Back Braces for Ankylosing Spondylitis: Do They Work?

If you have ankylosing spondylitis (AS), you may have heard that a back brace could help reduce back pain and maintain good posture. While temporary bracing can support the spine to control your pain, it is not a long-term solution for pain reduction or correcting postural problems. 

Finding the right tools to manage ankylosing spondylitis symptoms can sometimes feel like searching for a needle in a haystack. There are many options; braces and other assistive devices for AS are not one-size-fits-all devices. It may take trial and error until you find the best tools for your needs. 

This article explores using back braces, orthotics, and other assistive devices for ankylosing spondylitis. 

Why Use a Back Brace for AS

Chronic low back pain and stiffness are the most common symptoms of AS, which usually feel worse after long periods of rest or sleep and tend to improve with exercise. Wearing a lumbar support brace may relieve pain by taking pressure off the spinal vertebrae (spinal bones) and limiting motion. Bracing may also relax tense muscles to prevent muscle spasms.

At the onset of the disease, AS usually affects the sacroiliac joints that connect the spine to the pelvis. As the disease progresses, AS can impact the entire spine and lead to postural deformities such as:

• Kyphosis: Curvature of the upper spine that leads to a rounded upper back and a permanent stooped-over, hunchbacked posture. Kyphosis can cause upper back and neck pain. 
• Bamboo spine: In advanced AS, the spinal vertebrae may fuse together into one long, rigid bone. Known as bamboo spine, this can limit mobility and flexibility and affect your quality of life. 

Though a brace may seem effective in preventing or reducing postural problems, no research supports using back braces to treat AS. The Arthritis Foundation suggests that wearing a brace to correct AS-related posture problems is not practical or effective. Exercises for ankylosing spondylitis may help manage symptoms and improve posture in people with AS. 

Other Types of Assistive Devices to Use Instead

Pain and stiffness can make it challenging to carry out day-to-day tasks, especially during AS flare-ups (or flares, times of sudden or worsening symptoms). Rather than push through the pain, you may want to consider using assistive devices to minimize discomfort and make daily life more manageable. 

There are many types of gadgets, tools, and other devices available. What works for you will depend on your symptoms, lifestyle, and needs. If recently diagnosed, you may not need these devices, but people with advanced AS may find these tools help foster independence and maintain a good quality of life.

For Mobility

Mobility aids such as these can make it easier to get around at home, at work, and while you're out and about:

• Cane: If one side of your body hurts more than the other, a walking cane can alleviate pressure on sore joints in the lower body and help improve balance to reduce the risk of falls.
• Walker with wheels and a seat: When you’re fatigued and in pain during a flare, pushing a walker can help you get around. The seat gives you a place to stop and rest as needed.
• Mobility scooter: If you have trouble moving for long periods, a mobility scooter can help you participate in activities that require a lot of walking.
• Shoe orthotics: Heel pain is common in AS. Orthotics designed to relieve foot pain can make it easier to be on your feet for long periods. Custom-made orthotics, in particular, are built to your specific needs to relieve pressure on certain areas of the foot, such as the heel.

For Pain

Pain management is an important part of living with ankylosing spondylitis. In addition to taking medications prescribed by your healthcare provider, specific tools, such as the following, may help reduce joint pain and stiffness:

• Heating pads: Heat therapy can temporarily soothe achy joints and relax tense muscles. Electric heating pads may be helpful at home or in the office. Cordless heating pads, microwaveable heated pouches, and pillows are great for on-the-go use.
• Transdermal pain patches: Over-the-counter (OTC) pain patches (e.g., Salonpas) are designed to offer temporary relief for mild to moderate pain. These patches contain topical analgesic medications that are absorbed through the skin to reduce inflammation and pain. Patches come in various sizes and are easy to transport for use in the car, at work, and while traveling.
• Transcutaneous electrical nerve stimulation (TENS): A TENS machine sends electrical pulses through the skin to block nerve pain signals to the brain. Research results are mixed on the effectiveness of TENS in relieving AS pain, but some people may find it provides temporary relief.

