Ankylosing Spondylitis Massage: Benefits and Risks - Verywell Health

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Ankylosing spondylitis (AS) is an inflammatory form of arthritis that typically targets the spine (though other joints can also be affected).

This disease can lead to significant pain and disability in the back. In severe cases, it can cause excessive bone development (called ankylosis), which may lead to immobility in various spinal segments. Massage therapy is frequently suggested as a possible ankylosing spondylitis treatment.

This article will discuss the benefits and risks of using massage for this condition.


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How Does Massage Therapy Work?​

Massage therapy is a hands-on treatment typically administered by a licensed massage therapist.

During a massage, your healthcare provider will apply specific strokes in an effort to target the skin, fascia, and muscles in a particular area. There are a number of potential reasons why this type of treatment may be helpful. These include:

• Increasing the temperature of the region being targeted: Because of this localized warmth, the structures become more pliable, resulting in improved overall flexibility.
• Reducing pain levels: This is accomplished by stimulating areas of the brain that control arousal and self-awareness. It may also help reduce the firing of peripheral C nerve fibers, which regulate the body’s overall pain response.
• Fluctuating levels of chemical pain mediators: These circulate throughout the body's bloodstream.

Benefits​

Massage therapy has been shown to have a number of potential benefits for ankylosing spondylitis.

One research study found that receiving 10 massages improved function and reduced reports of disability in people with the condition. These benefits appeared similar regardless of whether a deep tissue technique or a lighter, more relaxing massage was administered.

Another study showed that individuals with chronic low back pain who were treated with 10 sessions of massage experienced similar decreases in their pain levels and increases in their overall function to people who received the massages and took NSAID medication. These results call into question whether massage therapy may be able to reduce the amount of anti-inflammatory medications people with AS take.

Finally, when applied correctly, certain gentle massage techniques may reduce muscle stiffness and improve the overall flexibility of your spine. However, it is important to remember that most of these findings are from smaller studies and that further research is needed to confirm the potential advantages of massage for AS.

Risks​

While massage therapy may offer several benefits to people dealing with ankylosing spondylitis, it is also important to be mindful of the potential risks of this treatment.

Certain styles of massage can be too aggressive and may actually lead to increased pain levels in this population. In some cases, inappropriate massage techniques could even contribute to an AS disease flare-up. As a result, it is important to inform your massage therapist of your condition and make them aware if any of the techniques they use are causing increased pain.

In addition, individuals with restricted spinal motion caused by ankylosis should not receive aggressive massage or manipulation to their back or neck. These treatments could lead to spinal fractures and cause unintended neurological symptoms like progressive weakness or sensory changes.

Types of Massages​

There are numerous different styles of massage that can be performed by your therapist. Some of the most common techniques are listed below:

• Effleurage: Gentle sliding movements performed in a circular pattern using the palm of the hand.
• Petrissage: Slow-paced kneading that is applied to the targeted area with the purpose of compressing the tissue.
• Tapotement: Faster, drumming-style movements performed with the edge of the hand, the fingers, or by making a cup with the palm.
• Vibration: A shaking movement using the hand or fingertips to release tension in a smaller body region.
• Friction: Quick circular or back-and-forth movements are applied to the tissue in a region to break through adhesions.

Use Caution​

While most types of massage are appropriate for people with ankylosing spondylitis, treatments that cause increased pain should be discontinued. In addition, treatments that utilize extreme pressure or manipulations of the spine should not be performed as they may lead to fractures or neurological symptoms in people with ankylosis.

Finding a Qualified Massage Therapist​

If you are looking for a licensed massage therapist, one of the best places to start is the American Massage Therapy Association’s website. This site will help you locate qualified healthcare providers in your area. In addition, you can use this tool to look for therapists who are board-certified massage therapists.

These individuals are not only accredited by the state but have also received advanced education and specialized hands-on skills that make them uniquely qualified. Your primary healthcare provider or rheumatologist may also have suggestions for a therapist in your area who is skilled in treating AS.

Recommendation​

If you have ankylosing spondylitis, be sure to consult your healthcare provider prior to trying massage therapy to ensure that it is appropriate for you.

Other Treatment Options​

While massage therapy has shown some promise in treating AS, it is typically meant as a complement to more traditional treatment options.

For active flare-ups of the disease, this commonly includes non-steroidal anti-inflammatory (NSAID) medications and physical therapy treatments.

Tumor necrosis factor inhibitor (TNFi) medications are also frequently recommended for people with active versions of the disease that do not respond well to NSAIDs.

Physical therapy and NSAID medications may also be prescribed on an as-needed basis for people with stable (non-active) ankylosing spondylitis.

Summary​

Certain types of massage may be helpful for people with ankylosing spondylitis. While more research is needed, initial studies have shown reduced pain and improved function in people with AS who received this treatment. At this point, massage therapy should be viewed as a potential complement to more traditional interventions for this condition. However, pain-causing or overly aggressive treatments should be avoided, as they could cause harmful side effects.

A Word From Verywell​

Ankylosing spondylitis can be a frustrating condition to cope with. There may be times when your pain is well managed; however, a flare-up of the disease can significantly hamper your independence at other points. Fortunately, massage therapy may be a valuable tool to manage your condition.

Not only can a massage be stress-relieving, but it may also help reduce your pain levels and improve your ability to function. Be sure to speak to a healthcare provider about whether this alternative treatment is appropriate for you.

Frequently Asked Questions​

• 
  Smoking cigarettes may contribute to a flare-up of AS and should be avoided. In addition, fried or sugar-laden foods may also cause high levels of inflammation in the body and should also be eaten sparingly. Additionally, individuals with advanced versions of the disease should avoid high-impact exercises or activities that could lead to losing balance.
  
  
• 
  Deep tissue massage does not lead to reduced levels of inflammation in the body. That said, one initial study found that people with ankylosing spondylitis who were treated with deep tissue massage had lower pain levels afterward. These individuals also reported higher functional scores after receiving this type of treatment.
  
  
• 
  Deep tissue massage is a specialized treatment best left to professional therapists. While common household objects like a tennis ball are sometimes utilized to apply firm pressure to a particular region, this is not typically recommended for people with ankylosing spondylitis. In certain cases, performing your own version of a deep tissue massage without a skilled knowledge of anatomy in the region may lead to increased pain or other side effects.
  

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. 
   Spondylitis Association of America. Overview of ankylosing spondylitis.
   
   
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   Romanowski MW, Špiritović M, Rutkowski R, Dudek A, Samborski W, Straburzyńska-Lupa A. Comparison of deep tissue massage and therapeutic massage for lower back pain, disease activity, and functional capacity of ankylosing spondylitis patients: a randomized clinical pilot study. Evidence-Based Complementary and Alternative Medicine. 2017;2017:1-7. doi:10.1155/2017/9894128
   
   
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   Majchrzycki M, Kocur P, Kotwicki T. Deep tissue massage and nonsteroidal anti-inflammatory drugs for low back pain: a prospective randomized trial. The Scientific World Journal. 2014;2014:1-7. doi:10.1155/2014/287597
   
   
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   Spondylitis Association of America. Complementary treatments.
   
   
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   Ward MM, Deodhar A, Akl EA, et al. American college of rheumatology/spondylitis association of America/spondyloarthritis research and treatment network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. ArthritisCare & Research. 2016;68(2):151-166. doi:10.1002/acr.22708
   

By Tim Petrie, DPT, OCS
Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.


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