• It is chronic progressive, inflammatory autoimmune disorder of sacroiliac joints and axial skeletal.
- Presence of HlA gene
- Ulcerative colitis
- Sacrolilac spine is 1st involved
- It is then followed by lumbar spine,hip,knee and manubriosternal joint.
- It is characterized by synovitis, arthritis leading to cartilage destruction and bony erosion.
- Later it leads to Bony ankylosis making the spine permanently stiff.
- Back pain
- Early morning stiffness
- Stiff spine
- Spasm of sacroiliac muscles
- Tenderness over sacroiliac joint
- Chest expansion is diminished to less than 5 cms due to involvement of costovertebral joints.
- In later stages, cervical spine become rigid.
- Flexion deformity of spine and knee and hip while atlanoaxial it in hyperextension
- Extraarticular manifestation
- -Acute iritis
- Aotic valve incompetence
- Pulmonary complication
- Dislocation of atlantoaxial joints
- Fracture of cervical spine
i. Localized tenderness in PSIS
ii. Straight leg raising test
• Patient is asked to lift the legs with knee in extended. This is cause pain in sacroiliac joints.
iii. Sacroiliac compression
• Direct side side compression of pelvic causes pain in sacroiliac joint.
iv. Pump handle test
• Patient lies supine on table with full flexion of hips and knee on affected side.
• The affected hip and knee is brought close to the opposite shoulder.
• This cause pain on affected side.
v. Fleche’s test
• Cervical spine involvement can be tested by asking the patient to touch the wall with the back of head without raising his chin.
i. Gaenshen’ s test
• The opposite side hip and knee is flexed to fix the pelvis.
• Affected hip is hyperextended over the edge of table.
• This will exert a rotational strain on sacroiliac joint causing pain
ii. Chest measurment
• Chest expansion is diminished to less than 5 cms.
• Reduction in vitak capacity
• Hazziness and erosion of SI joint
• Bamboo spine appearance
• Osteophytes formation
• Squaring of vertebral bodies
xiii. Deformities can be measured in ankylosing spondylitis by spondylometer
xiv pulmonary function test
1. To relieve pain
- Hot packs
- Progessive relaxation techniques
2. To reduce spasm
- Hydrocollateral packs
- Ultrasound for micromassage
- Sustain passive stretching of quadriceps, sacrospinalis, neck and spine muscles.
3. To improve spinal mobility
- Flexion, extension and rotational exercise of spine.
- Continuous or intermittent traction to widen IV space
- Medicine ball exercise
- Trunk rotation (side to side, forwards, backwards)
- Reaching activites in sitting and standing
- Spinal mobilization techniques
4. Use of splints and braces
- HKAFO, AKO, KAFO to prevent hip and knee flexion deformity.
- Spinal casts or frames
- Static/dynamic splints
- Soft cervical collars to prevent cervical flexion deformity
- Butterfly pillow to support the neck
- Lumbar corsets and lumbar belts to reduce excessive mobility
- Kypho – thoracolumbosacral orthosis
5. Postural correction and ergonomics
- Postural stability exercise done in front of mirror
- Visual and biofeedback
- Maintain an upright position in sitting and standing
- Chin should be tucked in
- Prone lying to prevent hip flexion and kyphotic deformites
- Hip should be in hyperextension in prone by using pillow support
- Shoulder bracing exercise
- Avoid stopping posture
- Sleep on a firm mattress
6. Chest physiotherapy
- Deep breathing exercises to improve vital capacity
- Incentive Spirometry
- Segmental i.e posterobasal expansion exercise
- Ventilatory muscle training
- Pursed lip breathing to prevent dyspnea
- Coughing and huffing technique
- Chest mobility exercises
7. Strengthening exercises
- Muscle power can be imoroved by progressive resisted exercises
- Pulley, weight, dumbells, spring resistance tubes can be used
- Spine, hip, knee, joint are mainly concentrated
- Cervical isometrics can be given
8. Functioning training
- Teaching ADL
- Gait training
- Group therapy
- Aerobics exercises
- Recreational exercises
9. Psychological support
10. Parent and family eduction