For Everyday Tasks

Daily tasks can be challenging when you’re experiencing an AS flare. Assistive devices can help you perform everyday tasks with minimal pain, including:

• Dressing devices: Pain from AS is often worse in the mornings, which can make getting dressed feel like a Herculean feat. Tools like sock aids to pull up your socks and long-handled shoehorns to slip your feet into your shoes can help you get dressed without bending. Zipper pulls and button hooks can help make dressing less painful too. 
• Grabber: A grabber or reaching tool can help you pick up items on the floor or up high without the excruciating pain that bending over or reaching up can cause. Easy to transport, grabbers can be helpful when running errands outside the home. 
• Kitchen tools: Adaptive kitchenware, such as electric knives and can openers, bristled gloves for cleaning, wide-handled cooking utensils, and specialized flatware for eating, are among the many types of assistive kitchen devices that can help take the pain out of mealtime. 
• Vehicle modifications: Research shows that 89% of people with AS have difficulty driving due to pain and stiffness. Transfer handles can make getting in and out of your vehicle easier. Side mirror extensions and wide-angled rearview mirrors can help you see better without straining your neck and back when turning your head. 

For Home and Office

Assistive tools can help keep your pain under control at work and home, such as:

• Ergonomic chairs and desks: Chairs with ergonomic features such as back support, adjustable height, armrests, and tilt capabilities are designed to facilitate optimal posture and maximize comfort. Standing desks come with adjustable height and tilt to help minimize pressure on your joints while you work. 
• Seat cushions and raised seats: Well-placed seat cushions and raised chairs can help reduce the pain of sitting and standing. Different options are available, with armchairs, sofas, and kitchen tables.
• Shower handrails and seats: When you’re having a flare, getting into and standing in the shower can be difficult. Shower handrails can support your weight to make getting in and out easier, and a bath/shower seat allows you to sit and take the pressure off your joints as needed.
• Toilet aids: Bidets and long-handled wiping aids can eliminate the need to twist, bend, and turn to help you wipe while on the toilet. Height-adjusted toilet seat cushions help with getting on and off the toilet.
• Mattress and lumbar support pillows: Pain and stiffness often feel worse at night with AS. A firm mattress with sufficient cushioning will distribute your body weight evenly to prevent too much pressure on your back and achy joints. Lumbar support pillows fit in the curve of your spine to relieve back strain and pressure as you sleep.

Accessing AS Aids and Therapy Tools 

With so many options, shopping for assistive devices can be overwhelming. Before making any decisions, you may want to consult your healthcare provider or an occupational therapist (OT). They can assess your symptoms and help you find the right tools to meet your needs. 

Assistive devices, tools, and gadgets can also be expensive. Even lower-cost ankylosing spondylitis aids can add up quickly when you need a few. Fortunately, there are ways to get help with covering the costs, including:

• Health insurance: If your healthcare provider prescribes the device as medically necessary, private health insurance, Medicare, Medicaid, and Tricare should cover at least part of the cost. Call the number on the back of your insurance card to ask about your plan’s coverage for assistive aids and what you may expect to pay out-of-pocket. 
• Employer and/or state vocational rehabilitation (VR) agency: If you plan to use assistive aids at work, your employer or your state’s vocational rehabilitation agency may pay for the device. 
• Supplemental Security Income (SSI) Plan to Achieve Self-Support (PASS): If you are an SSI beneficiary, SSI may provide funding through their PASS program to help pay for adaptive equipment needed to achieve a specific work goal.
• Department of Agriculture (USDA): If you live in a rural area in the United States, your local USDA office may have grant or loan programs to help cover the costs of home adaptations.
• Charitable programs: Some national, state, and local charities offer medical equipment and assistive devices. Some charities are disease-specific, and others require you to meet specific eligibility requirements to access free equipment.
• Medical equipment exchange programs: Many states have medical equipment exchange and repair programs that offer low-cost or free adaptive devices. Search for local programs in your area. 

Summary 

Ankylosing spondylitis (AS) is a form of inflammatory arthritis characterized by low back pain and stiffness. As the disease progresses, AS can lead to spinal deformities such as kyphosis (a hunched back) or bamboo spine.

Some people with AS wear a brace for pain relief or to maintain good posture. However, bracing is not a long-term solution for pain reduction or correcting postural problems.

Symptoms of AS can make getting through daily tasks difficult or even impossible. Assistive devices, tools, and gadgets can help you function at work, home, and when out and about. These tools are designed to control pain and/or support proper spinal alignment to help people with AS maintain their independence and live well.

Health insurance, government programs, and charitable organizations may help cover the costs of devices to ensure those who need them can access these tools.