ankylosing spondylitis (AS) is an inflammatory disease of the spine and entheses, the areas where tendons and ligaments attach to bone. AS can also affect other parts of the body, including the hips.
When AS affects one or both hips, it can limit a person’s mobility. Fortunately, there are many treatment options to manage AS inflammation and pain and reduce the potential for disability from hip involvement.
This article covers how ankylosing spondylitis affects the hips and your options for managing hip pain and other symptoms.
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How does ankylosing spondylitis affect the hips?
AS inflammation often begins in the sacroiliac (SI) joints, the areas where the lower spine connects to the pelvis. It can also cause enthesitis (inflammation of the entheses) in SI joints and affect other joints, including ankles, feet, knees, ribs, and shoulders.
While it primarily affects the spine, hip involvement in AS is quite common. According to a 2017 report, the prevalence of clinical hip involvement in AS ranges from 24% to 36%. The prevalence of radiographic hip arthritis (detectable on imaging) in people with AS ranges from 9% to 22%.
The report’s authors also point out that synovial (joint lining) inflammation could be to blame. This type of chronic inflammation leads to bone erosion and joint space narrowing. The damage in the hips could be similar to what is seen in another type of inflammatory arthritis called rheumatoid arthritis.
According to a 2021 report, AS hip involvement is associated with high levels of disability. However, it can take many years for joint changes in AS to show up on x-rays.
While magnetic resonance imaging (MRI) scans are much more useful for detecting changes in AS early, they are not always used because of their cost. This means that by the time hip changes show up on imaging, AS is already advanced and has caused damage to the hips.
If you already have AS, your doctor may recommend changes to help you manage AS pain better and slow down further damage. If you start to notice pain and stiffness in one or both of your hips, tell your doctor right away.
How to relieve hip pain with ankylosing spondylitis
The primary goals in treating AS hip pain and other symptoms are to relieve your pain, maintain mobility, improve your quality of life, and reduce the potential for further damage or disability.
You have a number of options to do this, including home remedies for pain relief, exercise, losing weight, physical therapy and, as a last resort, surgery.
heat or cold therapy
Both heat and cold therapy can be helpful to relieve sore hips. You can use any method that gives you relief, or you can switch back and forth between hot and cold.
Heat can be applied two to three times a day for 20 minutes each time. You can use a heating pad or heat pack, or take a warm shower or bath.
For cold therapy, use ice or an ice pack on sore hips for about 20 minutes at a time to numb a sore area. You should put a thin cloth between the ice and your skin.
Use a foam roller
A foam roller is a cylindrical piece of foam that you can use to self-massage to treat sores on your body, including your hips. Research on the use of foam rollers has shown that they are an effective method for relieving hip pain.
You can ask a physical therapist or personal trainer to show you how to use a foam roller effectively and safely. They can recommend different types of foam rollers and the types of exercises that might help relieve your hip pain.
Stretching can help relieve both hip pain and stiffness, especially in the morning. Stretching can help you get moving and start your day on a positive note. A physical therapist can recommend some safe stretches for AS.
Exercise is good for everyone and can keep you strong and flexible. It can also help you maintain a healthy weight that keeps pressure off already inflamed joints, including the hips.
According to the Spondylitis Association of America (SAA), exercise is an essential part of your AS treatment plan. It can counteract some of the effects of AS and keep you mobile and flexible. It is also effective in treating AS pain and stiffness.
You should check with your doctor about what exercises are safe for AS hip symptoms. In general, walking, swimming, biking, yoga, and Pilates are safe for people with AS. Try to avoid high-impact activities, especially if they cause you pain.
Lose weight if you are overweight
Losing excess weight can help reduce stress on your hips and even relieve joint pain.
A 2018 study found that the more weight a person loses, the less joint pain they experience. This study looked at older adults with osteoarthritis who were overweight. They concluded that a 10 to 20% weight loss improved pain, function and overall quality of life better than a 5% weight loss.
Losing weight can also help reduce inflammation. According to a 2018 report, obesity can trigger and maintain low-level inflammation. The more inflammation there is, the more pain you will experience, and uncontrolled inflammation eventually leads to joint damage and disability.
Contact a physical therapist
Physical therapists can help people with AS maintain physical function and learn to manage pain and other symptoms. A physical therapist can teach you exercises that increase joint strength and muscle flexibility. They can help you improve your posture and exercise habits.
A physical therapist can also be a valuable resource in educating patients about AS. Your rheumatologist or other treating healthcare provider can help you find a physical therapist who is knowledgeable about AS.
Total hip surgery
Persistent inflammation in AS leads to destruction of the hip joint, reduced function and disability. About 5% of people with AS require hip surgery. Hip surgery is usually done to relieve pain and restore function.
According to the American Academy of Orthopedic Surgeons, hip surgery is one of the most successful procedures in medicine. In this procedure, damaged bone and cartilage are removed and replaced with prosthetic parts.
Total hip arthroplasty (total hip replacement) is commonly performed in cases where AS has severely limited hip function or has caused severe pain and mobility problems. It can also be performed in cases where there is joint ankylosis (fusion) to restore joint function even without pain.
According to a 2015 report in the Open Orthopedics Journal, a total hip replacement can offer people with AS significant relief and an overall improved range of motion.
For some people with AS hip involvement, total hip arthroplasty of one hip may not be enough to relieve pain and restore mobility. Bilateral total hip arthroplasty (both hips are replaced at the same time) is generally recommended for people with bilateral (bilateral) AS hip disease.
A 2019 systemic review (a summary of multiple sources of medical literature on a topic) in the journal EFORT Open Reviews examined the outcome of bilateral hip arthroplasties performed in people with AS. In all studies reviewed, there was a significant improvement in hip function, mobility, and patient satisfaction with the bilateral procedure.
If you have AS in your hips and think you would benefit from a total hip replacement, you should consult your doctor for more information. A GP can refer you to an orthopedist or surgeon who can best explain your options.
Ankylosing spondylitis is an inflammatory condition that primarily affects the spine and the areas where tendons and ligaments meet bone. AS can also affect other joints in the body, including the hips.
Hip pain in AS can be managed and managed with a combination of different therapies, including home remedies, exercise, weight loss, and surgery. If you have AS and are experiencing hip pain and stiffness, you should tell your doctor.
A word from Verywell
There is currently no cure for ankylosing spondylitis, but there are treatments that can help slow the progression of the disease and relieve symptoms and pain. By working with your healthcare provider to treat AS effectively, you can maintain mobility and enjoy a good quality of life.
If you experience pain or stiffness in one or both hips, contact your doctor. They may request imaging and other tests to determine the cause of your symptoms. Timely diagnosis is the best way to prevent hip damage and disability and improve your outlook.
frequently asked Questions
What does the pain feel like with ankylosing spondylitis?
People with ankylosing spondylitis often report pain that comes and goes. This pain can get worse with inactivity or sitting for a long time. The pain may be dull and feel like it’s coming from deep in the back or buttocks. Joint stiffness can also accompany the pain.
How is ankylosing spondylitis diagnosed?
A diagnosis of ankylosing spondylitis begins with a physical exam, during which your doctor tests your spine’s range of motion. They can also press on areas of the pelvis to determine which parts of the pelvis may be inflamed. Your healthcare provider may request imaging and laboratory tests to help with the diagnosis.
Can you cure ankylosing spondylitis?
Ankylosing spondylitis is not curable. However, treatment can help relieve symptoms and slow down inflammation that leads to spinal, hip, or other joint damage. Your healthcare provider’s goal for you will be to get you into remission and keep you there for as long as possible. Remission is a period when AS symptoms subside.