# data[].attributes.body
Orthopaedic and Neuro/Spinal consultants

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KESO CPD Cert Nov '18 Margherita Piastri

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QA LEVEL 2 AWARD IN EMERGENCY FIRST AID AT WORK (QCF)

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QA LEVEL 2 AWARD IN EMERGENCY FIRST AID AT WORK (QCF)

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ESO Training Services

# data[].attributes.body
HELENA BRIDGE - Why are headache such a headache?

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HELENA BRIDGE - Why are headache such a headache

# data[].attributes.body
ALAN RASTELLI – An introduction to pain physiology

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ALAN RASTELLI – An introduction to pain physiology

# data[].attributes.body
JOHN DICKINSON – Delivering solution for breathless athlete

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JOHN DICKINSON – Delivering solution for breathless athlete

# data[].attributes.body
STUART KORTH – Experiences in the peadiatric field

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STUART KORTH – Experiences in the peadiatric field

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Running injuries, biomechanics and management. A theory and practice workshop

# data[].attributes.headline
Notes and reflection on clinical observation Year 1 & 2

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Notes and reflection on clinical observation Year 1 & 2

# data[].attributes.headline
Feedback on communication and patient partnership

# data[].attributes.subject
Feedback on communication and patient partnership

# data[].attributes.body
Mapped against OPS A1; A3

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Feedback on communication and patient partnership

# data[].attributes.headline
Reflection on Communication and Patient Partnership

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Reflection on Communication and Patient Partnership

# data[].attributes.body
Mapped against OPS A1; A3; A4; A5; A6

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Reflection on Communication and Patient Partnership

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A1 You must have well-developed interpersonal communication skills and the ability to adapt communication strategies to suit the specific needs of a patient 

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A1 You must have well-developed interpersonal communication skills and the ability to adapt communication strategies to suit the specific needs of a patient 

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Placebo/Nocebo effects

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We have a beautiful job where we have the opportunity to help people reduce their pain, be stronger and to have less disabilities.
But, we as physiotherapists have to do better!

I think, we have to stop making people worse with treatments focused on their flaws or "dysfunctions", "vertebrae being out of alignment", "leg length discrepancies", "rotated pelvis'", "unstable spine segments", or that they have triggerpoints and fascial adhesions which you want to "release".
Because there is no correlation between these "dysfunctions" and pain, and we induce vulnerability in our patients minds when they think about their body.
When you hear from your therapist that your vertebra is out of alignment, what do you think then? Pretty scary stuff, because if the vertebra goes a little further, it might hit the spinal cord and then you might end up in a wheelchair!
So your brain wants to protect that area by increasing muscle tension in the trunk and that is not helpful. It can only increase the sensitivity in the tissues and could cause more pain.
It can also induce external locus of control, so you are more dependent on your therapist to solve your "problem", like putting the vertebra back in place or "release" your triggerpoint.
When you have less control over your pain, you have more chance for increased pain and disabilities. Keedy et al. investigated this.

We have to focus on providing advice and education, explained in a non-harmful way and bear in mind that what we say can harm our patients, creating a "nocebo effect".

Reassurance is often half of the treatment. By reducing worry in your patients so they will have less fear for movement (kinesiophobia) and anxiety/stress for the future.

Focus on how you can make your patients more strong and feel more robust. Be more deliberate in the language that you choose to communicate your treatment choices with your patients. Give your patients more control over their pain and try to not make them dependent on you (internal locus of control).

Make them stronger in their mind and body through education and exercise.

The squat and deadlift: great exercises for strengthening the whole body.

Squat:

Picture from HERE.

Deadlift:

Picture from HERE.

Demonstrate how strong your patients are through symptom modification, for example:

Patient: 13 year old sporty girl with anterior knee pain and she feels pain during a squat. You notice she squats with a lot of forward knee travel. When assessing the hip muscles strength and motor control, you find weakness compared to the other side. Don't focus on telling all the things that is wrong with her, like a leg length discrepancy, shifted pelvis and inflamed tendon.
You can teach her to make the movement more hip dominant and hinge more from the hips, she feels no pain. She can do that as an exercise and become stronger in her hips. From the literature you know that hip training helps with anterior knee pain.

This way you focus on building her strength, not on her weaknesses.

Make her stronger.

Below you can see how communication which language is considered beneficial and harmful for your patients:

Both tables are from HERE.

I think it is important that we as physiotherapists focus on good, non-harmful communication and on implementing evidence based practice.

