Ankylosing spondylitis (AS) is an inflammatory condition that primarily impacts the spine and can significantly alter posture. One of the common complications is kyphosis, a forward curve in the upper back that creates a hunched appearance.

Fortunately, good posture can often be maintained or improved through exercise, physical therapy, and appropriate medication. Practicing proper posture can also help relieve pain, stiffness, and mobility issues.

How Ankylosing Spondylitis Can Affect Your Posture

AS is a type of arthritis that causes inflammation in the spine’s joints and ligaments. Over time, this inflammation can lead to stiffness and even fusion of spinal bones, which reduces spinal flexibility.

As stiffness increases, posture may worsen due to the spine’s limited ability to move naturally. While some individuals experience occasional discomfort, others may live with persistent, intense pain.

Common Postural Changes

forward head posture
The head may lean forward from the shoulders, increasing tension in the neck.

kyphosis
Excessive curvature of the upper spine results in a rounded or hunched upper back.

limited spinal mobility
Reduced ability to bend or twist the torso due to stiffness in the spinal joints.

pelvic tilt
The pelvis may rotate backward, disrupting the alignment of the spine and hips.

reduced lumbar lordosis
The natural curve in the lower back may flatten, leading to a straighter spine.

These posture changes can amplify pain, limit range of motion, and contribute to deformities over time.

How To Improve Your Posture

Maintaining good posture is essential for managing AS and may also prevent future complications like balance problems and falls. Attention to body alignment while standing, sitting, and sleeping can make a noticeable difference.

Standing Posture

When standing, visualize a straight line running from your ankles to the top of your head. Follow these tips:

  • avoid slouching or leaning forward

  • keep your weight evenly distributed, leaning slightly forward onto the balls of your feet

  • maintain a level head by gently tucking in the chin if needed

  • plant your feet firmly to stay grounded

  • stand tall with your shoulders relaxed and pulled slightly back

Sitting Posture

When sitting, aim to keep your ears, shoulders, and hips aligned. Avoid prolonged sitting by taking frequent breaks to stretch or walk. Additional tips include:

  • alternate between sitting and standing to avoid stiffness

  • sit in a spacious, relaxed position, not cramped

  • keep elbows bent between 90° and 120° while working

  • maintain a straight spine and avoid slouching

  • raise screens and phones to eye level to prevent neck strain

  • relax your shoulders, imagining they’re being gently pulled down

  • use a supportive cushion to maintain natural spinal curves

Sleeping Posture

Sleeping posture affects how you feel during the day. Use these strategies for better sleep alignment:

  • avoid sleeping on your stomach

  • choose a supportive mattress that distributes weight evenly

  • align your head, neck, and spine naturally

  • place a pillow between your knees if sleeping on your side

  • sleep on your back with no pillow or a thin one

  • do gentle stretches before bedtime to reduce stiffness

Physical Therapy for Ankylosing Spondylitis

A physical therapist can develop an individualized program to improve posture and reduce pain. Therapy usually focuses on spinal extension exercises, which counteract forward curving of the back.

Treatment methods may include:

  • deep breathing exercises to enhance chest expansion and circulation

  • flexibility training to maintain joint range of motion

  • low-impact aerobics, such as walking, biking, or swimming

  • strength-building exercises to reinforce back and abdominal muscles

These exercises support upright posture and ease pressure on affected joints.

Medications That Support Posture and Mobility

Medications can alleviate symptoms and make physical therapy more effective by reducing pain and inflammation.

  • biologics target axial symptoms in the spine and pelvis

  • corticosteroids help control swelling when injected into joints or tendons

  • DMARDs are used for peripheral symptoms, such as joint pain in arms and legs

  • NSAIDs are first-line medications for relieving pain and stiffness

Medication may be part of a broader strategy that includes lifestyle adjustments and physical rehabilitation.

A Quick Review

Managing posture with AS requires mindful body mechanics, regular movement, and therapeutic strategies. Whether standing, sitting, or sleeping, focusing on alignment and posture can ease symptoms and prevent deformities.

Working closely with a healthcare provider, especially a physical therapist, can significantly improve function and well-being. Early treatment and a consistent routine are key to preserving posture and quality of life.