TENS and EMS for Ankylosing Spondylitis

Key Characteristics of Ankylosing Spondylitis

• Inflammatory Arthritis: AS is an autoimmune condition where the body's immune system attacks its own tissues, causing inflammation in the spine and other joints.
  
• Spinal Fusion: Chronic inflammation can lead to the formation of new bone, causing vertebrae to fuse together. This can result in a loss of flexibility and a forward-stooped posture.
• Pain and Stiffness: The most common symptoms are chronic pain and stiffness in the lower back and hips, especially in the morning or after periods of inactivity.
• Systemic Condition: AS can also affect other parts of the body, including the eyes (uveitis), heart, and lungs.
• Genetic Link: There is a strong genetic predisposition to AS, with the HLA-B27 gene being a significant risk factor.

Causes and Symptoms of Ankylosing Spondylitis

• Genetic Predisposition: The HLA-B27 gene is found in about 90% of people with AS. However, many people with this gene never develop the condition.
• Immune System Response: AS is an autoimmune disease, meaning the body's immune system mistakenly attacks its own tissues. This leads to chronic inflammation in the spine and other joints.
• Environmental Triggers: It is hypothesised that infections, particularly in the gut, may trigger the inflammatory response in individuals with a genetic predisposition to AS.

• Chronic Pain and Stiffness: Persistent pain and stiffness in the lower back, hips, and buttocks are hallmark symptoms of AS. This discomfort is often worse in the morning and after periods of inactivity, and it tends to improve with exercise.
• Loss of Flexibility: As the condition progresses, the inflammation can cause the vertebrae to fuse, leading to a loss of flexibility in the spine. This can make it difficult to bend, twist, or maintain an upright posture.
• Fatigue: Many people with AS experience significant fatigue, which can be debilitating and impact their ability to perform daily activities.
• Pain in Other Joints: While AS primarily affects the spine, it can also cause pain and swelling in other joints, such as the shoulders, knees, and ankles.
• Enthesitis: This is inflammation where tendons and ligaments attach to bone. Common sites include the heel, the back of the ankle, and the chest wall.
• Eye Inflammation (Uveitis): About 40% of people with AS experience uveitis, which is inflammation of the eye. Symptoms include eye pain, redness, and sensitivity to light.

How it can affect your day to day life

• Physical Limitations: The pain and stiffness in the spine and other joints can make it difficult to bend, lift, or even walk for long periods. This can limit participation in sports, hobbies, and other physical activities.
• Work and Career: The symptoms of AS can affect productivity at work and may require modifications to the work environment. In some cases, individuals may need to change careers to accommodate their physical limitations.
• Sleep Disturbances: Pain and stiffness can make it difficult to find a comfortable sleeping position, leading to poor sleep quality and increased fatigue during the day.
• Emotional and Mental Health: Living with a chronic condition like AS can be emotionally challenging. Many people experience frustration, anxiety, and depression as they cope with the daily challenges of the disease.
• Social Life: The physical limitations and fatigue associated with AS can make it difficult to participate in social activities, leading to feelings of isolation and loneliness.
  
  

Traditional Treatments for Ankylosing Spondylitis

Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, are often the first line of treatment for AS. They can help reduce pain and inflammation.
• Biologic Medications: For individuals with more severe AS, biologic medications may be prescribed. These drugs target specific parts of the immune system to reduce inflammation. Examples include TNF inhibitors and IL-17 inhibitors.
• Janus Kinase (JAK) Inhibitors: JAK inhibitors are a newer class of medication that can be used to treat AS. They work by blocking specific enzymes involved in the inflammatory process.
• Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs, such as sulfasalazine, may be used to treat peripheral arthritis in individuals with AS.
  

Therapies

• Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs, such as sulfasalazine, may be used to treat peripheral arthritis in individuals with AS.
• Occupational Therapy: An occupational therapist can provide strategies and tools to make daily activities easier and less painful.

Lifestyle Modifications

• Exercise: Regular exercise is crucial for managing AS. It can help reduce pain and stiffness, improve posture, and maintain flexibility.
• Diet: While there is no specific diet for AS, a healthy, balanced diet can help maintain a healthy weight and reduce inflammation.
• Smoking: Smoking is known to worsen the symptoms and progression of AS. Quitting smoking is one of the most important lifestyle changes an individual with AS can make.
  
  

How can TENS & EMS therapy help?

• Improve Functional Capacity: Patients showed statistically significant improvement in Bath Ankylosing Spondylitis Functional Index (BASFI) scores (P=0.03) after one month of treatment
• Enhance Spinal Mobility: Improvements were observed in the Schober test and finger-to-floor flexion test, indicating better spinal flexibility
• Provide Accessible Treatment: TENS machines are available to all members of the public and can be used at home, ensuring consistent but also accessibility to treatment whenever the customer or users wishes. 
  
  

EMS Therapy for Ankylosing Spondylitis

Ankylosing spondylitis creates specific muscle-related challenges that EMS therapy can uniquely address. The condition often leads to:

• Paraspinal Muscle Weakness: The muscles running alongside the spine become weak due to pain avoidance and reduced activity.
• Core Instability: Deep abdominal and back muscles that support spinal alignment become compromised.
• Postural Muscle Imbalances: Chronic inflammation leads to compensatory muscle patterns and forward head posture.

Electrical muscle stimulation for AS patients works by:

• Activating Deep Stabilising Muscles: EMS machines can target the multifidus and other deep spinal muscles that are difficult to activate voluntarily in AS patients due to pain and inflammation.
• Counteracting Muscle Atrophy: Research shows that AS patients often experience muscle mass reduction. EMS machines can help maintain and rebuild muscle strength even when active exercise is limited by pain.
• Improving Postural Support: By strengthening the erector spinae and other postural muscles, EMS helps counteract the forward-stooped posture that can develop in AS.
  
  

EMS Machine recommendations for application

AS management emphasise that electrical stimulation should be integrated with other therapies.

• Targeted Electrode Placement: Focus on sacroiliac joints, lumbar spine, and thoracic regions where AS inflammation is most common.
• Timing with Medication: TENS can be particularly effective during morning stiffness periods when anti-inflammatory medications are taking effect.
• Integration with Exercise: Using TENS before stretching or EMS after strengthening exercises can enhance the benefits of physical therapy protocols specifically designed for AS