There’s no cure for ankylosing spondylitis, but stretching, heat therapy, and other natural approaches may help to ease symptoms.

Ankylosing spondylitis (AS) is a form of arthritis that causes inflammation in the joints of the spine.

The joints where the spine meets the pelvis are most affected. The condition may also affect areas where tendons and ligaments attach to bones.

It may cause inflammation in other areas of the body, such as the:

  • shoulders
  • ribs
  • hips
  • knees
  • feet
  • eyes
  • jaw
  • bowel
  • heart (rare)
  • lungs (rare)

Both natural and traditional treatments are available to help address AS symptoms.

Many people with AS experience stiffness and pain in the lower back. This pain may be sporadic and range in severity. These symptoms can progress into the upper spine.

Other symptoms vary from person to person and can include:

  • loss of flexibility
  • spinal fusion
  • blurred vision
  • sensitivity to light
  • red, watery eyes
  • eye pain
  • reduced lung capacity
  • difficulty breathing
  • cauda equina syndrome, which affects sensation in the lumbar spine
  • general unwell feeling
  • stomach or bowel problems

Although AS is progressive, not everyone will experience spinal fusion or severe complications.

AS symptoms may be atypical in women. For example, symptoms may begin in the neck instead of the lower back.

AS is a chronic condition. There isn’t a current cure, but treatments can relieve symptoms, like pain and stiffness. Treatment may also reduce flares.

Natural treatments may be used on their own or with traditional AS treatments.

These 10 natural therapies may help relieve symptoms:

1. Stretching

Stretching helps build flexibility and may reduce pain. Consider adding spine stretches or lower back stretches (like the trunk rotation stretch) to your daily routine.

2. Heat therapy

To reduce stiffness and pain, apply a hot-water bottle or heating pad to the affected area. You may also use moist or dry heat. A warm bath may also help, especially before exercise.

Don’t use heat therapy without consulting your doctor if you have:

  • diabetes
  • deep vein thrombosis (DVT)
  • vascular disease
  • an open wound
  • a skin condition, such as dermatitis

3. Cold therapy

Applying an ice pack, cold gel pack, or a bag of frozen vegetables to painful joints can help reduce swelling. After exercise, cold therapy may help reduce inflammation.

Don’t apply ice for more than 20 minutes at a time. If you have circulation problems, consult your doctor first before using cold therapy.

4. Acupuncture

Acupuncture is a complementary therapy that involves inserting thin needles into specific points in your skin. This is thought to activate your body’s pain-relieving hormones.

The use of acupuncture has been accepted more and more in North America. Some studies report acupuncture relieves AS pain.

A 2019 review of studies that examined 70 clinical trials as well as other reports found that acupuncture was generally a safe and effective intervention to reduce pain.

However, the research on acupuncture and AS was deemed inconclusive, so more studies are needed.

5. Massage therapy

Massage helps you relax. It may also help you feel more flexible or “loose” so you can exercise or stretch.

Massage may cause pain at tender points around your spine. If this occurs, avoid those areas, and only use light massage techniques until the pain improves.

6. Movement

The more you sit, the stiffer you’re likely to feel. Get up, move around, and stretch regularly. If you have a desk job, take a “get up and move” break every hour.

7. Exercise

Gentle exercise programs such as yoga and Pilates are great for AS because they incorporate stretching. Swimming may also be beneficial because it’s easy on your joints.

Strengthening exercises with weights can help build muscle, which supports joints affected by AS.

Talk with your doctor or a physical therapist to determine the best exercise plan for you.

8. Alexander Technique

Practicing good posture is critical with AS, since it can affect your back. The Alexander Technique teaches you to be aware of your posture throughout your day.

It also teaches you how to correct poor posture and may be helpful for people with AS. To find a qualified teacher, visit the official website.

9. TENS therapy

Transcutaneous electrical nerve stimulation (TENS) therapy uses an electrical current to manage pain.

