If you experience an early-morning stiffness and pain in your lower back, which becomes better during the day with exercise or as you get into your routine, there are chances that it could be more than just simple wear and tear in the back. If this has been a regular problem for more than three months, you could be suffering from ankylosing spondylosis (AS). Ankylosing spondylitis is a type of arthritis (joint inflammation) that starts from the sacroiliac joint (SI joint) and ascends up the spine (with time). Pain and stiffness in the lower back and hips are the earliest symptoms, and it mostly sets in between the ages of 20 to 30 years. Homeopathic medicine for ankylosing spondylitis helps moderate the overactive immune system, thereby halting the progression of the disease. The top grade natural homeopathic remedies for ankylosing spondylitis are Aesculus Hippocastanum, Kalmia Latifolia, and Rhus Tox.
Ankylosing spondylitis affects males 2-3 times morecommonly than females. Researches suggest that there is a strong link of AS being genetically inherited. The HLA-B27 gene can be detected in most patients with ankylosing spondylitis. This disease is thought to be an autoimmune disorder, which means that the body’s defense cells damage the joints of the spine.
Homeopathic Remedies for Ankylosing Spondylitis
Homeopathic medicines along with regular physiotherapy can help manage the symptoms of ankylosing spondylitis. Homeopathic medicines majorly provide symptomatic management of pain and stiffness and work well in cases where the inflammation is detected in its early stages. Homeopathic remedy for ankylosing spondylitis can help moderate the immune system to halt the progress of the disease in the initial stages, and also help manage pain and movement. Ideally, a homeopathic treatment should go hand-in-hand with conventional treatment and physiotherapy for optimal recovery.
Conventional treatment for ankylosing spondylitis includes the use of NSAIDs (Nonsteroidal anti-inflammatory drugs) like Indocin and Naproxen, TNF blockers (tumor necrosis factor), and DMARDs (Disease-modifying antirheumatic drugs ).
NSAIDs are the first line of treatment used in cases of ankylosing spondylitis. They help relieve inflammation, stiffness, and pain. The use of NSAIDs takes into account risk factors for cardiovascular disease as well as gastrointestinal disease, since these medications might cause gastrointestinal bleeding.
The next part of treatment involves the use of TNF blockers, or a tumor necrosis factor (TNF) blocker or an interleukin 17 (IL-17) inhibitor. These drugs target the cell protein in the body that causes inflammation. TNF blockers help reduce pain, stiffness, and tender or swollen joints. They are administered through injections.
These drugs have made a massive difference in the treatment of ankylosing spondylitis by their action of inhibiting tumor necrosis factor (TNF), but their side effects include reactivation of latent tuberculosis in some cases.
The next line of conventional treatment includes DMARDs (Disease-modifying antirheumatic drugs) that work to suppress the body’s inflammatory systems or an overactive immune system. The use of DMARDs depends on factors like the severity of the joint inflammation and the associated side effects and the expected results. These drugs are usually designed to work over a few weeks or months and do not provide immediate relief.
1. Aesculus Hippocastanum – Top Medicine for Ankylosing Spondylitis
Aesculus Hippocastanum is a top listed medicine for ankylosing spondylitis. This medicine is prepared from a plant commonly called ‘horse chestnut.’ The natural order of this plant is Sapindaceae. The prominent symptom indicating the use of Aesculus Hippocastanum is a pain in the sacrum and the hips. Along with this, there is marked stiffness in the lower back. The symptoms get worse from rising from the seat, and the person has to make repeated efforts. At that time, there is a sensation as if the back would break. Aching pains in the lumbar, sacral and the pelvic region are treated well with homeopathic medicine Aesculus Hippocastanum.
Key Indications for using Aesculus Hippocastanum:
-Pain in sacrum and hips due to inflammation.
– Marked stiffness in the lower back.
– Back pain worse rising from a seat and on stooping.
