© 2019 Jake Adkins
Background and Purpose: Ankylosing spondylitis (AS) is a form of arthritis characterized by chronic inflammation of the axial skeletal system that causes back pain and loss of mobility with strong potential for slow, eventual spinal fusion. The condition affects 0.2-0.5% of the United States population. There is no known cure for AS and the cause is unknown. The purpose of this case report is to describe a comprehensive approach for physical therapy (PT) management of AS in order to assist clinical reasoning and clinical decision-making and enhance care management in this patient population. Case description: A 27-year old female referred to PT for low back pain after diagnosis of AS. Patient presented with range of motion, strength, and balance deficits along with neurological signs and symptoms. Key interventions during episode of care involved targeted therapeutic exercise, soft tissue mobilization, modality use, and pharmacological management. Outcomes: After 13 weeks of PT, significant changes included Oswestry Disability Index (32-50/100), Numeric Pain Rating Scale (1-10/10 – 0-6/10), straight leg raise (left: 35°-60°, right 36°-72°), and improvements in lower extremity strength and lumbar range of motion, particularly lateral flexion (left: 14 cm, painful – 14 cm, right: 7 cm, painful – 14 cm). Patient reported the initiation of pharmaceutical therapy provided greatest degree of relief. Soft tissue mobilization combined with modalities during PT provided consistent but short-term relief. Discussion: A multi-modal approach of pharmaceutical intervention combined with targeted, symptom-specific PT intervention appeared to be beneficial for this patient. Future research and development of a clinical practice guideline could assist clinical decision-making and improve consistency of care for this population.
Adkins, Jake, "Physical Therapy Management Of Low Back Pain In A Young Female With Ankylosing Spondylitis Associated With HLA-B27 Antigen: A Case Report" (2019). Case Report Papers. 112.