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Is Chiropractic Care Safe for Ankylosing Spondylitis?

Posted on July 15, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Ryan Chiu, M.D.

In most cases, chiropractic care is not safe for people living with ankylosing spondylitis (AS). Some MySpondylitisTeam members said that spinal manipulation has improved their main symptoms of low back pain and decreased range of motion. However, these cases are few and far between, and many others have reported negative results.

In this article, we discuss why chiropractic care is not a good choice for AS and explore better ways to achieve pain relief and better quality of life while living with AS.

What AS Does to Your Back

AS is an autoimmune disease that causes inflammatory back pain. Starting at the sacroiliac joints in the hips, AS slowly moves its way up to the lower back (lumbar spine) and upper back (thoracic spine), causing some of the back bones to become less flexible and to fuse over time.

The bone changes in AS, which can usually be seen on X-rays, can result in difficulties bending forward (in flexion), backward, or side to side. You may also experience long-standing lower back pain, neck pain, and other joint pain.

Why Chiropractic Manipulation May Be Dangerous

Even chiropractors have cautioned that spinal manipulation should be limited to the non-acute inflammatory stage of AS. Although certain symptoms and pain may improve, chiropractors cannot treat or stop the progression of the condition.

When recommending for or against certain treatments, including complementary therapies like chiropractic adjustments, doctors and scientists look at evidence of the risks versus benefits of those treatments. If something has potential benefits and a low risk of side effects, it is generally recommended. If there is no clear benefit and a higher-than-acceptable risk, then those treatments are usually not recommended.

In the case of chiropractic treatment for AS, there is no strong data that says chiropractic care significantly improves the chronic pain, symptoms, or progression of AS. Meanwhile, there have been case reports of people with AS becoming paralyzed due to chiropractic care. Because of the risk of spinal fractures, paralysis, and spinal cord injury, combined with unproven benefits, medical organizations including the Spondylitis Association of America don’t recommend chiropractic adjustments for people who have AS.

What You Should Consider Instead

AS is an inflammatory disease, so treatment plans include anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) and biologic medications that can help with pain and control of the condition. Other complications of AS, such as eye inflammation (uveitis) or brittle bones (osteoporosis) may require separate medications and treatments such as eye drops, or calcium and vitamin D supplements.

Outside of medications, seeing a physical therapist (PT) who has experience working with people who have AS can often help. Your doctor may be able to recommend an experienced PT. Physical therapy guides you through special exercises that can help with controlling the chronic pain that comes with AS, rather than directly bending and manipulating your spine as chiropractors do. Exercise is an effective strategy for managing AS.

Make sure to keep regular appointments with your rheumatologist. These specialized doctors keep up to date on the latest research and therapies for your condition and can recommend the right treatments as your ankylosing spondylitis symptoms change or progress. Always seek your doctor’s medical advice before trying any complementary therapy.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 67,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Have you discussed chiropractic care with your doctor? Share your experience in the comments below, or start a conversation by posting on MySpondylitisTeam.

Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Ryan Chiu, M.D. obtained his medical degree from the University of Illinois College of Medicine in 2021. Learn more about him here.

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