Ankylosing spondylitis (AS) is an inflammatory disease that affects the spine. It’s a form of arthritis.

People with AS mainly experience symptoms of pain and stiffness in their lower back. The condition may also cause pain in your:

  • neck
  • upper back
  • hips

This pain usually:

  • begins between ages 20 and 40
  • develops slowly
  • lasts for weeks or months
  • is worse after waking up or resting for long periods
  • feels better after movement and stretching

With AS, the stiffness and loss of mobility caused by inflammation can make it hard to maintain good posture.

Your back might become less flexible over time, making it harder to do things like bend forward to put on socks or shoes. AS can also lead to a “hunchback” posture.

Read on for tips to help improve your posture, as well as other information about supporting your posture when you have AS.

Managing AS effectively and sticking to your treatment plan can help reduce stiffness and improve your posture.

Proper treatment for AS, including both medication and exercise, can help reduce symptoms and may slow possible complications that affect posture, such as changes to your bones.

There are several simple lifestyle changes and habits that can help you improve or maintain good posture.

General tips for good posture

  • Always sit and stand with your spine straight, shoulders squared, and head up.
  • Don’t look down while you’re walking, and don’t slouch.
  • Whenever possible, sit in a firm, straight-back chair, with your feet on the floor. Add a small cushion to support your low- and/or mid-back.
  • If you use your cellphone frequently, be mindful of your posture and avoid “text neck.”
  • When driving, adjust your headrest to support your neck, and always wear a seat belt with a shoulder harness.
  • Pace yourself. If you’re having a tough day, take short breaks to manage your fatigue. This may help reduce slouching.

Maintaining good posture while working

  • Avoid sitting in the same position for too long. Take breaks — get up and move your body often to reduce stiffness.
  • If your job involves sitting at a desk, consider investing in an ergonomic desk chair or standing desk.
  • Make sure your work surface allows you to sit without slumping and that your computer monitor is at eye level.

Supporting good posture while you sleep

  • Choose a firm mattress that supports your body and allows you to keep your spine straight.
  • Try sleeping on your back while using a thin pillow or a pillow that supports the hollow of your neck.
  • Avoid sleeping in a curled-up position and straighten out your legs to preserve flexibility.

If you’re having difficulty with any of your daily activities, consider reaching out to a licensed occupational or physical therapist who can help you avoid injury and find ways to perform tasks with less stress on your joints.

If you’re concerned about your posture, try a simple wall test. Stand with your back and head against a wall.

If your spine is straight, your chin should be parallel to the floor. With proper alignment, your heels, buttocks, shoulders, and head should be able to touch the wall at the same time.

If you think you’re not aligned properly, your doctor or physical therapist can recommend safe, specific strategies to improve your alignment. These strategies will need to take into consideration the severity of your AS symptoms.

Daily exercise is a key part of AS symptom and posture management. It can reduce AS-related pain and improve function. For those with AS, even a short 10-minute walk is better than not exercising at all.

In a 2019 review of 14 studies, review authors found that exercise programs, ranging from tai chi to yoga, are likely to improve overall function and reduce pain in people with AS.

The review included more than 1,500 people with AS. In most cases, people participating in the exercise programs were also receiving medication for AS.

Exercises focused on stretching, range of motion, and strength training — such as yoga and swimming — help strengthen muscles and can improve joint mobility and flexibility over time.

Modified Pilates and tai chi, which incorporate both stretching and strengthening, have also been shown to be beneficial for AS mobility.

Some best practices for exercise include:

  • Establish a routine and stick with it.
  • Always start with a warmup to loosen stiff muscles. Keep in mind that it may be easier to exercise after a warm bath or shower.
  • Avoid exercising on hard surfaces and consider using a thick exercise mat to protect your spine.
  • Start slow and listen to your body. If you experience pain while exercising, stop immediately.
  • Don’t perform strenuous exercises when you’re having an AS flare-up.

Your doctor may prescribe some medications to help you manage pain and stiffness, and to allow you to maintain proper posture, exercise, and perform everyday activities comfortably.

Your doctor will first recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as:

  • ibuprofen (Advil)
  • naproxen (Aleve)
  • celecoxib (Celebrex)

If NSAIDs don’t provide relief after several weeks, stronger medications may be considered, such as or corticosteroids or biologic disease-modifying antirheumatic drugs (DMARDs).

Be sure to talk with your doctor if you have questions about AS medications.

Maintaining mobility is top of mind for many people living with AS. Inflammation from AS can cause pain and stiffness, which ultimately affect your posture.

Although there’s no cure for AS, you can help maintain good posture by making some changes to your everyday routine.