2. Kalmia Latifolia – For Ankylosing Spondylitis with Constant Pain in Spine
Kalmia Latifolia is a highly beneficial medicine for ankylosing spondylitis. This medicine is prepared from the fresh leaves of a plant named ‘Mountain Laurel.’ The natural order of this plant is Ericaceae. It is indicated when there is a constant pain in the spine. Pain in the lumbar area and a burning/heat sensation in the lumbar spine is present. A feeling of lameness in the back is present. Sometimes there is a sensation as if the back would break. There is also an intense pain in the neck (cervical spine) along with stiffness. The neck feels tender to the touch. Kalmia Latifolia is an effective homeopathic remedy for the pain in the neck (cervical spine) that radiates to the shoulders. Early morning worsening of neck pain and stiffness is also present.
Key Indications for using Kalmia Latifolia:
– Constant pain in the spine.
– Pain in lumbar back attended with heat / burning in the spine.
– Neck pain and stiffness.
3. Rhus Tox – For Morning Stiffness in Back
Rhus Tox is a well indicated medicine for ankylosing spondylitis. It helps in reducing the stiffness of the back. The stiffness is most intense in the morning. Sitting also aggravates the stiffness. Rhus Tox also works wonders in reducing back stiffness that gets worse from taking rest. Here lying or sitting still worsens the stiffness. The person requiring Rhus Tox gets relief by walking. Pain in the lower back is also severe along with stiffness. Rhus Tox is also a natural medicine for managing back pain which gets relieved by the application of hard pressure.
Key indications for using Rhus Tox:
– Intense stiffness in the back.
– Back stiffness that is worse in the morning or due to inactivity.
– Back pain and stiffness that is reduced by walking.
Other Important Remedies
4. Colocynthis – For Hip Pain in Ankylosing Spondylitis
Colocynthis is a medicine for ankylosing spondylitis with marked hip pain. Colocynthis is prepared from a plant named ‘bitter cucumber.’ This plant belongs to the family Cucurbitaceae. For using Colocynthis hip pain may be cramping, drawing or tearing in nature. The pain from hip may also extend down to the knee, leg or even to the feet in a few cases. Sensitivity to touch the affected hip is also seen in many cases. Colocynthis is also a useful remedy for hip pain that gets better by lying on the affected side. In some cases, pressure on the affected hip offers comfort. Hip pain that gets better by warmth also indicates the use of homeopathic medicine Colocynthis. The person needing Colocynthis also experiences an aggravation of hip pain by sitting, standing, being in motion, and gets relief from rest.
5. Bryonia Alba – When Backache is Worse from Motion
Bryonia Alba is another well-indicated medicine for treating ankylosing spondylitis. This medicine is prepared from a plant commonly named ‘Wild Hops.’ The natural order of this plant is Cucurbitaceae. A backache that is worse from motion or walking is the guiding feature to use Bryonia Alba. In a few cases, stooping, standing and sitting also worsen the backache. The relief in back pain is afforded only with absolute complete rest. Stiffness is also present along with a backache. The stiffness is so intense that a person has to sit and walk in a stooped posture. Maintaining an upright posture while sitting/walking is difficult.
6. Agaricus Muscarius – When Back is Sensitive to Touch with Pain
Agaricus Muscarius is majorly used in ankylosing spondylitis when the spine is sensitive to touch, along with pain. The sensitivity of the spine is severe in the morning. Other symptoms pointing towards the use of Agaricus Muscarius are back pain getting worse from stooping, a burning sensation in the spine, and a feeling of tightness in the back muscles. A lumbosacral backache that is worse during daytime exertion is also treated well with Agaricus Muscarius. A marked stiffness in the back is present along with pain. There is a sensation as if the back would break. Another sensation that may appear is that of a cold or hot needle piercing the back.
7. Kali Carb – For Weakness in Back
Kali Carb is a medicine is used to treat ankylosing spondylitis where weakness in the lower back accompanies back pain. The pain is present in the lower back, hips, and the thighs. The person feels better by lying down. Homeopathic medicine Kali Carb is also helpful when there is difficulty in turning in bed from a backache. Another chief indication to use Kali Carb is a sharp pain in back extending up and down.
