How well someone does when ankylosing spondylitis affects their ribs depends on things like the success of their overall treatment, and whether they follow exercise and physical therapy recommendations. “I have patients who have severe ankylosing spondylitis and are really diligent about practicing their range of motion exercises from one visit to another,” says Minhas. “They were able to improve their scores on measurements I was taking of their back mobility and [other metrics] within two or three months.”
Try the following strategies to help manage symptoms like rib pain and difficulty breathing.
Treatment With Medications
With ankylosing spondylitis, the first line of treatment is typically a nonsteroidal anti-inflammatory drug (NSAID) to reduce inflammation and pain, says Minhas. You could also try applying a topical NSAID to the affected area. If that’s not effective or you experience side effects, your doctor may try tumor necrosis factor (TNF) inhibitors or IL-17 inhibitors, which target the underlying cause of inflammation and may alter the course of the disease. Minhas recommends working with your doctor to make sure your treatment is helping you, and making adjustments if necessary.
Cold or Heat
For some people, applying ice packs on the chest, back, or other affected areas may help ease pain and inflammation. For others, a hot shower or warm bath can do the trick.
Breathing Exercises
Practicing breathing exercises regularly can help keep your rib cage flexible and, Minhas says, can delay the need for respiratory therapy as the disease progresses. These can be as simple as taking deep breaths after a warm shower or bath.
Diaphragmatic breathing is one technique your doctor might recommend to help you maximize air intake by using the muscles in your stomach rather than your chest. To do this, you lie on your back with one hand on your upper chest and the other on your stomach. As you breathe in through your nose, expand your stomach so that it pushes against your hand. Your chest should not move out. Exhale through pursed lips and contract your stomach muscles while keeping the hand on your chest as still as possible.
Rib Support
Minhas suggests trying the kind of athletic tape that athletic trainers and physical therapists use to support injured muscles and joints, improve circulation, and decrease pain. “Any kind of joint trauma will make arthritis worse,” notes Minhas. “Joint-protection techniques like this can help by giving you support and reducing inflammation, but it’s not a brace so it doesn’t restrict your motion.”
Exercise and Stretching
Physical therapy and exercise are an essential part of ankylosing spondylitis management, and have been shown to maintain and improve function and decrease pain and disability, says Minhas. “Physical therapists have techniques to further mobilize the spine and ribs to prevent them from becoming too stiff,” she says.
Every day, do some gentle stretching and range of motion exercises such as raising your arms over your head to open up your chest and breathing deeply to work on your diaphragm muscle. Pay attention to your back as well. “This is something that people don’t realize is connected,” says Minhas. “If your back is stiff, then your ribs have to do more to breathe in or out.”
Make posture muscles stronger with exercises like yoga’s Mountain pose, which prompts you on how to stand properly: with your chest open, ribs out, glutes tightened, and core tucked in, says Minhas. “I tell my patients to start with that and then add to that by keeping that pose in mind while walking around or sitting down during the day.”
You can work with a physical therapist or talk to your doctor about appropriate kinds of exercise. The bottom line: Don’t stop moving. “If you have a flare, you can make it worse by not being mobile,” says Minhas.
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