Physiotherapy for Axial Spondyloarthritis in Weybridge & Woking
Specialist physiotherapy to help you keep moving, manage stiffness and flare-ups, and stay active for the long term with axial SpA, including ankylosing spondylitis.
Axial spondyloarthritis (axial SpA) is a long-term inflammatory arthritis that mainly affects the spine and the joints at the base of the spine. Stiffness, pain and fatigue can change from day to day, and it's easy to feel unsure about which movement is helping and what might be making things worse.
Regular, well-chosen exercise is one of the most important things you can do to manage axial SpA. Physiotherapy can help you find the right exercise, keep your spine, chest and hips moving, and build a routine you can keep up for the long term.
At Trinity, this is what we call Rheumatology in Motion: our philosophy of helping people stay active, keep their independence and keep moving forward, whatever their condition throws at them. Our specialist rheumatology physiotherapists work with people at every stage, from a new diagnosis to many years of living with axial SpA.
We always start with what you want to keep doing or get back to, whether that's getting through a working day without stiffness taking over, sleeping through the night, playing sport or keeping up with family. Your treatment is then built around those goals and how your condition is behaving right now.
We can help if you have
You don't need a GP referral to see us, and you don't need to wait for a flare-up. Physiotherapy works best alongside the care you receive from your rheumatology team. Axial SpA is one of the conditions we support as part of our wider rheumatology physiotherapy service.
What is axial spondyloarthritis?
Axial spondyloarthritis is a type of inflammatory arthritis that mainly affects the spine and the joints where the spine meets the pelvis. There are two forms. In ankylosing spondylitis (AS), changes to the spine or pelvis joints show up on an X-ray. In non-radiographic axial SpA, X-rays look normal, but people can still have significant symptoms, and inflammation may show up on an MRI scan.
The inflammation tends to start where tendons and ligaments attach to bone. Over time, repeated cycles of inflammation and healing can make parts of the spine stiffer and, in some people, join together. Medication from your rheumatology team and regular movement both play an important part in managing this.
According to the National Axial Spondyloarthritis Society (NASS), around 1 in 200 adults in the UK have axial SpA, women and men equally, and it usually starts in the late teens or early twenties. On average it takes about 8.5 years to get from the first symptoms to a diagnosis, which is why recognising the signs early matters.
Common features include:
- Gradual back pain: coming on over weeks or months and lasting longer than three months.
- Morning and after-rest stiffness: stiffness that is worst first thing in the morning or after sitting still, and eases with movement.
- Pain that improves with exercise, not rest: including pain at night that eases once you get up and move around.
- Fatigue: feeling exhausted or low on energy, even when you've rested.
- Neck, rib, hip and buttock symptoms: pain and stiffness are not always limited to the lower back.
- Pain where tendons attach to bone: such as the heels.
- Inflammation elsewhere in the body: including the eyes (a red, painful eye) and the bowel.
Axial SpA is diagnosed by a doctor or rheumatologist, usually using a combination of your symptoms, examination, scans and blood tests. If you've had back pain like this for more than three months, particularly if it began when you were young, please speak to your GP and mention axial SpA.
Living with axial SpA, and often waiting years to be taken seriously, can be frustrating and exhausting. Whatever stage you're at, we'll listen to your story, take your symptoms seriously and help you feel more in control.
How can physiotherapy help with axial SpA?
Physiotherapy can't cure axial SpA, but it can help you keep your spine and joints moving, reduce pain and stiffness, and feel more in control of your condition.
Your physiotherapist will start by understanding your condition, your medical history and what matters to you, including how axial SpA affects your day-to-day life and what you want to keep doing or get back to. We'll assess your posture and how well your spine, chest, neck and hips move, so your programme starts from where you are today rather than from a standard set of exercises.
What might your treatment involve?
Depending on your symptoms and how your condition is behaving, your treatment may include:
- Education: understanding how axial SpA affects your body and everyday life, and practical ways to reduce its impact.
- Mobility and flexibility exercises: targeted exercises to keep your spine, neck, chest and hips moving, including stretches for the chest and hips.
- Posture and everyday positions: advice and training on posture, including sitting, desk set-up and driving.
- Strengthening: safe, progressive strength work to support your posture, joints and everyday function.
- Breathing and chest expansion: exercises to keep the ribcage moving and support your lung capacity.
- Cardiovascular fitness: help choosing aerobic activities that suit you and your joints.
