Exercising in Ankylosing Spondylitis


Treatment for ankylosing spondylitis is what many often enquire about. People ask for treatment that completely cures ankylosing spondylitis disorder. Well, there is no known curative treatment for ankylosing spondylitis. However, there are different techniques & methods that reduce the effects or intensity of ankylosing spondylitis considerably.
Understanding ankylosing spondylitis, is very important so that you can opt for the best suited treatment for it. Ankylosing spondylitis is an inflammatory arthritis that mainly affects spinal cord & sacroiliac joints, causing fusion of the spine- Bamboo Spine. It is of type autoimmune spondyloarthropathy. There may be involvement of other organs such as kidneys, lungs, eyes and heart. Hence, when your diagnosis is ankylosing spondylitis, you should immediately seek the treatment.

Treatment for ankylosing spondylitis includes various options such as medications, exercise & physiotherapy.
Goal of Treatment: Relieve pain, manage symptoms & prevent further progress of the disease.
Physiotherapy:
  • Various types of movements of back & neck
  • Deep breathing for expansion of lungs
  • Stretching exercises for joint mobility
  • Guidelines- Maintaining erect posture is also very important to reduce spinal scoilotic curvature. Slipping on firm surface & avoid use of pillow while sleeping
Yoga:
  • Yoga can provide a relief from pain, stiffness, improve breathing & improve the range of mobility.
  • Yoga also helps to reduce stress and maintain the energy of patients
  • Asanas: (positions in Yoga) such as Vajra Asana, Dhanura Asana, Makara Asana, Bhujanga Asana, Ardha Matsyendrasana & Neti kriya help to remove rigidity, improve flexibility of joints & also correct bad posture. Pranayama is helpful for muscle relaxation as well as to improve the movements of ribs & changes in pressure within abdomen & chest
  • Before practicing Yoga session, a person should perform stretching to prevent sprains, muscle strains or further injuries
Pilates:
  • Build flexibility, increase strength, endurance, & coordination in legs, abdominals, arms & back.
  • Help with maintaining the  natural curves of the body
  • Create a neutral position for each joint that is close to the optimal alignment of the head, shoulders, thorax, spine & pelvis which ensures that all sections of the body are in their ideal place
However, high-impact exercises such as jogging & sports are jarring to your frame and are generally not recommended. Instead, engage in Tai chi, Swimming because it involves all muscles & joints in a low-impact, buoyant environment. Cycling can also help restore lost movement.
Option of surgery is also viable, in case of severe ankylosing spondylitis condition. Joint replacement surgery, especially of hip and knees is opted for reducing further development of ankylosing spondylitis.
Significance
Exercise, even in small five to 10 minute doses, can improve posture & mobility. According to the Spondylitis Association of America, most people say that their condition improves after exercise. However, first consult a rheumatologist or physical therapist before you begin, because movements that may be beneficial under normal conditions may actually harm those with AS.
Time Frame
Convenience and consistency are the most important parts of your routine. If you feel stiff in the morning, then you may try to loosen up early & then exercise in the midday or evening. If necessary, you can split your exercises throughout the day. For example, you can first do exercises while lying down, and then later in the day you can work on neck stretches or deep breathing.
Much relief can be gained in ankylosing spondylitis by following an exercise regime consistently.
DISCLAIMER: Please consult your medical professional before beginning exercises.
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How to Breathe during Labour


Welcome Back!



We have already seen the Role of Exercise in Pregnancy & labour & the modes of Relaxation during LabourTo understand how the following breathing techniques help during labour, it is first important to understand how labour works.


Labour is a series of events that bring about the opening up of the cervix (opening of the mouth of uterus) descent of the foetus and finally the delivery of the baby and the afterbirths. It commences with the onset of true pain and uterine contractions, which bring about gradual opening up of the cervix.


Now, each contraction has three phases:

  1. Preparatory Phase- Beginning of contraction
  2. Active Phase- Highest intensity of pain
  3. Recovery Phase- End of contraction
Types of Breathing:
(Always Begin (Preparatory Phase) & End (Recovery Phase) with a Deep Breath.
Throughout the Active Phase
  • Slow Paced Breathing: Inhale (4 counts in) & Exhale (4 counts out) slowly.
  • Shallow “Hee-Hee” Breathing: Focus on breathing out, blowing from your mouth, one breath/second.
  • “Hee-Hee-Blow” Breathing: This is the same as shallow Hee-Hee breathing. After every 5-6 breaths, blow out/’sigh’.

The above kinds of breathing can be used throughout labour. Slow paceed breathing used more for relaxing during a contraction.


Many times, without complete cervical dilatation, an involuntary urge to push is felt. At times like these, your doctor would advice to avoid pushing. In such cases, Blow gently from your mouth. You can practice this technique with a candle-Blow gently just to flicker the candle flame.

When its time to push-Inhale deeply & Exhale with pursed lips (like when blowing a whistle), Tighten Tummy & simultaneously relax Pelvic Floor & Slowly Push.

These techniques are extremely helpful if practiced regularly from 8th month onwards.

Breathe your way through labour & have a safe delivery!

Happy Motherhood!