Focus on a good therapist-patient relationship. Evidence shows that this helps the outcomes.

Focus on an active treatment which makes the patient feel more strong and robust. Exercise and strength training has an analgesic effect.
Passive treatment can be useful, but most of the time, should be in combination with education and exercise. It's just how we explain to our patients what is happening during the passive treatment, which is very important.

How can we do this better?

Through education.

Education begins at the Physiotherapy schools and Universities.

Maybe we have to shift our focus more to clinical reasoning, communication skills and prescribing exercise.

After physiotherapy school, I think social media can definitely help to keep yourself up to date with the latest knowledge which can be implemented in clinical practice.

What do you think has to be better?
Let us know in the comments in the post of the Trust me Facebook page. 🙂

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We have a beautiful job where we have the opportunity to help people reduce their pain, be stronger and to have less disabilities. But, we as physiotherapists have to do better!

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A2 Listen to patients and respect their concerns and preferences

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A2 Listen to patients and respect their concerns and preferences

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A3 Give patients the information they need in a way that they can understand

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A3 Give patients the information they need in a way that they can understand

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MSD MANUAL - A comprehensive medical information source covering thousands of topics in all fields of medicine

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Our mission is simple:

The Manuals, first published in 1899 and now known as MSD Manuals outside the United States and Canada, are one of the world's most widely used medical information resources. The Manuals are committed to making the best current medical information accessible to health care professionals and patients on every continent.

We believe that health information is a universal right and that every person is entitled to accurate and accessible medical information. We have a responsibility to protect, preserve and share the best current medical information to enable more informed decisions, enhance relationships between patients and professionals, and improve health care outcomes around the world.

That's why we are making the Manuals available for free in digital form in multiple languages to professionals and patients around the world.

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The Trusted Provider of Medical Information since 1899

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The Manuals, first published in 1899 and now known as MSD Manuals outside the United States and Canada, are one of the world's most widely used medical information resources. The Manuals are committed to making the best current medical information accessible to health care professionals and patients on every continent.

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A4 You must receive valid consent before examination and treatment

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A4 You must receive valid consent before examination and treatment

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Patients’ capacity to give consent: guidance for osteopaths practising in England and Wales

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Example of an informed consent form for osteopaths OPS A4

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The creation of an informed consent form for osteopaths in clinical practice using a consensus process

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How can I explain the benefits of osteopathic treatment to my patients in a way that is meaningful to them? OPS A4

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A5 Work in partnership with patients to find the best treatment for them

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A5 Work in partnership with patients to find the best treatment for them

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A biopsychosocial approach to low back pain

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Acute low back pain - Beyond drug therapies

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Peer feedback Term 1 Week 6 YEAR 3

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Peer feedback Term 1 Week 6 YEAR 3

# data[].attributes.body
Peer feedback Term 1 Week 10 YEAR 3

# data[].attributes.body
Peer feedback Term 3 Week 10 YEAR 3

# data[].attributes.body
Peer feedback Term 1 Week 4 YEAR 4

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Children clinic Term 1 Week 1-6 YEAR 4

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Lecture about consent, risk & decision making

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Lecture about consent, risk & decision making

# data[].attributes.body
Mapped against OPS A2; A3; A4; A5

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Children clinic Term 1 Week 1-6 YEAR 4

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Adult clinic Term 1 Week 7-12 YEAR 4

# data[].attributes.body
Adult clinic Term 1 Week 7-12 YEAR 4

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Psycho-emotional aspects of Osteopathic Treatment: Helping you establish and maintain a healthy work-life balance

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LEPB 1/3 (formative) YEAR 3

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LEPB 1/3 (formative) YEAR 3

# data[].attributes.body
LEPB 2/3 (formative) YEAR 3

# data[].attributes.body
LEPB 2/3 (formative) YEAR 3

# data[].attributes.body
LEPB 3/3 (formative) YEAR 3

# data[].attributes.body
LEPB 3/3 (formative) YEAR 3

# data[].attributes.body
LEPB 1/3 (summative) YEAR 3

# data[].attributes.body
LEPB 3/3 (summative) YEAR 3

# data[].attributes.body
LEPB 3/3 (summative) YEAR 3

# data[].attributes.body
LEPB 1/3 (formative) YEAR 4

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Why Women's Health and Osteopathy?

