Aims of treatment

a. Facilitate skeletal mobility.

b. Prevent contractures.

2. Exercises. F.i,9.y.r§...,56:.l, .F.ig.yi§...56z2., .Figure, 56-3, F,i.g.u.re,..,5.6.-.4, Figure. .56-5, .F,i.g.u.r.e,..5.6.-6 and Fig.yie 5.6-Z are examples of appropriate exercises used in the treatment of patients with back involvement in ankylosing spondylitis and other seronegative spondyloarthropathies.

Chest Mobilization

FIG. 56-1. Chest mobilization (inspiration). Bend away from right side during inspiration.

Lateral Costal Deep Breathing

FIG. 56-2. Chest mobilization (expiration). Bend toward right side during expiration. Push fisted hand into the lateral aspect of chest as you bend toward the right side.

Lateral Costal Expansion Exercises

FIG. 56-3. Belt exercises for lateral costal expansion. Reinforce lateral costal expansion during inspiration. Assist with pressure along the rib cage during expiration. (Reprinted from the Saunders Group, Inc. © 1996.)

Flow Incentive Deep Breathing Exercises

FIG. 56-4. Deep breathing with an incentive inspirometer. For inspiration, use right side up and breathe in. For expiration, use upside down and breathe out.

Shoulder Blade Pinch

FIG. 56-5. Pectoral stretching (shoulder blade pinch). Stand or sit straight and tall. Pull your shoulders back, squeezing your shoulder blades together.

Hands Behind Head Pectoralis Stretch

FIG. 56-6. Pectoral stretching (hands behind head). Stand or sit. Place your hands behind your head with elbows in front. Move your elbows back as far as possible.

Pectoral Stretching

FIG. 56-7. Pectoral stretching (standing). Stand facing a corner. Put the palms of your hands on the wall. Slowly lean your chest into the corner. (Reprinted from the Saunders Group, Inc. © 1996.)

C. Osteoporosis. Weight-bearing activities such as brisk walking, biking, jogging, and working with a selected group of exercise machines can be an effective way to maintain and strengthen muscles while stimulating bone formation. These types of exercises and activities are referred to as impact-loading or weight-bearing exercises. An exercise program should consist of postural retraining, education in proper body mechanics, deep breathing, stretching, strengthening, and impact-loading activities. Extreme caution should be taken during forward flexion exercises of the spine because of the longer lever arm produced with increased flexion. An osteoporotic vertebral body may not be able to tolerate this load, and compression fracture with wedging may occur.

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