Title: Ankylosing Spondylitis treated with Physioball Exercises Using Yoga and Gravity – An Innovative Means of physiotherapy

Author: Dr S.S.Subramanian

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i4.112

Abstract

Ankylosing spondylitis is a chronic disease affecting spine, few peripheral joints and diminished chest expansion. It causes considerable pain disability, reduces subject’s quality of life and inflicts huge health care burden. This study subject with ankylosing spondylitis was diagnosed in February 2016, but had symptoms, remained undiagnosed and was treated for the musculoskeletal pain since 2012. This presentation aims at to analyze the efficacy of Physioball based exercises using yoga and gravity. The results were encouraging with an improved BASDAI index by 32%. The subjects with AS could be treated with this innovative means of yoga and physical ball exercises for an enhanced quality of life.

Keywords: AS- Ankylosing Spondylitis, BASDAI – Bath Ankylosing Spondylitis Index, BMD – Bone Mineral Density, VD- Vitamin D, PTH – Para Thyroid Hormone,  Physioball – Air Inflated Ball of Varying Sizes from 55 cm to 75 cm.

References

1.      Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998; 41:58–67.

2.      Sjef M, Van Der Linden, Van Der Heijde D, Maksymowych W. Ankylosing Spondylitis. In: Firestein, Gary S, Budd, Ralph C, Harris, Edward D, editors. Kelley's textbook of Rheumatology. 8th Ed. Saunders; 2009. pp. 1169–1190.

3.      Ehrenfeld M. Spondyloarthropathies. Best Pract Res Clin Rheumatol. 2012; 26:135–45.

4.      Reveille JD, Basu D, Williams FM, Ahn CW. Changing spectrum of the diffuse infiltrative lymphocytosis syndrome. Art-hritis Rheum. 2006 Jun 15; 55(3):466-72.

5.      Gouveia EB, Elmann D, Morales MS. Ankylosing spondylitis and uveitis: overview. Rev Bras Reumatol 2012; 52(5):742-756.

6.      Vjollca Koko, Ana Ndrepepa, Skënder Skënderaj, Avraam Ploumis, Teuta Backa,  and Argjend Tafaj. An Epidemiological Study on Ankylosing Spondylitis in Southern Albania. Mater Sociomed. 2014 Feb; 26(1): 26–29.

7.      Baek, Shin K.C, Lee Y.J, Kang S.W, Lee E.B, Yoo C.D, et al. Clinical features of adult-onset ankylosing spondylitis in Korean patients: patients with peripheral joint disease (PJD) have less severe spinal disease course than those without PJD. Rheumatology. 2004; 43:1526–1531.

8.      Akkoc N. Are spondyloarthropathies as common as rheumatoid arthritis worldwide? A review. Curr Rheumatol Rep. 2008 Oct; 10(5):371-8.

9.      Khudhir Z. Mayouf Al-Bedri. Prevalence, Clinical Features, and Radiological Features of Iraqi Patients with Ankylosing Spondylitis. Journal of Natural Sciences Research. Vol.4, No.24, 2014

10.  El Maghraoui A. Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics and therapeutic implications. Eur J Intern Med. 2011 Dec; 22(6):554-60. doi: 10.1016/j.ejim.2011.06.006

11.  Ahmet Inanır , Serbulent Yigit , Mustafa Akif Sariyildiz , Erkan Sogut. Outcomes of Turkish Ankylosing Spondylitis Patie-nts. Eur J Gen Med 2013;10(3):145-149

12.  Linda E. Dean, Gareth T. Jones, Alan G. MacDonald, Christina Downham, Roger D. Sturrock, Gary J. Macfarlane. Global prevalence of ankylosing spondylitis. Rheumatology (Oxford). 2014 Apr; 53(4):650-7. doi: 10.1093/rheuma-tology/ket387. Epub 2013 Dec 9.

13.  Gran JT, Husby G. Epidemiology of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 3 rd ed. London: Mosby, 2003: 1153-9.

14.  Marks SH, Barnett M, Calin A. A case-control study of juvenile and adult-onset ankylosing spondylitis. J Rheumatol. 1982; 9:739–41.

15.  Ankylosing Spondylitis; NICE CKS, February 2013 (UK Access Only)

16.  Ward MM. Predictors of the progression of functional disability in patients with ankylosing spondylitis. J Rheumatol.  2002; 29:1420–5.

17.  Chung HY, Machado P, van der Heijde D, D'Agostino MA, Dougados M. Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Ann Rheum Dis. 2012 Jun; 71(6):809-16.

18.  Van der Linden SM, Valkenburg HA, de Jongh BM, Cats A. The risk of developing ankylosing spondylitis in HLA-B27 positive individuals: a comparison of relatives of spondylitis patients with the general population. Arthritis Rheum. 1984; 27:241–249.