8. Natrum Mur – When Lying on the Back brings Relief
Natrum Mur is another valuable medicine used to treat ankylosing spondylitis. The characteristic feature to use Natrum Mur is relief from back pain upon lying down, especially on a hard surface. Other symptoms include difficulty in stooping, a pulsating sensation in the back and pain in the sacrum. The person needing homeopathic medicine Natrum Mur may also need firm support on the back.
9. Cimicifuga Racemosa – For Ankylosing Spondylitis with Neck (cervical back) Pain and Stiffness
Cimicifuga Racemosa is prepared from a plant named black cohosh of natural order Ranunculaceae. Cimicifuga Racemosa is used to treat neck (cervical back) pain and stiffness in cases of ankylosing spondylitis. A contracted sensation in the neck is present, and the neck is sensitive to touch. Pressure seems to worsen the pain in the neck. Any motion of the head and hands also aggravates the neck pain. Worsening of neck pain from exposure to cold air is also treated well with homeopathic medicine Cimicifuga Racemosa.
10. Calcarea Fluor – To Dissolve Osteophytes
Calcarea Fluor is a well indicated medicine for dissolving osteophytes (bony outgrowths appearing in the spine) in cases of ankylosing spondylitis. Another symptom that suggests the use of Calcarea Fluor is a back pain that is worse from rest and better from motion. Application of warmth may also relieve back pain in a few cases. Restlessness along with back pain is also present.
11. Tellurium Met – For Sacral Pain Radiating Down the Thigh
Tellurium Met is a medicine for ankylosing spondylitis with marked sacral pain radiating down the thigh. The back is sensitive, and the pain gets worse from touch. A feeling of weakness in the back, and cervical back pain spreading to the shoulder and between the scapulae are other symptoms that indicate the need for this medicine. The cervical spine is also sensitive to pressure and touch.
12. Conium Maculatum – For Sacral Pain from Walking a Short Distance
Conium Maculatum is indicated when there is a severe aching in the sacral region from walking a short distance. Stitching pain in the sacrum when standing, weakness and lameness in the small of the back, tightness in the nape of the neck with pain and stiffness and soreness in the lower cervical spine are also present.
Pain in the dorsal back between the shoulders and the lumbar region also indicates the need for this medicine.
13. Guaiacum – For Ankylosing Spondylitis with Stiff Neck
Guaiacum is a significant medicine for ankylosing spondylitis with a stiff neck. It is a plant-based medicine prepared from the plant ‘Guaiacum Officinale.’ The natural order of this family is Zygophyllaceae. Marked stiffness in the neck is the key feature to use this medicine. Pain in the neck and the back (between scapulae) is also treated well with this medicine. It is also indicated in some cases where neck pain radiates down the sacrum.
Cause of Ankylosing Spondylitis
The exact reason behind ankylosing spondylitis is not clear yet. It is considered to be a disease of autoimmune origin. Autoimmune means destruction of healthy body tissues by immune cells of the body due to a misdirected response. In autoimmune diseases, immune cells recognize healthy tissue as a foreign, harmful organism due to mistaken identity and set an immune reaction to destroy it. In ankylosing spondylitis, an immune response gets initiated against the sacroiliac joints and joints of the spine resulting in its inflammation, destruction and eventually fusion.
Symptoms of Ankylosing Spondylitis
The primary symptom at the beginning of ankylosing spondylitis is pain and stiffness in lower back and hips, followed by general fatigue. The starting of pain and stiffness is usually gradual, and it worsens over a period of months. The signs are worse early in the morning (often waking the person from sleep), and tend to decrease as the day passes. The symptoms also tend to get worse after periods of prolonged inactivity.
As the disease progresses up the spine, pain and stiffness start to appear in mid back and neck (cervical spine). In the case of permanent fusion of vertebra, the spine gets rigid as a board with the entire loss of flexibility – a condition known as bamboo spine.
