Ankylosing spondylitis (AS) causes painful inflammation and eventual ossification of the axial skeleton. The pathology of AS typically begins with enthesopathy-painful inflammation at the attachment site of ligaments and tendons to bone-and is gradually replaced with diastrophic calcification. Patients with untreated AS may eventually develop a "stooped" posture due to increased thoracic kyphosis and flattening of the lumbar lordosis, and it can ultimately result in spine immobility and decreased chest expansion. In addition to medication and surgery, physical therapy and regular exercise are important in managing AS, with the aim of encouraging spinal mobility, chest expansion, deep breathing, erect posture and a healthy fitness level. Similarly, certain types of Osteopathic Manipulative Treatment (OMT) can help achieve these goals, and thus, may play more of an integral role in AS management than for which it is generally given credit. Despite the lack of studies specifically for OMT in AS, the current literature concerning the benefit of exercise, stretching and physical therapy can be used to predict the efficacy of osteopathic manipulation in AS patients. While forceful, direct techniques, like high velocity-low amplitude (HVLA) and certain articulatory methods should be avoided in AS patients, indirect muscle energy, counterstrain, spray and stretch, rib raising and soft tissue may prove to be rather effective.
Available at: http://works.bepress.com/kristie-petree/4/