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D1 You must consider the contributions of other healthcare professionals to ensure best patient care

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D1 You must consider the contributions of other healthcare professionals to ensure best patient care

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Improving global health through universal access to physiotherapy knowledge

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Our mission is to improve global health through universal access to rehabilitation knowledge

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Scoliosis SOS clinic OPS D1

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Non-Surgical Scoliosis Treatment | Scoliosis SOS Clinic

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Scoliosis clinic offering effective non-surgical therapy for scoliosis. Specialist scoliosis treatment in London, UK. Patients of all ages welcome.

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Database of prescription and generic drugs, clinical guidelines MIMS OPS D1

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Peer feedback Term 1 Week 1-6 YEAR 4

# data[].attributes.body
LEPB 2/3 (formative) YEAR 4

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2nd formative(1 meet, 2 well above, all the rest above).JPG

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Mapped against OPS A1; A2; A3

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6 evening conferences organized by Prof Renzo Molinari

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PIASTRI Margherita - Invoice Evening Talks 18-19

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LEPB 3/3 (formative) YEAR 4

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LEPB 3/3 (formative) YEAR 4

# data[].attributes.body
Mapped against OPS B1; B2

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D2 You must respond effectively to requirements for the production of high-quality written material and data

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D2 You must respond effectively to requirements for the production of high-quality written material and data

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D3 You must be capable of retrieving, processing and analysing information as necessary

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D3 You must be capable of retrieving, processing and analysing information as necessary

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D4 Make sure your beliefs and values do not prejudice your patient's care

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D4 Make sure your beliefs and values do not prejudice your patient's care

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D5 You must comply with equality and anti-discrimination laws

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D5 You must comply with equality and anti-discrimination laws

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D6 Respect your patients' rights to privacy and confidentiality

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D6 Respect your patients' rights to privacy and confidentiality

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D7 Be open and honest when dealing with patients and colleagues and respond quickly to complaints

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D7 Be open and honest when dealing with patients and colleagues and respond quickly to complaints

# data[].attributes.headline
D8 Support colleagues and cooperate with them to enhance patient care

# data[].attributes.subject
D8 Support colleagues and cooperate with them to enhance patient care

# data[].attributes.headline
D9 Keep comments about colleagues or other healthcare professionals honest, accurate and valid

# data[].attributes.subject
D9 Keep comments about colleagues or other healthcare professionals honest, accurate and valid

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D10 Ensure that any problems with your own health do not affect your patients

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D10 Ensure that any problems with your own health do not affect your patients

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D11 Be aware of your role as a healthcare provider to promote public health

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D11 Be aware of your role as a healthcare provider to promote public health

# data[].attributes.body
Healthcare Week

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Back care awareness week OPS D11

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London Marathon 2018 OPS D11

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Heart of Kent Hospice Walk25 OPS D11

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D12 Take all necessary steps to control the spread of communicable diseases

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D12 Take all necessary steps to control the spread of communicable diseases

# data[].attributes.headline
D13 Comply with health and safety legislation

# data[].attributes.subject
D13 Comply with health and safety legislation

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Assessing capacity of patients to get consent

# data[].attributes.body
Keeping up to date with legal requirements on advertising your practice OPS 13

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Note: This advice is given by the CAP Executive about non-broadcast advertising. It does not constitute legal advice. It does not bind CAP, CAP advisory panels or the Advertising Standards Authority.

Osteopaths are trained in therapeutic approaches that are suitable for a broad range of individuals, including pregnant women, children and babies. Osteopathic care is delivered through a range of interventions which may include onward referral, health management advice, manual therapy, exercise therapy and others. Osteopaths adapt their therapeutic approach depending on the individual needs of the patient and their presenting complaint. Manual therapy techniques employed may include articulation and manipulation of joints and soft tissues.

Osteopaths have been regulated by statute since 1993 by the General Osteopathic Council (GOsC) and may refer to conditions for which medical supervision should be sought if they hold convincing evidence of the efficacy of their treatments.

Which medical conditions can osteopaths claim to treat?

Based on evidence submitted to CAP prior to November 2016, the ASA and CAP accept that Osteopaths can claim to treat the following:

Arthritic pain
Circulatory problems
Cramp
Digestion problems
Fibromyalgia
Frozen shoulder/ shoulder and elbow pain/ tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
Headache arising from the neck (cervicogenic)
Joint pains
Joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
General, acute & chronic backache, back pain (not arising from injury or accident)
Generalised aches and pains
Lumbago
Migraine prevention
Minor sports injuries
Muscle spasms
Neuralgia
Tension and inability to relax
Rheumatic pain
Sciatica
Uncomplicated mechanical neck pain (as opposed to neck pain following injury i.e. whiplash)

If marketers use different medical terms to describe one of the above conditions, they may be asked to provide evidence to demonstrate that this description is generally agreed to have the same meaning as that approved condition.