Ankylosing spondylitis is primarily a disease affecting the spine. But it may affect other joints including the shoulder, knees, and ankles in some cases.
In a majority of cases, ankylosing spondylitis starts from the sacroiliac joint. But in some cases, this disease also begins from other areas, like foot, heel, and knees, especially if the disease sets in at a young age.
The Disease Mechanism of Ankylosing Spondylitis
Ankylosing means ‘joining together’ and spondylitis means ‘inflammation in the vertebrae’ (the bones that make up the spine). In ankylosing spondylitis, there appears inflammation in the joints of the spine and sacroiliac joint (SI Joint, between the sacral spine and pelvis) and fusion of these joints in the long run.
In the case of ankylosing spondylitis, T cells begin the inflammation in SI joint and joints of the spine. With time, these joints start eroding and get damaged. The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). In a person suffering from AS, joints and ligaments that generally allow the spine to move, get inflamed and stiffen up. This inflammation takes place where the ligaments or tendons are attached to the bones.
In the process of healing, new bone develops at the site of damage, replacing flexible cartilage and bridging the gap between two bones. As a result, the elastic tissue is replaced by bony growth. Continued formation of new bone can lead to fusion of the vertebrae (bones of the spine), leading to a significant reduction in the movement of the spine.
The spine is the central support structure of the body. It keeps us upright. Although there are many bones (vertebra) in the spine (stacked one over the other) it is flexible due to the presence of elastic intervertebral spinal discs and ligaments. An intervertebral disc is a fibrocartilaginous cushion between two vertebrae. Each disc has an annulus fibrosus (tough exterior of a spinal disc) and has nucleus pulposus (soft inner core). In ankylosing spondylitis, annulus fibrosus become calcified and fuse with adjacent vertebrae. Continued formation of new bone can lead to fusion of the vertebrae, leading to a considerable reduction in the movement of the spine. Ankylosing Spondylitis can also affect eyes, lungs, bowel, and heart.
Factors that Contribute to the Development of Ankylosing Spondylitis
Age – In most cases, the onset of AS is between the age of 20 years – 30 years (especially during the early 20’s). However, in some cases, it can start at the age of 18.
Gender – Males are at a higher risk of developing ankylosing spondylitis as compared to females. The incidence ratio of ankylosing spondylitis in male and females is around 3:1.
Family History – Persons having a family history of ankylosing spondylitis, along with the presence of the HLA-B27 are at risk of developing the disease. A family history of the diseases can increase the chances of developing the disease by about 20 percent.
Diagnosing Ankylosing Spondylitis
In cases where the clinical symptoms point toward ankylosing spondylitis, an X-ray or MRI are useful tools that help find changes appearing in joints to confirm ankylosing spondylitis. The most critical diagnosis that can be caught in these early investigations is the inflammation of the sacroiliac joint. Other tests that are recommended in addition to these include ESR, vitamin D levels, and HLA- B27.
Complications from Ankylosing Spondylitis
- Permanent fusion of the sacroiliac joint and vertebra in the back due to chronic inflammation can make the spine stiff and inflexible (in the process of healing new bone forms in spine bridging the gap between vertebrae causing fusion of vertebrae).
- Compression fractures are a result of weakened vertebrae since the bones can thin-out during the initial stages of ankylosing spondylitis. These vertebrae can crumble or shrink in size, putting pressure on the spinal cord.
- Eye inflammation or uveitis is a common complication of AS. It causes rapid eye pain, blurred vision and extreme sensitivity to light.
- Heart problems are another complication of this disease since it causes inflammation and enlargement of the aorta. Enlargement leads to a distortion of the aortic valve in the heart, and its subsequent functional impairment.
- Difficulty in breathing due to the fusion of the ribs with breastbone (fusion restricts, chest expansion, reduces lung capacity and function.
- Inflammation of the intestines can lead to other diseases like Crohn’s disease and Colitis.
Managing Ankylosing Spondylitis with Diet and Exercise
Maintaining a healthy weight is essential for people with AS since excessive weight excessive weight can add stress on the joints and bones. Physiotherapy and regular exercise can help halt the progression of the disease and provide symptomatic relief.