- Hands-on treatment: gentle mobilisation and soft tissue techniques, where appropriate, to ease stiffness and pain alongside your exercise programme.
- Acupuncture: where suitable, medical acupuncture may be used as part of your plan to help with pain.
- A flare-up plan: knowing how to adapt your exercise when symptoms are worse, and when to contact your rheumatology team.
- Pacing and fatigue management: balancing rest and activity so you make the most of your energy.
- Long-term self-management: a routine you can keep up, with reviews at regular intervals so your programme changes as you do.
Our aim isn't to hand you a sheet of exercises and send you on your way. It's to help you build a routine that fits your life, that you'll actually keep doing, and that supports you for years to come.
Axial Spondyloarthritis Physiotherapy FAQs
What is the difference between axial spondyloarthritis and ankylosing spondylitis?
Axial spondyloarthritis is the overall term for inflammatory arthritis that mainly affects the spine and the joints where it meets the pelvis. Ankylosing spondylitis (AS) is one form of it, where changes can be seen on X-ray. In non-radiographic axial SpA, X-rays look normal but people can still have significant symptoms. Both are managed in a similar way, and physiotherapy can help with either.
Can physiotherapy help with axial spondyloarthritis?
Yes. Physiotherapy cannot cure axial SpA, but it plays an important part in managing it. We can help you keep your spine, chest and hips moving, reduce pain and stiffness, improve posture, build strength and fitness, and manage flare-ups and fatigue.
Medication is prescribed and managed by your rheumatology team, and physiotherapy works alongside it.
Is exercise safe with axial spondyloarthritis?
For most people, yes, and regular exercise is one of the most important parts of managing the condition. The key is choosing the right type and amount for you, and building up gradually.
It is worth getting personalised advice first if you are having a flare-up, have had axial SpA for many years, have fused areas of the spine, have osteoporosis, or have not exercised for a while. We'll help you find a safe way to get started.
Can I have physiotherapy during a flare-up?
Yes. During a flare-up we adapt your treatment rather than push through it. Intense exercise is best avoided while symptoms are worse, so the focus is usually on gentle movement, comfortable positions, pain relief and pacing. Once things settle we build back up gradually.
If your symptoms change suddenly or you are worried, please also contact your rheumatology team.
How often should I see a physiotherapist?
NASS recommends seeing a physiotherapist when you are first diagnosed and then reviewing your programme with one at least annually. Some people also like a short block of appointments to get established with a programme, or a check-up when their symptoms change or a flare-up hits.
We will agree a plan that suits you, with the aim of helping you manage independently.
What happens at my first appointment?
We take time to understand your symptoms, your diagnosis and medication, your daily activities and what you want to achieve. We look at your posture and how well your spine, chest, neck and hips move, then agree a plan with you.
You leave with practical advice and, usually, a personalised exercise programme that you can start straight away.
I think I might have axial SpA but I don't have a diagnosis. Can you help?
Axial SpA is diagnosed by a doctor or rheumatologist, so we cannot diagnose it ourselves. Many people wait years for a diagnosis, so if you have had back pain for more than three months that eases with movement and is worse after rest, especially with morning stiffness or if it began when you were young, please speak to your GP and mention axial SpA.
We can assess your back and movement in the meantime, and tell you if we think you should be seen by your GP or a rheumatologist.
Should I avoid running, gym workouts or contact sports?
Not necessarily, but it depends on you. High-impact activities such as running can aggravate symptoms for some people, so it helps to build up gradually and adjust if pain increases. Contact sports carry a fracture risk if you have thinner bones or a fused spine, so speak to us or your rheumatology team first.
Our aim is to help you keep doing the activities you enjoy in the safest way possible, rather than to simply tell you to stop.
Can physiotherapy help with fatigue and sleep?
It can help you manage them. Fatigue is common in axial SpA. We can help with pacing, balancing rest and activity and building your fitness gradually. Regular exercise can also reduce pain and stiffness at night, which may help you sleep better.
It won't remove fatigue completely, but many people find they cope with it better.
Do I need a GP referral?
No. You can book directly with us in Weybridge or Woking. Our fees page lists the price of a rheumatology initial assessment and follow-up appointments.
Keep Moving and Feel More Like Yourself Again
Whether you have just been diagnosed, are struggling with stiffness and flare-ups, or have lived with axial SpA for many years, Rheumatology in Motion is about keeping you active, independent and doing the things that matter to you. We'll build a plan around your symptoms and your goals, and help you feel like yourself again.