6 Pilates Moves to Try if You Have Ankylosing Spondylitis

Could Pilates, the body-conditioning program created by Joseph Pilates in the 1920s, help you manage the symptoms of ankylosing spondylitis?

The answer may be “Yes.”

Regular exercise and proper posture are key recommendations for people who have ankylosing spondylitis, according to the Spondylitis Association of America (SAA). Pilates can help with that — and more. “Pilates is a movement system designed to promote strength and flexibility through spinal articulation, proper breathing, alignment, focus, concentration, and control via training the body’s core musculature,” explains Shannon Foley, owner of EnCore Pilates in Gainesville, Florida, and a physical therapist, athletic trainer, and Pilates instructor who has worked with people with ankylosing spondylitis.

A review of existing research published in February 2018 in the journal Archives of Physical Medicine and Rehabilitation found that exercise, including Pilates, reduced pain and other symptoms in people with ankylosing spondylitis.

“Pilates is an excellent low-impact exercise for people with ankylosing spondylitis as it can be programmed to focus on spinal mobility, muscle strengthening, and flexibility, as well as focused directional breathing to promote rib cage mobility,” Foley notes.

Pilates exercises are very specific, yet can be personalized, so Foley emphasizes the importance of finding a Pilates instructor who has the training to know which exercises will help you achieve your goals — and including them as part of your ankylosing spondylitis care team. Ask potential instructors about their certification as well as their experience working with people who have ankylosing spondylitis. If they don’t have experience with the condition, ask if they’re willing to learn about it and help you make modifications in the routine as you get stronger and more flexible.

Pilates Moves for Ankylosing Spondylitis

Among the many Pilates exercises available, the following moves may be particularly helpful for those with ankylosing spondylitis. These descriptions are for mat work, but most have variations that can be performed using Pilates machines:

Pilates breathing Some people with ankylosing spondylitis may experience tightness in the rib cage. This can cause shortness of breath, according to the National Axial Spondyloarthritis Society (NASS).

Pilates uses lateral breathing, which focuses on drawing the breath into the back and sides of the rib cage. Breathe in through the mouth without using your neck muscles. Inhale deeply, trying to get the ribs to expand as much as you can. Practicing this breathing technique while lying flat on your back, as is recommended by the SAA and NASS, will help you feel how well your rib cage moves.

Shoulder bridge According to NASS, bridging moves your spine through flexion and extension as you go up and come down. To do this move, lie on your back with your feet on the floor, knees together. Your shoulders and arms are flat on the floor, palms down. Your heels should be just out of reach of your fingertips. Slowly lift your pelvis up and then lower it down.

If you’re new to Pilates, you’ve been physically inactive for a while, or your ankylosing spondylitis symptoms are severe, you might feel some discomfort at first. Work with an instructor so that you can progress safely.

Side twist “It’s important to add side-bending and rotation into a spinal mobility Pilates routine, Foley says. Pilates instructor Sherri R. Betz, DPT, owner of TheraPilates in Santa Cruz, California, and Monroe, Louisiana, explains that to do this exercise, you sit facing forward with your legs straight out. Hold your arms out in a “T” position. Look over one shoulder and turn your torso in that direction. Hold for a count of three and then return to center. Repeat on the other side.

Kneeling hip flexor stretch “Making sure that the hips are stretched in front aids with proper posture,” Foley says. Start on your knees, with your upper body straight. Bring one foot forward so that the knee and ankle are in alignment. In this half-kneeling position, rotate your pelvis as if you’re tucking your tail between your legs, while drawing in at your navel. Place your hands on your hips and keep your hips aligned forward as you shift your weight slightly forward. Hold for 30 to 45 seconds and then ease back to start. Repeat two or three times, then switch the forward knee and repeat.

Side arm lift This is a good beginning exercise to protect your shoulders and lengthen tight muscles on the side of your ribs and spine, Foley says. With your thumb pointing upward and palm facing forward, extend one arm out to the side; slowly lift it to the ceiling and then lower it. To add a challenge, hold a light weight or use a resistance band as you work. Be sure to use your breath to increase mobility and expansion through the ribs.

The Swan “People with ankylosing spondylitis tend to be bent forward, so I prioritize thoracic mobility,” Dr. Betz says. One of the best moves for this is the Swan. Lie facing down, elbows bent to 90 degrees and tucked into your sides. Keep your wrists aligned with your ribs. As you press your pelvis into the floor, slowly lift your face, breastbone, and ribs upward. Keep your eyes gazing forward at the end of your mat. Draw your shoulders down as you move. Slowly roll back down in the reverse order.

In general, Betz recommends daily spinal exercises and three classes a week. Though it’s possible to do Pilates mat work at home, she says, there are advantages to working at a Pilates studio equipped with unique Pilates machines. “Studios may have the Reformer, the Trapeze Table, the Wunda Chair, and the Ladder Barrel,” she explains. “You’ll also see Spine Correctors and Foot Correctors.” But before signing up, ask for a tour, attend an open house, or try a private session first, Foley recommends.

Additional reporting by Brian Dunleavy