Which medical conditions can osteopaths not claim to treat?

Any conditions that are not reflected above are likely to be problematic unless the marketer holds robust clinical evidence to support their claims.

Are claims to treat babies, children and pregnant women acceptable?

As regulated health professionals, osteopaths may refer to treating specific population groups such as pregnant women, children and babies. However, at present there is a limited or negative evidence base for the effectiveness of osteopathy in treating conditions specific to those groups, such as colic or morning sickness.

Consequently, references to treatment for symptoms and conditions that are likely to be understood to be specific to babies, children or pregnant women are unlikely to be acceptable unless the marketer holds a robust body of evidence.

Where an adequate evidence base has been established for the efficacy of osteopathic treatment for particular conditions in the general population, claims that do not materially depart from those already deemed acceptable by CAP and which describe interventions that are consistent with osteopathic practice, are likely to be acceptable.

The ASA has recently carried out a review of advertising claims in relation to the treatment of babies, children and pregnant women using osteopathy which explains in more detail the types of claims (including phraseology) that are likely to be acceptable and those that are not. Osteopathy: ASA review and guidance for marketing claims for pregnant women, children and babies.

Can I call myself a "Doctor"?

Claims such as "Dr" and "Doctor" are likely to be understood to mean that the Osteopath holds a general medical qualification. As such, Osteopaths not holding such a qualification should avoid references to "Dr" or claims that are likely to have the same meaning.

Updated on 2 December 2016.

More on

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Advertising Standards Authority | Committee of Advertising Practice

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Note: This advice is given by the CAP Executive about non-broadcast advertising. It does not constitute legal advice. It does not bind CAP, CAP advisory panels or the Advertising Standards Authority. Osteopaths are trained in therapeutic approaches that are suitable for a broad range of individuals, including pregnant women, children and babies.

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D14 Act with integrity in your professional practice

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D14 Act with integrity in your professional practice

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D15 Be honest and trustworthy in your financial dealings, whether personal or professional

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D15 Be honest and trustworthy in your financial dealings, whether personal or professional

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D16 Do not abuse your professional standing

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D16 Do not abuse your professional standing

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D17 Uphold the reputation of the profession through your conduct

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D17 Uphold the reputation of the profession through your conduct

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D18 You must provide the GOsC any important information about your conduct and competence

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D18 You must provide the GOsC any important information about your conduct and competence

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The management of patients suffering with chronic pain OPS A5

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Find the Right Information about Persisting Pain

Most of what you'll find on the internet about injuries and pain won't help you recover. There's lots of conflicting information that's difficult to navigate when you're struggling with pain and need actionable and trustworthy guidance. You'll find scary information about all of the damage that is happening inside your body.You'll find sources trying to sell devices, supplements and other unproven quick-fixes that are not backed by an up-to-date scientific and medical understanding of pain.Most people that need help don't get the full story about what pain is and how you can get back to living well again. It IS possible to recover from pain, even pain that has been persisting for a long time, and knowing what to do when plays a significant role in facilitating the process of recovery.

We're Listening to People in Pain

One of the most important things that people in pain need is for their health professionals to hear their stories. We've been searching, listening and asking questions of people all over the internet to find out what information people in pain are missing. Then we found the clinicians with the relevant expertise to answer those questions with the right advice.

Get Expert Advice from People Who Care

What you'll find on this site is helpful information for people in pain, informed by both the science of pain and the stories of people who have recovered from ongoing pain. We've asked health professionals, representing a variety of specialties, who have dedicated their lives to working with people in pain to share advice on how they help people get better from persisting pain. As a community of professionals, we want to sit alongside you and offer you some guidance that's sound on science and strong on compassion.

There is Hope and Help for Pain Recovery

Pain doesn't just happen in your back, or your neck, or your knees. Pain happens in your whole life. There are injuries, illnesses and challenges in life that often contribute to pain that can last far longer than is needed for healing. The often toxic social attitude and discourse regarding people struggling with persistent pain is a sad reality. Moreover, the capacity of the healthcare system to address the problem is limited and inadequate, as evidenced by the rising rates of chronic pain throughout the developed world despite an enormous amount of spending that is swelling to unsustainable levels. These social conditions are not fair for people in pain, nor do they foster recovery. As a community of concerned professionals, advocates, and human beings, we've come together to do something positive about it.
There's are many topics to talk about related to pain. You're going to get the stories and advice in bite-sized chunks you can easily use. Ready to get started?

