How figuring out what caused your Ankylosing Spondylitis flare-up can help you end it faster

The symptoms of ankylosing spondylitis flare-ups vary from person to person, but almost everyone experiences an onset of pain, stiffness and fatigue.

The frequency and severity of flares varies, with some people existing in an almost perpetual state of chronic inflammation (an ongoing flare). More common is a fluctuating state where symptoms become dramatically worse for a period of time then ease off once again.

Some flares seem to come out of nowhere, arriving without warning and derailing any plans for a normal, manageable life. More often, it’s possible to pinpoint what caused it. This could be anything from a physical injury to a stressful life experience or a change in the weather.

Being stuck in a flare is a lonely place.

In the midst of a flare, the sense of feeling trapped can be overwhelming, especially when combined with the brain-fog brought on by inflammation and lack of sleep. It brings with it a sense of hopelessness that life will never return to normal and the isolating thought that no one else can really relate.

If you’re in a flare-up right now I want to reassure you that you aren’t alone. And if you’re reading this, you might also be ready to try some new approaches to bring yourself relief.

What do you think triggered your last flare?

It’s helpful to figure this out, not only so that you can minimise the chances of it happening again but because it gives insight into how best to support yourself through this time.

Example One: The Stress Trigger

You may have been going through a particularly stressful situation and believe this is the cause of the flare (stress, conflict and grief are all common triggers for autoimmune flare-ups).

Even if you can’t change the situation that caused the stress, identifying this as the cause can prompt you to give extra attention to your nervous system. This might include trying strategies like meditation, deep breathing exercises, time in nature, writing down troubling thoughts in a journal or seeking additional support from a professional.

It might also signal that your gut is reacting to the steady stream of cortisol (the stress hormone) being produced when you are existing in a state of chronic stress. This interferes with your ability to digest and absorb nutrition, increases the permeability of your gut wall and promotes inflammation.

In response to this aspect you can aim to include more foods, supplements and lifestyle habits that support the health of your gut. By supporting both your digestive system and your nervous system you are getting to the root cause of what has prompted the flare up of symptoms and stand a better chance of the flare coming to an end.

Example Two: The Strain or Injury Trigger

You’ve been feeling better and decided to get back to nature and exercise with a couple of weekend hikes. All of a sudden you find yourself in a flare. The pain of your lower back and hips is excruciating – it’s keeping you awake at night and has put an end to something you were really enjoying.

In analysing the pain you start to wonder if the hiking was actually what set off the flare. You hadn’t tackled such hilly terrain in years and kind of went from 0-100, an unrealistic expectation. You realise that your hamstrings are incredibly tight and your core is weak, the perfect storm when it comes to setting off lower back pain (especially when walking at a steep incline). In hindsight you realise that even some simple stretching before and after may have helped.

In the meantime, you need to let your body recover. Possible strategies could include some physio or physical training with someone who understands AS and your areas of weakness. Acupuncture, epsom salt baths, hydrotherapy exercises and gentle stretching all feel like good approaches to supporting the system that was put under pressure and caused your flare. Taking a collagen supplement and magnesium could also be ideas to research further.

Questions to ask yourself when in a flare

Looking deeper into what caused your ankylosing spondylitis to flare-up can be an effective strategy to get back on your feet and prevent it happening again. It can also give you back a sense of control when it comes to managing your health. Ask yourself these questions next time your symptoms spike:

What do I think caused this to happen?

What can I do now to best support my body in recovering?

What help do I need to enlist right now to help me get through this?

How can I make sure this doesn’t happen to me again?

Lastly, it’s important to let your doctor know when a flare is beyond what you can stand. Tolerating excessive pain is NOT a badge of honour and can create a vicious inflammation-cycle that is hard to get out of. Part of good self-management with AS is knowing when to put your hand up and ask for help.