Bechterew’s disease is named after its discoverer Vladimir Bechterew. The term ankylosing spondylitis is used as a synonym for Bekhterev’s disease: ankylosis = stiffening, -itis = inflammation, spondyl = vertebra. As the name describes, it is an inflammation of the vertebral joints, which over a longer period of time leads to stiffening and thus to the hunchback typical of Bekhterev’s disease.
Bekhterev’s disease belongs to the rheumatic group of diseases, which includes all inflammatory diseases with joint involvement. Bekhterev’s disease is an autoimmune disease and is a clinical picture of spondylarthritis. This means that the body is attacked by excessive reactions of the immune system (the body’s own defense and protection system).
In ankylosing spondylitis, the joints and ligaments of the spine are particularly affected. The structures stiffen over time due to a chronic, i.e. long-lasting, inflammation of the structures. The back is held in an increasingly bent position, which leads to a progressive restriction of movement of the upper body and also of the extremities (arms and legs). Physiotherapy aims to strengthen the lower and upper back muscles early on.
Physiotherapy for ankylosing spondylitis
Physiotherapeutic exercises are designed to counteract the symptoms of Bekhterev’s disease. The focus of physiotherapy and its goals is to stop the curvature and joint stiffening. Furthermore, shortened muscles should be loosened and stretched, weakened muscles should be trained, the upright posture should be trained and the breathing volume should be deepened.
Everyday activities and independence should also be encouraged. The ankylosing spondylitis patient should actively participate as much as possible during physiotherapy. You will find exercises for stretching and for loosening adhesions on the pages Stretching exercises and Fascial roll.
The following is a list of physiotherapy exercises for patients with Bekhterev’s disease
- So-called “bilateral PNF patterns” in the seat are suitable for training the upright position. PNF stands for Proprioceptive Neuromuscular Facilitation. In physiotherapy, movements and muscle chains are activated by means of movement patterns, stimulation and the setting of resistance at certain points.
The movement pattern on both sides of the arms continuously straightens the upper body, which can be combined with breathing during physiotherapy.
- Furthermore, working in a closed chain is useful in Bekhterev’s disease, e.g. the 4-footed stand. The fixed points on the hands and feet allow the trunk and spine to move and at the same time stabilizing muscles are trained by the support. Here too, the therapist should use stimuli with his hands to control and simplify the patient’s posture during physiotherapy.
- Furthermore, exercises on the Pezzi ball (large gymnastics ball) are very beneficial for the mobility of the spine, for the nutrition of the intervertebral discs, for stretching tense muscles, relieving the structures, but also for training stability and balance.
Exercises in physiotherapy for ankylosing spondylitis from the functional movement theory according to Klein-Vogelbach are ideal for this purpose. You start with an upright sitting position on the ball, with your feet firmly on the floor. The intervertebral discs receive the right nutritional stimuli by simply rocking up and down.
For the mobility of the lower spine (lumbar spine) the pelvis can be moved slowly forward and backward or right and left on the ball. Gentle movements often already counteract pain and tension caused by long stiff positions.
- In order to train the holding muscles in physiotherapy for Bekhterev’s disease, the patient runs forward with his feet, rolls the ball upwards and gets more and more into a lying position until the upper spine (thoracic spine) rests on the ball. The buttocks and the abdomen are strongly tensed so that the back does not sag but is kept stable like a board.
The arms are stretched out long above the head. This position is held for a short time and then slowly with muscle power back into the upright position. This exercise can be repeated several times not only in physiotherapy but also at home.
- An exercise for stretching the front side of the body in Bekhterev’s disease, i.e. against the crooked back, looks like the following The ankylosing spondylitis patient sits upright again on the pezzi ball, his hands are crossed behind his head.Now roll yourself forward a little bit, stretch your legs, put your whole back down and also stretch your arms in extension.
So lie down for a few minutes and increase the stretching by deep breathing.
- Finally, a strengthening exercise for the abdomen and back from physiotherapy: the patient kneels on the floor with the Pezzi ball in front of him. Now the front of the body is rolled over the ball until it reaches under the thighs, the arms are stretched out, the hands rest on the floor, so that the body forms a stable board with a view towards the floor. Now the legs are bent by much body tension and the ball is pulled under the upper body.
Alternately, the legs are bent and stretched. Do not sink into the hollow back, the tension in the whole body – especially in the torso – is maintained the whole time.
- For the strength-endurance area, 12-15 repetitions are always performed. However, you should increase slowly and always pay attention to the quality of movement before increasing the scope.
At the beginning you can start with 3 x 5 repetitions.
More exercises against a hunchback can be found in the articles:
- An exercise for daily relaxation, opening the chest and stretching the shortened chest muscles is the “U-hold” in the supine position. This exercise from physiotherapy only requires a thin rolled up blanket or a small pillow and a mat. The ankylosing spondylitis patient lies on the mat in supine position, the roll of the blanket lies lengthwise under the thoracic spine, the feet are upright – so that the lower back does not move into a hollow back.
Now the arms are spread apart from the body at right angles so that the upper arms are at shoulder level and together form a “U”. Now the eyes can be closed and all tension can be released. The body should become very soft on the blanket roll, the chest opens, the chest muscles are stretched.
A slight pull can be felt in the front shoulder and chest area. This exercise from physiotherapy can be done every evening for 15-20 minutes.
- For simultaneous mobilization of the spine in ankylosing spondylitis, the legs can be slowly tilted to the right and left. For simultaneous expansion of the flanks, the legs simply remain on one side until the knees touch the ground.
Breathe deeply into the side and you will feel a slight stretching sensation. Self check for stretching the chest muscles at the end: Can the back shoulders touch the floor?
- A further and more intensive stretching method for the chest muscles in Bekhterev’s disease is the spreading of the arm against a wall. In this exercise from physiotherapy, the patient stands sideways to the wall, the arm is splayed backwards at right angles, the palm of the hand is against the wall.
Now the whole body turns away from the arm and the wall, so that a feeling of stretching occurs in the area of the front shoulder and the chest. To reach all parts of the large pectoral muscle, simply hold the arm at different heights – slightly higher and slightly lower than shoulder height. Hold each stretch for about 30 seconds.
Always observe both sides. This is an important aspect of physiotherapy for Bekhterev’s disease. For a relaxed neck, rotate the shoulders and arms backwards from time to time, so that the stiff muscles are moved.
- Since the most conspicuous phenomenon in ankylosing spondylitis is the crooked posture, this should be checked and corrected in everyday life and during physiotherapy. A sideways glance in the mirror, tensing the abdomen and bringing the shoulders back and down – this way, you will feel more upright.
- Exercises against ankylosing spondylitis
- Physiotherapy against a hunchback
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