ABSTRACT
Ankylosing spondylitis (AS) is associated with significant disability and increased socioeconomic costs (1). Until recently, available conventional therapies for AS were palliative at best, and often failed to control symptoms at the long run. With the introduction of the so-called “biologicals” that specifically inhibit mediators of inflammation, more promising effects in the long term may be expected. Physiotherapeutic interventions have always been considered as a necessary adjunct to drug therapy. But what is exactly meant by the word physiotherapy and how is it applied in AS? Traditionally, the mainstays of physiotherapy in the management of musculoskeletal conditions have been massage, manual therapy (manipulation and joint mobilization), electrotherapy (ultrasound, short-wave diathermy, or low-energy laser), and therapeutic exercises. In AS, various forms of physical therapy can be distinguished: supervised individualized physical therapy, unsupervised self-administered individualized physical therapy or exercises at home, and supervised group physical therapy. For each of these forms, physiotherapeutic interventions as described above may be applied, but also hydrotherapy (pool sessions) and patient education and information may be offered (Table 1). Special forms of physical therapy for AS are inpatient physiotherapy for two to four weeks at a specialized clinic consisting of daily physical exercises and pool sessions, but also education, and spa therapy consisting of a two to four week course of balneotherapy (bathing in mineral water), hydrotherapy [immersion of (parts of) the body in water], massages, physical exercises, mud applications, and education.