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The Right Advice is your Best Pain Medicine | PainChats

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Most of what you'll find on the internet about injuries and pain won't help you recover. There's lots of conflicting information that's difficult to navigate when you're struggling with pain and need actionable and trustworthy guidance.

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Top quality education for therapists and trainers who want to use a movement-based approach for assessment, rehabilitation and training founded on the latest research and evidence in movement, pain and neuro sciences.

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Medical Imaging: The Untold Truth OPS A5

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A6 Support patients in caring for themselves to improve and maintain their own health

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A6 Support patients in caring for themselves to improve and maintain their own health

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Introduction to biomechanics and ergonomics, protocols for rest and movement designed to help recharge the mind, body and spirit

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Published

Is sitting really the new smoking? Will a standing desk save your aching back? Sort of...but not entirely. It's not which position we're in, but rather how long we stay that way, that can negatively affect our physical, mental and even emotional states. Those of us who spend long days stationed in front of a computer may know too well the day's end result of stiff muscles, tired eyes, sore joints, and foggy brains. This presentation will provide a basic introduction to biomechanics and ergonomics, and include brief protocols for rest and movement designed to help recharge the mind, body and spirit. Takeaways may include reduced fatigue, clearer thinking, tension relief, and, ultimately, increased productivity.
Presentation Slides "
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Jessica Gardner: Movement Tips for Desk Workers

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Is sitting really the new smoking? Will a standing desk save your aching back? Sort of...but not entirely. It's not which position we're in, but rather how long we stay that way, that can negatively affect our physical, mental and even emotional states. Those of us who spend long days stationed in front of a...

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B1 You must understand osteopathic concepts and principles, and apply them critically to patient care

# data[].attributes.subject
B1 You must understand osteopathic concepts and principles, and apply them critically to patient care

# data[].attributes.headline
B2 You must have sufficient knowledge and skills to support your work as an osteopath

# data[].attributes.subject
B2 You must have sufficient knowledge and skills to support your work as an osteopath

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Definitions and physiology of back pain, referred pain and radicular pain

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Management of LBP and sciatica OPS B2

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The BNF & BNFC App provides practical, evidence-based medicines information B2

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Search or browse

Quickly find information about drugs and the management of common medical conditions

BNF and BNF for Children

Easily switch between adult and child content; colour-coded to aid navigation

Check drug interactions

Effortlessly identify interactions between a combination of drugs, with the most important interactions clearly highlighted

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Quickly find information about drugs and the management of common medical conditions Easily switch between adult and child content; colour-coded to aid navigation Effortlessly identify interactions between a combination of drugs, with the most important interactions clearly highlighted

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B3 Recognise and work within the limits of your training and competence

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B3 Recognise and work within the limits of your training and competence

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Improving health and social care through evidence-based guidance

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C1 You must be able to conduct an osteopathic patient evaluation sufficient to make a working diagnosis and formulate a treatment plan

# data[].attributes.subject
C1 You must be able to conduct an osteopathic patient evaluation sufficient to make a working diagnosis and formulate a treatment plan

# data[].attributes.headline
C2 You must be able to formulate and deliver a justifiable osteopathic treatment plan or an alternative course of action

# data[].attributes.subject
C2 You must be able to formulate and deliver a justifiable osteopathic treatment plan or an alternative course of action

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The Problem with a (Entirely) Structural Based Approach to Low Back Pain

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The Problem with a (Entirely) Structural Based Approach to Low Back Pain

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The problem with a (entirely) structural based approach to low back pain…. Is there may actually be no problem. This sounds like channeling the girl from the Matrix proclaiming there is no spoon, b…

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C3 Care for your patients and do your best to understand their condition and improve their health

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C3 Care for your patients and do your best to understand their condition and improve their health

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National Institute for Health Research (NIHR)

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The nation's largest funder of health and care research, providing the people, facilities and technology for research to thrive.