19.  Kemal NAS, Remzi ÇEVİK, Mehtap BOZKURT, Ali GÜR, Ayşegül Jale SARAÇ. Relationship Between Clinical Findings, Quality of Life and Functional Disability Related to Disease Activity in Patients with Ankylosing Spondylitis. Turk J Rheumatol 2011; 26(1):29-37

20.  Dougados M, Simon P, Braun J, Burgos – Vargas R, Maksymowych WP, Sieper J, Van der Heijde D. ASAS Recommendations for Collecting, Analysing and Reporting NSAID intake in Clinical Trials / Epidemiological Studies in Axial Spondyloarthritis.  Ann Rheum Dis 2011; 70: 249-251.

21.  J Sieper, J Braun, M Rudwaleit, A Boonen, and A Zink. Ankylosing spondylitis: an overview. Ann Rheum Dis. 2002 Nov; 61(Suppl 3): iii8–iii18.

22.  Viitanen JV, Kokko ML, Heikkilä S, Kautiainen H. Neck mobility assessment in ankylosing spondylitis: a clinical study of nine measurements including new tape methods for cervical rotation and lateral flexion. Br J Rheumatol. 1998 Apr; 37(4):377-81.

23.  Elyan M, Khan MA. The Role of Nonsteroidal anti – Inflammatory Medications and Exercise in the Treatment of Ankylosing Spondylitis. Curr Rheumatrol Rep 2006: 8; 255-259.  

24.  Dagfinrud H, Kvien TK, Hagen KB (2008) Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev CD002822

25.  Zochling J, D van der Heijde, R Burgos-Vargas, E Collantes, J C Davis Jr, B Dijkmans. ASAS/EULAR recommend-ations for the management of ankylosing spondylitis. Ann Rheum Dis 2006; 65:442–452.

26.  Kraag G, Stokes B, Groh J, Helewa A, Goldsmith CH. The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis--an 8-month followup. J Rheumatol. 1994 Feb; 21(2):261-3.

27.  Hidding A, van der Linden S, de Witte L. Therapeutic effects of individual physical therapy in ankylosing spondylitis related to duration of disease. Clin Rheumatol. 1993 Sep; 12(3):334-40.

28.  Underwood MR, Dawes P. Inflammatory back pain in primary care. Br J Rheumatol. 1995; 34(11):1074–7 Epub 1995/11/01

29.  Mau W. Zeidler, Mau R, Majewski A.Freyschmidt J, Stangel W. Clinical Features and Prognosis of Patients with possible Ankylosing Spondylitis. Results of a 10 Year Follow Up. J Rheumatol 1988, 15: 1109-14.

30.  Braun J, Bollow M, Remlinger G. prevalence of Spondylarthropathies in HLA – B27 Positive and Negative Blood Donors.  Artheitis Rheum 1998: 41; 58-67.

31.  Sundström B, Ekergård H, Sundelin G. Exercise habits among patients with ankylosing spondylitis. A questionnaire based survey in the County of Västerbotten, Sweden. Scand J Rheumatol. 2002; 31(3):163-7.

32.  Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the long-term outcome of spondyloarthropathies. J Rheumatol 1994; 21:1883–7.

33.  Chou CT. Factors affecting the pathogenesis of ankylosing spondylitis. Chin Med J (Engl) 2001; 114:212–13.

34.  Mori. K, T. Ushiyama, K. Inoue, S. Hukuda. Polymorphic CAG repeats of the androgen receptor gene in Japanese male patients with ankylosing spondylitis. Rheumatology (Oxford) (2000) 39 (5): 530-532.

35.  Boonen A, van der Heijde D, Landewe R, Rutten M, Spoorenberg A, Schouten H, et al. Work status and productivity costs due to ankylosing spondylitis: comparison among three European countries. Ann Rheum Dis 2002; 61:429–37. 140

36.  Boonen A, Chorus A, Miedema H, van der Heijde D, van der Tempel H, van der Linden S. Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis 2001; 60:353–8. 141

37.  Ward MM. Functional disability predicts total costs in patients with ankylosing spondylitis. Arthritis Rheum 2002; 46:223–31.

38.  Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 1999; 12:247–55.

Corresponding Author

Dr S.S.Subramanian

M.P.T (Orthopaedics), M.S (Education), M. Phil (Education), Ph.D (Physiotherapy)

The Principal, Sree Balaji College Of physiotherapy, Chennai – 100

Affiliated To (Bharath) University, BIHER Chennai – 73

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., This email address is being protected from spambots. You need JavaScript enabled to view it., Phone: 99400 47137