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IRD AS – Keep your neck and back flexible

Maintaining flexibility 

Evidence summary

Maintaining spinal and peripheral joint mobility is essential for people with ankylosing spondylitis. Millner et al. meta-analysis (included 11 RCTs) and consensus statement suggest that this can be achieved through a variety of exercise interventions including active stretching, specific physiotherapy-based programmes, swimming, walking and tai chi [1]. Mobility outcomes included lumbar flexion, cervical mobility, chest expansion and fingertip to floor distance were all improved following exercise interventions [1].  One approach was found not to be superior to another. Activity selection should be based on the individuals’ preference and goals. Miller et al. recommends an individual exercise prescription with an emphasis on spinal mobility is paramount for best management of ankylosing spondylitis.

Quality of evidence

High quality

Strength of recommendation



A variety of physical activity and exercise interventions have been shown to improve mobility outcomes. Activity selection should be based on individual preference and a specific emphasis on spinal mobility is recommended.


  1. Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum. 2016;45(4):411-427.