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How to sit correctly OPS C3

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Osteoporosis - Information and Support OPS C3

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Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, which can lead to increased risk of fracture. Known as the "silent thief", bone deterioration can occur over a number of years without presenting any symptoms. Unfortunately, if detected at the time of a break, the disease is already fairly advanced. The most common fractures associated with osteoporosis are in the hip, spine, wrist, and shoulder. Today, no single cause for osteoporosis has been identified.
Find Out More

At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime

2 million Canadians are affected by osteoporosis

Peak bone mass is achieved at an early age (16-20 in young women and 20-25 in young men), so building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later in life.

View More Facts

Donate

Osteoporosis Canada, a registered charity, is the only national organization serving people who have, or are at risk for, osteoporosis. We work to educate, empower and support individuals and communities in the risk-reduction and treatment of osteoporosis. But we can't do it alone.

Donate Now

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Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, which can lead to increased risk of fracture. Known as the "silent thief", bone deterioration can occur over a number of years without presenting any symptoms. Unfortunately, if detected at the time of a break, the disease is already fairly advanced.

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Arthritis Foundation - Living with arthritis OPS C3

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National Ankylosing Spondylitis Society (NASS) - Information and Support OPS C3

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NASS is dedicated to transforming the treatment and care of axial spondyloarthritis (anklyosing spondylitis) care in the UK. We offer information and support.

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C4 Be polite and considerate with patients

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C4 Be polite and considerate with patients

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C5 Acknowledge your patients' individuality in how you treat them

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C5 Acknowledge your patients' individuality in how you treat them

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PhysioTools Online - Home Exercise Programs

for physical therapy, rehabilitation and fitness

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C6 Respect your patients' dignity and modesty

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C6 Respect your patients' dignity and modesty

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C7 Provide appropriate care and treatment 

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C7 Provide appropriate care and treatment 

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Exercises for Ankylosing Spondylitis (AS)

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What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (AS) is an inflammatory condition that affects the joints in your spine. Spondylitis simply means inflammation of the spine.

As part of the body's reaction to inflammation, calcium is laid down where the ligaments attach to the bones that make up the spine (vertebrae). This reduces the flexibility of your back and causes new bone to grow at the sides of the vertebrae. Eventually the individual bones of the spine may link up (fuse). This is called ankylosis and can be seen on x-rays.

Ankylosing spondylitis typically starts in the joints between your spine and pelvis, but it may spread up your spine to your neck. It can sometimes affect other parts of the body, including your joints, tendons or eyes.

Ankylosing spondylitis varies from person to person - your symptoms might be so mild that you can almost forget you have the condition, but if they're more serious it could have a big impact on your quality of life.

Ankylosing spondylitis is one of a group of conditions known as 'spondyloarthritis' (pronounced as spond-ee-lo-arthritis). These conditions share many of the same symptoms.

Related conditions

There are a number of conditions related to ankylosing spondylitis which have many similar symptoms:

Non-radiographic ankylosing spondylitis and undifferentiated spondyloarthritis (uSpA) have similar symptoms to ankylosing spondylitis but x-rays won't show the signs of damage to your joints. Sometimes people with these conditions are later diagnosed with ankylosing spondylitis.

Psoriatic spondyloarthritis is a form of psoriatic arthritis which occurs in association with the skin condition psoriasis.

Spondyloarthritis associated with inflammatory bowel disease (or enteropathic arthritis) is related to bowel conditions such as Crohn's disease or ulcerative colitis.

Reactive arthritis (which used to be known as Reiter's syndrome) is diagnosed when your arthritis is a reaction to an infection.

Enthesitis-related arthritis is the name used when children and teenagers develop arthritis of the entheses, the sites where tendons and ligaments attach to bone.

Some doctors use the terms spondarthritis, spondyloarthropathy, spondyloarthritides or seronegative spondyloarthritis. These terms all describe types of arthritis belonging to the same group of conditions as ankylosing spondylitis.

Who gets ankylosing spondylitis?

Ankylosing spondylitis can affect anyone, although it's most common in young men and most likely to start in your late teens or 20s.

The genes you inherit from your parents may make you more likely to develop AS, but the condition isn't passed on directly. Most people with ankylosing spondylitis have a gene called HLA-B27, which can be detected by a blood test. This gene isn't the cause of ankylosing spondylitis but it does contribute to it.

Having this gene doesn't mean you'll definitely get AS, and the blood test isn't very useful in diagnosing the condition. Even in families where somebody's been diagnosed with ankylosing spondylitis there may be brothers or sisters who have the HLA-B27 gene but who don't have the condition.

