Managing flare-ups

Managing AS flare-ups

Professor Peter Youssef, Rheumatologist

It’s not uncommon for people living with AS to experience symptom flare-ups from time to time. What’s important is that you know how to manage them, so they don’t have a major impact on your ability to live the life you love.

While typical AS symptoms can range from stiffness or aches in your spine, hips and neck, flare-ups tend to be even more painful, and stick around. If you’ve experienced any of the below AS lingering or worsened symptoms, you may have experienced a flare-up:

  • Severe and lingering pain
  • Increased stiffness in the morning and at night, without improvement
  • Increased pain at night and upon waking
  • Restricted movement


Your rheumatologist and healthcare team are the best people to help you manage your flare-ups and advise you on a personalised management plan. In the meantime, here are a few of the ways people manage flare-ups and pain while living with AS.

1. Keep moving

Maintaining some form of exercise even during a flare-up is important. While you may need to modify exercise from what you usually do, low impact exercise like swimming or hydrotherapy (water-based exercise) or gentle stretching could also be a great way to go.

Find out more about exercises for AS.


2. Muscle Relaxation

Consider starting your day with a hot bath or shower, or in a hot pool using an aqua aid help soothe flare-up pain. Soaking in warm water reduces the force of gravity compressing the joints that offer 360-support for limbs, and can reduce swelling and increase circulation.1,2 But make sure you get up early! The maximum benefit of a hot bath occurs after 20 minutes of soaking.

Consider applying a heat pack or placing a hot water bottle over the painful area for 15 minutes may also help soothe the pain. If the joints feel hot and swollen, applying a cold pack to the area for 15 minutes may help to numb the pain and reduce swelling. Regardless of whether you are using a hot or cold pack, make sure the temperature of your skin has returned to normal, to prevent any tissue damage before reapplying the pack (suggest alternating 15 minutes on, 15 minutes off).1,2

3. Breathing exercises

Deep breathing exercises are not only a good tool in the short-term to help manage flare-up pain but they can also help longer-term too as they maintain chest expansion of the rib cage, preventing the bones, the spine and rib cage from fusing together. This is something that may happen as AS progresses leading to pain when breathing.3

4. Anti-inflammatory medications

Using pain relief during a flare-up can be helpful but it’s important that you only use anti-inflammatories following the advice of your rheumatologist and healthcare team and only as directed.

5. Invest in a good night’s sleep

Lying still for too long can contribute to painful inflammation and stiffness, which makes some people with AS wake up in the second half of the night. While getting a good night’s sleep is important all the time, it can be hard during a flare-up. A firm mattress, a flat pillow or no pillow at all may feel more comfortable.3

Occasional pain or discomfort may be expected when living with a chronic illness such as AS. But that doesn’t mean you should accept frequent flare-ups as the norm. If you’re suffering from persistent or painful flare-ups, the first step is to back yourself to talk to your rheumatologist and share how AS is impacting your life.

This information is general information for people with AS and may not suit all individuals. It does not take your own circumstances into consideration. Your team of healthcare professionals are the best people to advise you on what is suitable for you depending on the severity of your condition and your management plan.



  1. Arthritis Australia. Dealing with pain. Available at:
  2. Arthritis Foundation. Heat therapy helps relax stiff joints. Available at:
  3. Creaky Joints. The 10 worst side effects of ankylosing spondylitis, and how to cope with them. Available at:
Managing AS flare-ups

Ready to take control of AS?

Your rheumatologist and healthcare team are your best allies in taking control of AS. It doesn’t matter whether it’s been one or many years since your diagnosis with AS, it’s never too late.

If you think AS is holding you back or impacting your life, it’s time to talk to your rheumatologist about your goals and how you’re managing. Don’t let AS hold you back, take control.

Download the guide to help you make the most out of your conversations with your doctors.

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