    How to be comfortable in Labour


    The anxiety of pregnancy followed by painful childbirth dogs most women. However, following a few easy steps and making adequate preparations can significantly make labour easy.

    Fear of the unknown is one of the biggest factors that contributes to pain. Throughout labour, the woman, if not aware, will be anxious whether the developments in her body are normal or not, which is why it is important to tell women beforehand what to expect.

    Everyone’s labour is different, and pinpointing when it begins is not really possible. It’s more of a process than a single event, when a number of changes in your body work together to help give birth.

    In early labour, also called the latent phase you may feel: 

    • Persistent low back or abdominal pain, usually accompanied by the crampy premenstrual feeling.
    • A bloody show (a brownish or blood-tinged mucus discharge). If you pass the mucus plug that blocks the cervix, labour could be imminent or it could be several days away. But it’s a sign that things are moving along.
    • Painful contractions occurring at regular and increasingly shorter intervals and become longer and stronger in intensity.

    How you feel in early labour depends on whether you’ve had a baby before, how you perceive and respond to pain, and how prepared you are for what labour may be like.


    What should be done in early labour?
    This will depend on what time of day it is, what you like doing and how you’re feeling. Keeping calm & relaxed will help your labour to progress and help you cope with the contractions.
    This could mean watching a favourite film, relaxing, or asking a friend or relative over to keep you company. You could alternate between walking and resting, or try taking a warm bath or shower to ease any aches & pains. If you can, try to get some rest to prepare you for the work ahead. 
    During early labour, you may feel hungry so eat & drink if you feel like it. This will help to comfort you and help you to rest. 
    Early labour is a good time to try out various positions & breathing techniques to see if they help you cope with the contractions.

    How make yourself comfortable during labour?
    One’s posture tells a vivid story about the person’s state of mind. When tensed, we tend to curl into a ball, like a new born baby. Our shoulders get hunched, we tuck are chin in, bend our elbows & pull in out arms. When pain is felt, we adopt a similar position.
    Some of the strategies that can be used to relax during labour include:

    • Postural Awareness
    • Relaxation Posturing
    • Visualization & Imagery
    • Breathing Patterns
    • Labour Positions
    • Touch & Massage

    Postural Awareness:
    Being aware of your posture can be used when you are tensed or in pain. Relaxation can be obtained when consciuosly you move from a posture of pain to a posture of relaxation.
    Relaxation Posturing:
    Irrespective of which posture you choose, maximum relaxation can be obtained when the whole body is completely supported. This can be achieved by taking complete support from in the chosen position & with the use of pillows.
    In Sitting-


    Sit with complete back support, from buttocks to neck, arms resting on arm rests & feet on the floor. If your feet do not reach the floor, keep a pillow or a stool to place your feet on. Hips & knees both should be at 90 degrees.

    Leaning forward, resting your head on a table is also a good posture for relaxing. Make sure the edge of the table is not pressing against the baby.

    In Lying-
            

    Visualization & Imagery:
    Visualization & imagery is an technique which depends on your imagination. You can picture & relive a happy experience. Relive the sounds, touch, emotions & all sensations pertaining to that memory. If not, you can visualize a scenery-beach, mountains, the calm ocean, & experience the sounds of the waves/birds chirping/feeling of the wind on  our face/feel the sand between your toes etc.
    Breathing Patterns:
    Breathing Deeply increases the oxygen content in the body & induces relaxation on exhalation.
    How To- Keeping your shoulders relaxed, take a deep breath in through your nose. On exhaling through your mouth, feel the tension leaving your body.

    Labour Positions:
    Adopting different positions is helpful in dealing with the contractions. Breathing techniques can be used in these positions. It is advisable to practice these positions from 7-8th month onwards, so that you can decide which positions are comfortable for you. Few of the commonly used positions are shown.


    Above shown positions help in reducing low back ache ( No.3-All Fours/No.5-Squatting) during contractions & increases blood supply to the baby. The Squatting position (No. 5) helps the baby to descend and gets the head locked in the birth canal. The baby’s head gets fixed in the right position, which helps during labour. However, make sure you consult an expert before engaging in this exercise.
    The breathing patterns used to relax during contractions can be practiced in these positions.
    Massage:
    Massage in labour is a very personal thing. It is most important that whoever is giving the massage is sensitive to your changing needs- with regard to location, depth, technique & well supported positioning.
    Back pain in early labour is commonly felt in the low back region & can intensify as labour progresses.

    Performed usually with you sitting & leaning forwards on your hands. Using the heel of their hand, your partner can gently knead your low back & increase or decrease pressure according to your comfort.

    Performed either in side lying or in the sitting position. Slow rhythmical stroking using fingertips from the neck to the tail bone, single or double handed, can relieve tension & induce relaxation. Can be performed over the spine or parallel to it. Pressure can become slightly deeper as the hands descend.
    The lower half of the stomach is the most common site of pain. This massage can be done using fingertips of both hands.


    Side to Side stroking over the area of pain, will give relief. Perform using fingertips/ palms of both hands.


    We hope these tips have been useful to you to prepare for your labour. We would like to hear about your experience.


    (Read about Breathing Patterns in How to Breathe during Labour)