Electrodes are usually connected to a TENS machine and applied at the site of the pain. It’s thought that when TENS stimulates nerves, it overrides pain signals in the body.

A physical therapist can teach you the TENS technique so you can continue using it at home.

10. Quitting smoking

Smokers, especially men, are at risk for greater spine damage from AS than nonsmokers. Quitting smoking not only helps reduce AS damage but also improves your overall health.

Quitting smoking isn’t easy. Get all the support you can get. is a great place to start.

A good night’s sleep can often be an elusive goal if you have AS. Pain may be worse at night due to inadequate bedding.

Your mattress should keep your spine straight when you lie on your side. Your mattress should also allow your spine to have an “S curve” when you lie on your back.

Try these tips for a good night’s sleep:

  • Use a medium-firm mattress, which can mold to the shape of your spine.
  • Use only enough pillows to keep your neck aligned.
  • Use heat therapy before bed to help reduce pain.
  • Don’t sleep with a pillow between your legs.

Traditional treatments can also manage pain, reduce stiffness, and help prevent flares. Several types of medications may be used.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs help reduce pain. Some examples include:

  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve)
  • aspirin


Your doctor may prescribe corticosteroids if your AS symptoms are severe and don’t respond to other medications. Corticosteroids also help reduce inflammation and pain.

Corticosteroids are usually injected into the affected joint for fast pain relief. Due to their side effects, these drugs are intended for short-term use.

Examples include prednisone (Deltasone, Rayos) and prednisolone (Omnipred).

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs can help slow down the inflammatory process. Examples include sulfasalazine (Azulfidine) and methotrexate (Rheumatrex, Trexall).

These drugs are used for long-term treatment.

Biologics and biosimilars

Biologic agents can block proteins that cause inflammation. Seven different biologics are approved by the Food and Drug Administration (FDA) to treat AS:

These drugs are injected or given intravenously.

Biosimilars are also available. These drugs aren’t exact copies of biologics, but they’ve been engineered to produce the same effects. The following biosimilars have been FDA-approved for AS:

Enbrel biosimilars

  • etanercept-szzs (Erelzi)
  • etanercept-ykro (Eticovo)

Humira biosimilars

  • adalimumab-adaz (Hyrimoz)
  • adalimumab-adbm (Cyltezo)
  • adalimumab-afzb (Abrilada)
  • adalimumab-atto (Amjevita)
  • adalimumab-bwwd (Hadlima)

Remicade biosimilars

  • infliximab-abda (Renflexis)
  • infliximab-axxq (Avsola)
  • infliximab-dyyb (Inflectra)
  • infliximab-qbtx (Ixifi)

However, the only two that are currently available to U.S. consumers are the Remicade biosimilars Renflexis and Inflectra. This is largely because of patents held by the biologics’ manufacturers.

The exact cause of AS is unknown, though genetics play a role. The genetic marker HLA-B27 is present in more than 95 percent of Caucasians with AS. This gene association varies across ethnic and racial groups.

Overall, carrying the HLA-B27 gene may present a 30 percent risk of developing AS. Many people with this genetic marker don’t develop AS, and you don’t have to be HLA-B27-positive to have AS.

More than 60 genes may have a connection to AS. When these genes combine with a bacterial infection or other environmental factor, they may trigger AS. More research is needed in this area.

AS usually begins in adolescence or young adulthood and continues throughout your life. It occurs more often in men than women. As a result, if you’re an adolescent or young adult male, your risk for AS is higher.

Other risk factors are:

  • a family history of AS
  • having the HLA-B27 genetic marker
  • frequent gastrointestinal infection

Although most people require some type of medical therapy for AS, natural remedies may also help reduce symptoms.

Not all natural remedies and alternative treatments are right for everyone with AS. Some people may have success with yoga and acupuncture. Others may feel better using cold therapy and massage.

It’s important to consult your doctor about your medications and any natural remedies or alternative treatments you’re considering.

If you’re experiencing any side effects or pain related to these therapies, talk with your doctor as soon as possible.