Chiropractic Care for AS: Yes or No?
Thinking about seeing a chiro for your AS back pain? Make sure you understand the potential risks and benefits.
Ankylosing spondylitis (AS), a form of inflammatory arthritis, can wreak havoc on your body—and particularly your back, since the spine is the main area the inflammation affects. One common way to deal with back pain is to go to the chiropractor. So it makes sense that if you have AS, you may be curious about chiropractic care as a way to help manage your condition. But before you make that appointment, here are some things you need to know.
What Is Chiropractic Care?
Chiropractic care is a type of medical practice involving manual therapy and spinal manipulation, according to the National Institutes of Health (NIH). A chiropractor is trained to use methods like stretching and pressure with the goal of improving function and mobility of your spinal joints.
“Chiropractic care is a type of treatment that is put in the category of complementary therapies,” explains Terence Starz, M.D., clinical professor of medicine and occupational therapy in the division of rheumatology and clinical immunology at University of Pittsburgh School of Medicine in Pittsburgh, PA.
“It’s a manual, hands-on therapy.”
Chiropractors are trained, licensed professionals who have to get a Doctor of Chiropractic (D.C.) degree, which is different from a medical doctor (M.D.), and pass a national exam in order to practice, per the NIH. Some insurance plans may not fully cover chiropractic care.
Evidence With AS Is Scarce
The goal of chiropractic care is usually to restore mobility in your joints, says Dr. Starz. This may be beneficial for certain back troubles, but with AS, it’s a bit more complicated. “I don’t think there is going to be a lasting benefit. It may feel good while the chiropractor is doing it, but the reason or the pain and stiffness that AS patients have is primarily inflammation in the spine, and there is no evidence that chiropractic interventions have an impact on the inflammation,” explains Joerg Ermann, M.D., rheumatologist with the Division of Rheumatology, Inflammation and Immunity at Brigham and Women’s Hospital in Boston, MA.
Not only is there no evidence that it aids in inflammation, but when there’s inflammation present, manually stressing the spinal joints through chiropractic care may actually irritate the problem even more, says Dr. Starz. The American Chiropractic Association (ACA) agrees: While chiropractic care may provide some pain relief for some folks with AS, it should not be performed if your AS is in an active inflammatory state because it could injure your connective tissues. “Overall, there is a need for more scientific evidence of chiropractic in the areas of inflammatory arthritis like AS,” Dr. Starz says.
It Might Be Risky When AS Is Advanced
Chiropractic care may actually be dangerous if your disease is severe. In fact, 2019 AS treatment guidelines from the American College of Rheumatology specifically recommend against spinal manipulation for people with AS who also have spinal fusion or advanced spinal osteoporosis. “The reason for this recommendation is that there is an increased fracture risk, so adjustments or external manipulations are discouraged,” says Dr. Ermann.
Bottom Line on Chiropractic Care for AS
So could seeing a chiropractor help with your AS? Frankly, there’s just not enough evidence to suggest that it could be beneficial. Plus, the evidence we do have is enough that rheumatology professionals actively recommend that people with severe AS avoid this complementary therapy altogether.
Oftentimes, back pain may lead someone to a chiropractor before they even know that AS is the cause. “One of the problems we are still facing with AS is the delay in diagnosis, which can be between 5-10 years, and frequently people with back pain will talk to their primary care provider and get sent certain ways, which could include chirporactors” says Dr. Ermann. “We are still facing a situation where outside of rheumatology, this condition is not well known enough that people who see patients with back pain always recognize its features.”
That’s why if you do want to seek chiropractic care and you have AS, it’s important to talk to your rheumatologist first—and if you do see a chiropractor, make sure they understand your disease and can work with your rheumatology team to provide you with the best treatment options.
What Is Chiropractic?: National Institutes of Health. (2019.) “Chiropractic: In Depth.” nccih.nih.gov/health/chiropractic-in-depth
Chiropractic and Anklyosing Spondylitis: American Chiropractic Association. (2016.) “Chiropractic and Ankylosing Spondylitis.” acatoday.org/News-Publications/ACA-News-Archive/ArtMID/5721/ArticleID/79/Chiropractic-and-Ankylosing-Spondylitis
AS Treatment Recommendations: American College of Rheumatology. (2019.) “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.” rheumatology.org/Portals/0/Files/Recommendations%20for%20the%20Treatment%20of%20Ankylosing%20Spondylitis.pdf