Versus Arthritis has recently awarded grants for a project which will aim to understand how genes combine to cause AS and find out how alterations in gene regulators influence AS.

Symptoms

In the early stages, ankylosing spondylitis and the related conditions are likely to cause:

stiffness and pain in the lower back in the early morning which eases through the day or with exercise

pain in the sacroiliac joints (the joints where the base of your spine meets your pelvis), in the buttocks or the backs of your thighs.

Some people first notice problems after a muscle strain, so the condition is often mistaken for common backache. However, stiffness that lasts at least 30 minutes in the morning helps to distinguish ankylosing spondylitis from simple back pain. The symptoms may also occur after rest, or may wake you in the night.

You may also have neck, shoulder, hip or thigh pain, which is often worse if you've been inactive for a time, for example if you work at a computer. Some people have pain, stiffness and swelling in their knees or ankles. In psoriatic arthritis, the smaller joints of the hands and feet may be affected. For some people, especially children and teenagers, the first signs may be in their hip or knee rather than their back.

Inflammation can occur anywhere in the body where tendons attach to bone (this is called enthesitis), for example, at the elbow and heel. Inflammation comes and goes so the symptoms may vary over time.

The inflammation that causes these symptoms comes and goes, so the degree of pain can vary over time and from person to person. If the condition is mild and only affects the sacroiliac joints, it may go almost unnoticed, but if most of the spine is affected it can cause difficulty with activities that involve bending, twisting or turning.

Other possible symptoms include:

tenderness at the heel - This makes it uncomfortable to stand on a hard floor. Inflammation can occur at the back of your heel where the Achilles tendon meets the heel bone, or in the tendon in the arch of the foot which is known as plantar fasciitis.

pain and swelling in a finger or toe - When the whole digit is swollen it's known as dactylitis.

tenderness at the base of your pelvis (ischium) - This makes sitting uncomfortable.

chest pain or a 'strapped-in' feeling that comes on gradually - If your spine is affected at chest level (the thoracic spine) it can affect movement at the joints between the ribs and the breastbone, which makes it difficult for you to take a deep breath. Your ribs may be very tender, and you may feel short of breath after even gentle activity. Coughing or sneezing may cause discomfort or pain.

inflammation of the eye (uveitis or iritis) - The first signs of this are usually a red (bloodshot), watery and painful eye, and it may become uncomfortable to look at bright lights. If this happens, or if you develop blurred vision, it's important to get medical help within 24-48 hours. The best place to go is an eye casualty department - this might not be at your local hospital. Your GP surgery, local A+E or your optician will know where the nearest eye casualty department is. Treatment is usually with steroid eye drops, which are generally very effective. Some people get repeated attacks of eye inflammation, but they're extremely unlikely to cause permanent damage if they're treated promptly.

inflammation of the bowel - People with ankylosing spondylitis can develop bowel problems known as inflammatory bowel disease (IBD) or colitis. Tell your doctor if you have diarrhoea for more than 2 weeks or begin to pass bloody or slimy stools. You might be referred to a bowel specialist (gastroenterologist). Symptoms of IBD can vary, but it can usually be treated successfully with medication. Sometimes treatments like non-steroidal anti-inflammatory drugs (NSAIDs) can make bowel problems worse, so you might be advised to stop taking them.

tiredness (fatigue) - This may be caused by the activity of the condition, anaemia or sometimes depression and frustration associated with the condition.

How will ankylosing spondylitis (AS) affect me?

Ankylosing spondylitis (AS) and the related conditions are quite variable and difficult to predict. They can cause a lot of pain, although treatment will help to ease this. You may have times when the symptoms become worse and other times when you find it easier to cope with the pain and stiffness. AS can make you feel generally unwell, lose weight or tire easily.

Most people with a spondyloarthritis have some stiffening in the spine, usually in the lower back. This can be painless and may not interfere with physical activity because the neck, hips, limbs and the upper part of your spine can remain quite mobile. However, if more of your spine stiffens or your knees or hips are affected, you may have more difficulty with mobility. Treatment can help prevent these mobility problems.

Very rarely, there may be complications affecting the heart, lungs and nervous system. The valves in the heart may leak, which can put it under more strain. And long-term inflammation and tissue scarring in the lungs can reduce rib movement, which means you can't take in a full breath. Very rarely, the top of the lungs may become scarred. Fewer than 1 in 100 people with ankylosing spondylitis have these problems, and they are even less common in other types of spondyloarthritis. Even so, if you smoke, it's extremely important to try to stop because smoking is likely to add to any heart or lung problems.

