Start where you are

Let's say you want to start training, but you have no idea what type of workout or exercises would be appropriate for you. It is important to determine what your limitations are prior to starting a training regimen. This will help you better decide your training goals, both in the short term and in the long term. In order to help you figure this out, I’ve formulated a continuum that will enable you to better understand your current restrictions and that will empower you to curb further joint degeneration. Once you know where you are starting from, a tailored program can be constructed to help you achieve your long-term goals, whether you want to lose weight, gain muscle or play a sport.

Whatever the stage you find yourself, our main objective behind all the training and mobility drills is to prevent falling along the continuum to the next stage. In some cases, participants can even experience increases in mobility, though these increases are challenging and de-fusion of the spine is highly unlikely. Remember that bone formation and breakdown are dynamic processes. These processes are affected by AS but also by training stresses, diet, genetics and environment. If you work at increasing your mobility through training, diet and environment, you can hope to tilt the balance of these forces toward greater mobility over time - the opposite of ankylosing.

How to identify your current state:

Category 0.5 : Intermittent inflammation
Inflammation of the axial skeleton is present but it comes and goes. You may or may not have a diagnosis of spondylitis. This stage can also be a remission stage where you have reduced your inflammation from category 1. In this stage your training regimen will focus on large, multi-joint movements major, joint function and mobility drills. Stress should be increased progressively while being careful to stay below the threshold of inflammation.

Category 1 : Spondylitis
At this stage, you have chronic inflammation of the axial skeleton. Like many other spondyloarthropathies, you may have overlapping arthritic issues but the underlying inflammatory condition in the spine is present. There is no fusion of the spine at this point but you may have high levels of pain in various areas of the body. Not everyone will develop fusion in their axial skeleton but because osteoproliferation is very difficult to predict, measures should be undertaken to maximize mobility preventatively. Statistically, most people suffering from AS will experience some measure of spinal fusion, but this is just a statistic not a hard and fast rule (just like "most people get fat as they get old"). You can be an exception to the statistical trend by doing all you can to resist immobility.

Category 2: Spondylitis + partial fusion
This stage shows fusions of 2 or more vertebrae. This can be anywhere along the spine (cervical, lumbar, thoracic, SI) but you must be able to identify the fused areas so that when you are training, you can concentrate your mobility drills in the areas above and below the fused segments. If important osteoproliferation has commenced, postural work must be the major emphasis to prevent fusion of the spine in a forward kyphotic posture.

Category 2.5: Spondylitis and segmental fusion
In this stage, several adjacent vertebrae will have fused in an area along the spine. Once again, you must be able to identify the fused areas and concentrate your mobility drills in the areas above and below the fused segments to keep as much movement in these non-fused segments as possible. Postural work is still the primary emphasis in trying to avoid kyphotic posture — this forward head position can be very debilitating in everyday activities.

Category 3: Full fusion
At this point there is no turning back on the position at which your spine has fused. However, work can be done on the adjacent joints such as the shoulders and hips. In an effort to keep a maximum of functional capacity, work on such qualities as balance, core bracing and strength should be the mainstays of your training regimen.

Stay tuned:
In upcoming articles, I'll give you some sample workout ideas for each of the categories. Be sure to like my Facebook page to get all the updates as they happen.

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