Background AxSpA encompasses the conditions Axial Spondyloarthritis (AS) and non-radiographic axial spondyloarthritis. [1] AxSpA patients often present with symptoms such as inflammatory back pain, stiffness, fatigue and joint swelling. [2] To date, optimal management of axSpA has included a combination of medical and therapy interventions. [3] Regular exercise and stretching are fundamental parts of AS rehabilitation that has been used for many years.

The protein Tumour Necrosis Factor- alpha (TNF) is often overproduced in axSpA leading to inflammation which can damage connective tissue structures. In the last decade, anti-TNF agents (biologics) have been used more regularly in the treatment of AS. [4]

Objectives To establish an evidence-base for a physiotherapy-led programme by:

• – Clarifying the effect of stretching exercise therapy for patients with axSpA

• – Determining whether exercise therapy is indicated in the management of axSpA patients receiving biologic therapy

Methods The search databases used were AMED, EMBASE, HMIC, BNI, Medline, PsycInfo, CINAHL, and HEALTH BUSINESS ELITE. The “PICO” approach to literature searching was used.

“'P' Patient/ population: Ankylosing Spondylitis, Axial Spondyloarthritis

“I” Interaction: Stretch*, Active, Passive, Dynamic, Resistant, Yoga, Pilates, Proprioceptive neuromuscular facilitation

“C” Comparison: Not applicable

“O” Outcomes: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI)

• – Stretching with other modes of exercise improves BASDAI, BASMI, and BASFI measurement

• – Individual specific stretching programs have better results than segmental stretching

• – Stretching with strengthening is a favourable approach with a focus on movement control

• – Possible decrease in inflammatory processes during stretching

• – Possible decreased occurrence of tendinopathy/ enthesopathy which may lower risk of ossification and associated stiffness

Conclusions There is evidence to support that exercise is beneficial for the axSpA patient, and research is beginning to study the components of such programs. Patients with axSpA on biologics should complete regular multi-modal exercise. Exercise works synergistically with Biologics to aid decrease of systemic inflammation. This review has shown that stretch is used as an integral part of patients' exercise programs. Only a few articles have looked specifically into the effects of stretching on axSpA, therefore it is difficult to give definitive recommendations regarding intensity and frequency. High quality studies are needed on axSpA patients completing specific postural stretches in a group setting, with further investigation into the impact on BASDAI, joint ROM and systemic inflammation. Different frequencies and intensities of stretching could then be studied.

1. Malaviya, A. Indian Journal of Rheumatology 2013, 8(3), 122–129.

2. Gyurcsik, Z. N., András, A., Bodnár, N., Szekanecz, Z., & Szántό, S. Rheumatology international 2012, 32(12), 3931–3936.

3. Ince, G., Sarpel, T., Durgun, B., & Erdogan, S. Physical therapy 2006, 86(7), 924–935.

4. Lubrano, E., Spadaro, A., Amato, G., Benucci, M., Cavazzana, I., Chimenti, M. S, … De Marco, G. Seminars in arthritis and rheumatism 2015, 44(5), 542–550.

Disclosure of Interest None declared