People with ankylosing spondylitis, especially those who've had the condition for a long time and whose vertebrae have fused, are at increased risk of spinal fractures following a trauma (for example, a fall or car accident). Spinal fractures can cause nerve damage, so it's important to tell any doctor treating you following trauma that you have ankylosing spondylitis, especially if you have new unexplained pain in your spine or new weakness or tingling in your arms or legs. The fracture may not show easily on x-rays, so you may need a magnetic resonance imaging (MRI) or computed tomography (CT) scan.

Some people with ankylosing spondylitis develop osteoporosis (thinning of the bones), and it's important that this is treated. Your doctor may suggest you have a bone density (DEXA) scan to check for this.

Diagnosis

Most back pain isn't caused by ankylosing spondylitis (AS). However, the symptoms, especially in the early stages, can be very similar to more common back problems. Because of this, many people put up with the pain for some time before seeking help. When you first see your doctor, there may be little to show whether the problem is ankylosing spondylitis or some other, more common, back problem. Unfortunately, ankylosing spondylitis may even be misdiagnosed at first. Ankylosing spondylitis is normally diagnosed by a rheumatologist.

There's no specific test that will confirm you have ankylosing spondylitis, so diagnosis involves piecing together information from different sources, including:

the history of your condition (including whether pain and discomfort is waking you during the second half of the night)

a physical examination

blood tests, which may show inflammation.

What tests are there for ankylosing spondylitis?

A blood test can sometimes show if there's inflammation in the body. You'll probably have one or more of these tests:

C-reactive protein (CRP)

erythrocyte sedimentation rate (ESR)

plasma viscosity (PV).

These all test for inflammation, so they give similar information. Different laboratories use particular tests. Only 30-40% of people with ankylosing spondylitis have inflammation that can be picked up in a blood test, so in many cases these blood tests will be normal.

Another blood test can confirm whether you have the HLA-B27 gene. Most people with ankylosing spondylitis test positive for HLA-B27, but so do some people who don't have the condition. A positive test may point to AS but it won't confirm the diagnosis.

X-rays sometimes help to confirm the diagnosis, though they generally don't show anything unusual in the early stages. As the condition progresses new bone develops between the vertebrae, which will be visible in x-ray images. However, it may be several years before these signs show up in x-rays. Magnetic resonance imaging (MRI) scans may show changes in the spine or sacroiliac joints at an earlier stage of the disease.

You may need further tests, especially in the early stages. MRI scans may show the typical changes in your spine and at the sacroiliac joints at an earlier stage of the disease and before changes can be identified on x-rays.

Treatment

A number of treatments are available that can ease pain and stiffness, but exercise and close attention to your posture are just as important to keep the spine mobile and help you to live a normal life.

Drugs

Physical therapies

Surgery

Drugs

Physical therapies

Surgery

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Managing your symptoms

Self-help measures, especially exercise, can help to minimise the long-term effects of ankylosing spondylitis (AS).

Exercise

Diet

Pain management

Complementary therapies

Supports, aids and gadgets

Sleep

Feet and footwear

Smoking

Posture

Exercise

Diet

Pain management

Complementary therapies

Supports, aids and gadgets

Sleep

Feet and footwear

Smoking

Posture

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Living with ankylosing spondylitis

Sex, pregnancy and children

Work

Driving

Life insurance

Sex, pregnancy and children

Work

Driving

Life insurance

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Exercise

Contact sports such as rugby, hockey or basketball aren't generally recommended if you have advanced disease as your joints and spine may be more easily injured, but there are plenty of other activities that are suitable. If you enjoy competitive sports, volleyball and badminton are both low-impact.

Pilates, yoga and t'ai chi may also be useful as these can help with posture and flexibility.

Swimming is one of the best forms of exercise because it uses all of your muscles and joints without jarring them. If you have limited neck movement, breaststroke and front crawl may become more difficult, and if you swim with your head up it can make neck pain worse. Using a snorkel can be helpful. Speak to a physiotherapist for advice if you have discomfort when swimming, as a different stroke or modification to your technique can often help. As an alternative to swimming, ask for a programme of exercises you can do in the pool.

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Ankylosing spondylitis (AS) is an inflammatory condition that affects the joints in your spine. Spondylitis simply means inflammation of the spine. As part of the body's reaction to inflammation, calcium is laid down where the ligaments attach to the bones that make up the spine (vertebrae).

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