup. When you have ankylosing spondylitis (AS), good posture can be even more of a challenge—yet more important to maintain—thanks to the way this condition impacts your spine over time. The key is making good posture a habit, so that eventually, you don’t need to think about it so much.

AS is a form of arthritis that causes chronic inflammation and eventually, fusion of the spinal vertebrae. One very common symptom of the condition is spinal stiffness. This can lead people with AS to adopt a kyphotic posture, which is an exaggerated forward rounding of the shoulders, says Wai-Kwong Hui, DPT, a physical therapist at Hospital for Special Surgery in New York City.

“As you spend time in this posture, the muscles in the front of the body shorten, and muscles on the back of the body lengthen,” Hui explains. If you’re not actively focusing on fixing your posture throughout the day, it’s easy to lean deeper into this rounded position—and it will be harder to get yourself out of it, thanks to the added stiffness and mobility issues that come with the condition . “People with AS really need to remind themselves about their posture,” Hui says.

Another way to look at it: “The forces of gravity are pushing down on all of us, all day long every day. This often contributes to slouching,” says Clare E. Safran-Norton, Ph.D., a board-certified clinical specialist in orthopedic physical therapy and a clinical supervisor in the department of rehabilitation services at Brigham and Women’s Hospital in Boston, MA. “When the bones start fusing together with ankylosing spondylitis, they are going to feel really stiff or fuse in a way that makes you feel slouched, so staying active can help with flexibility and better posture,” she says. “If gravity is pushing you down, you push back.”

One excellent way to fight gravity is by practicing good posture every day. Here, Hui and Safran-Norton share five tips for good posture—including how to remind yourself to think about it during the day.

1. Try the Kitchen-Bathroom Workout

One of Hui’s favorite posture-training activities is something he calls the Kitchen-Bathroom Workout. It goes pretty much just as it sounds. “First thing in the morning when you get to work, go to the little kitchenette. Walk around and drink a cup of water. Finish drinking and then come back to your desk and work for 30 minutes. Then, go use the bathroom. Then, back to your desk.” Thirty minutes later, do it all over again: kitchen for water, desk, bathroom. What this is really doing is getting you out of your seat so you’re not just sitting for hours on end (and also making sure you’re hydrated along the way), which will help you maintain a more proper upright posture and not slip into slouching. If every 30 minutes isn’t possible, do it every hour.

“When we’re working at a desk, it’s easy to lose track of time and then two hours later you realize you haven’t moved from your desk,” Hui says. “So this is a great way to force people to get out of that position.”

2. Do Deep Breathing Exercises

Usually, AS affects the lumbar spine (low back) first, but can eventually impact the thoracic spine, or midback. When it affects this area, taking a few deep breaths can do wonders in mobilizing the ribs and the thoracic spine, Hui says. Making time to breathe deeply throughout the day can really help. Safran-Norton recommends doing two to three reps of deep breaths throughout the day. “Breathe long and slow, in and out and try to do that two to three times a day.”

Hui suggests putting your hands on the top of your head as you do your breathing to help open up your rib cage area even more.

3. Take Frequent Stretch Breaks

Stretching and strengthening is extremely important for people with AS. It can make a huge difference in maintaining mobility and function. For that reason, Safran-Norton recommends working stretching into your day at small doses. It can be a lot easier than trying to plan a whole 30-minute exercise session before or after a busy day.

Each time you stand up (every 30 minutes or every hour), stretch a different body part. Safran-Norton recommends hitting on all the following areas:

Neck: Turn your head down, to each side, and up, to work on mobility and feel a nice stretch from every angle.

Spine: In a seated position, rotate your entire trunk to the right and then to the left to open up the thoracic spine and ribs. “Performing this exercise sitting allows you to focus more on the spine versus the legs,” Safran-Noton says. You can also try lying on your stomach, rising up onto your forearms (mini-Cobra in yoga), and then onto your hands (full Cobra) if you can without pain. “Gravity wants you to slouch and this fights back by flexing your spine in the opposite direction,” Safran-Norton says. You can also do this standing up and simply bending backwards a few times, with your hands on your hips or low back.

Arms and Chest: Slouching doesn’t do your chest any favors. “With time, the pectoral muscles in the front of the shoulders [and chest] may get tight,” Safran-Norton says. Try doing a corner stretch where you place one forearm on each side of the corner of a wall, elbows bent and fingers pointing up towards the ceiling, one foot a few inches from the wall and other a feet or two behind it (like you’ re going to get into a lunge). Then, gently lean your upper body into the corner, sliding your shoulder blades together, to feel a stretch across your chest.

Shoulders: “Much of our movement throughout the day tends to be forward: reaching for things, typing on a keyboard, gravity pulling forward,” Safran-Norton says. So it’s important to engage and mobilize the back. Draw your shoulder blades back and together and roll your shoulders backwards, Safran-Norton recommends. Try doing this five times—though you can certainly do more if it feels good and you want to keep going!

Legs: The hamstrings along the backs of the legs typically get tight if you’re sitting a lot, Safran-Norton says. Tight quads can be a nuisance, too, because they can make it harder to bend your torso backward. To stretch your hamstrings, step one leg one to two feet in front of the other, bend the back leg, shift your weight to your back leg, and bend forward as you stretch the front hamstring. For the quads, stand tall, bend your right knee and lift your right foot behind you, then pull the foot toward your butt so that you feel a nice stretch in the front of the thigh. (Switch sides and repeat.)

4. Set Timers

Of course, it’s easy to go into the day thinking “I’m going to really mind my posture today!” Remembering to focus on it amidst all the other things you have going on? Not so easy. For that reason, Hui is a big fan of setting timers. Whether it’s the timer on your phone, a watch, or your computer, find one that works for you and set reminders throughout the day to get up, walk, breathe, and stretch. Similar to an alarm clock, it works better if you put it just out of reach so that you can’t snooze it and ignore it. “If you have to get up, you’re in a better position,” he says. (That better position is standing up, of course.)

5. Revamp Your Desk Setup

The right setup can, well, set you up for good posture all day long.

Here’s what good, seated posture looks like: feet flat on the floor in front of you, shoulder blades back and down and chest up (but not flared out), and core engaged, Hui explains. You also want to take a note of your head posture, he adds. Your gaze should be forward, not down or up high, so that your neck is in line with the rest of your spine and not cringing forward or straining backward.

If you can’t maintain this with your current desk set up, it’s time to change things. Safran-Norton recommends investing in a supportive chair, ideally with arm rests. Set the height so that you can keep your knees bent and feet flat on the floor. Also, check out your lighting. “Good lighting is important so you don’t have to strain your neck looking forward to the computer,” she explains. If you’re straining to see the screen, you may also need to make the font larger. Another great tweak? “Obtain a headset for the phone so that you can maintain good upright posture and alignment,” Safran-Norton recommends. “Craning your head to the side may strain your neck.”

Finally, a flexible workstation that allows you to move between sitting and standing throughout the day is great. “It’s best not to be stay in one posture too long, you want to move dynamically throughout the day,” Safran-Norton says. Our bodies were designed to move—and movement helps counteract AS stiffness—so the more you can do that, the better off you’ll be.

Amy Marturana Winderl

Meet Our Writer

Amy Marturana Winderl

Amy is a freelance journalist and certified personal trainer. She covers a wide range of health topics, including fitness, health conditions, mental health, sexual and reproductive health, nutrition, and more. Her work has

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