Foods to Eat to Manage Ankylosing Spondylitis
Omega-3 Fatty Acids
Omega-3 fatty acids are known to have a small but consistent effect on the inflammation of joints. Fatty fish like tuna and salmon, flaxseeds, walnuts, chia seeds are some examples of foods that contain Omega-3 Fatty Acids.
Fruits and Vegetables
Fruits and vegetables contain many nutrients, minerals, and vitaminsand are generally low in calories and high in fiber. The antioxidants present in the vegetables help fight inflammation in the body.
Whole grains like quinoa, brown rice, oatmeal, and corn contain nutrients and fiber that help reduce inflammation.
Calcium keeps the bones healthy, and calcium-rich foods include low-fat dairy products, fortified cereals and tofu, broccoli, almonds, and dark, leafy green medicines like kale.
The body requires vitamin D for using calcium. Higher levels of vitamin D (within limits) decrease the risk of developing the disease and also reduce the symptoms. Seafood, egg yolks, fortified cereals and plant-based milk, and cod liver oil are food sources of vitamin D. The other source of vitamin D is direct sunlight.
Foods to Avoid that Worsen the Condition
Foods that cause inflammation can worsen the symptoms of AS. These foods include:
Foods High in Fats
High-fat foods like red meat, pizza, cheese, and processed foods contain omega-6 acids and saturated fats that contribute to inflammation.
Sugar and Refined Foods
Sugar and refined foods lead to inflammation, so those suffering from AS should avoid foods like candy, desserts, sodas, and juices.
Lifestyle Modifications to Ease the Symptoms of Ankylosing Spondylitis
- Exercise is an essential habit for those dealing with AS. Exercise helps maintain or reduce weight, reduce inflammation in the body, and helps increase the mobility and flexibility in the body. In most cases, exercise reduces the symptoms of AS and people tend to feel better.
- A good posture can help decrease the chances of abnormal spinal fusion and also reduce further complications.
- Physiotherapy with a professional therapist can help improve the posture, pain management, and joint mobility. The exercises included in a physiotherapy program work on the person’s stretching, targeted activities, flexibility and overall strength.
- Use cold or hot packs to manage symptoms of pain and inflammation.
Frequently Asked Questions on Ankylosing Spondylitis
1. Is HLA- B 27 positive diagnostic of ankylosing spondylitis?
No, just carrying the gene HLA- B 27 is not diagnostic of ankylosing spondylitis. Positive HLA-B 27 makes a person susceptible to get ankylosing spondylitis, but most people with this gene never develop any symptoms. For diagnosis, clinical symptoms and the X-ray/MRI findings must match with the disease symptoms in addition to a positive HLA-B27 test.
2. Is ankylosing spondylitis curable?
Ankylosing spondylitis is a chronic lifelong problem, and unfortunately, there is no cure for it. However, there are treatments available that help effectively manage the symptoms and slow down the progression of the disease. Caught early, it is also possible to prevent fusion of the spine. Early diagnosis and treatment along with regular physiotherapy is the key to manage the complaint and improve the quality of life.
3. Does spinal fusion appear in every case of ankylosing spondylitis?
No, each case of ankylosing spondylitis does not always progress to the stage of spinal fusion. It varies highly from person to person. No two cases of ankylosing spondylitis progress in the same manner. Some cases of ankylosing spondylitis have very mild progression of disease without spinal fusion, and the person leads a reasonably healthy, independent life, while in others, the disease progresses rapidly along with spinal fusion, leading to disability.
4. Does homeopathy work for ankylosing spondylitis?
Since ankylosing spondylitis has no cure, homeopathy can help in the symptomatic management of the disease. In cases where the disease is diagnosed at an early stage, homeopathy can work hand-in-hand with conventional treatment to halt the progression of the disease and provide significant relief from the symptoms. Homeopathy alone is not advised as a long-term treatment for ankylosing spondylitis.