Full range of orthopedic services from diagnosis to rehabilitation. We provide assistance with injuries and diseases of the joints, as well as sports injuries.
Rehabilitation After Arthroscopy: What You Need to Know
After joint arthroscopy, it is necessary to restore movement, weight-bearing ability, muscle strength, and the capacity to tolerate everyday activity.
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Shoulder and Arm Pain: Causes and Treatment
The shoulder has a wide range of motion, which makes it particularly sensitive to injuries, overuse, and inflammatory changes.
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Intra-Articular Injections: Indications and Risks
Intra-articular injections are a common treatment option for joint pain. They may provide relatively rapid relief, improve mobility, and help a person return to everyday activities.
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Ankylosing Spondylitis: What It Is, Symptoms, and Diagnosis
Ankylosing spondylitis, also known as Bechterew’s disease, is a chronic inflammatory condition that affects the spine and sacroiliac joints. Over time, it can limit mobility and significantly affect quality of life.
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Osteoarthritis of the Joints: Symptoms, Causes, and Treatment
Osteoarthritis is a chronic disease of the entire joint in which the articular cartilage gradually deteriorates, bone tissue changes, and the surrounding joint structures function less effectively.
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Rheumatoid Arthritis: Symptoms and Rheumatoid Factor
Rheumatoid arthritis is a systemic autoimmune inflammatory disease that affects the joints, tendon sheaths, and other tissues throughout the body.
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De Quervain’s Disease: Symptoms and Treatment Methods
De Quervain’s disease, also known as De Quervain’s tenosynovitis, is a condition affecting the first extensor compartment of the wrist. The thumb tendons pass through a narrowed tunnel and begin to glide with pain.
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Hygroma: Causes and Effective Treatment
A hygroma is a superficial, bony formation near a joint or tendon canal that most often appears on the hand, wrist, or fingers.
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Trigger Finger (Stenosing Tenosynovitis)
Stenosing ligamentitis disrupts the normal gliding of the finger tendon and gradually makes the usual hand movements more difficult. At first, a person feels stiffness, then a painful clicking appears, and at later stages the finger becomes fixed in a bent position.
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Why Does a Finger Hurt: Main Causes and Treatment
Pain in the finger appears after injury, overload, inflammation or compression of the nerve. The symptom itself does not indicate one specific problem, because the source of discomfort can be a joint, tendons, ligaments, nerve or surrounding soft tissues.
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Joint Contracture: Causes, Symptoms, Types, and Treatment Methods
Joint contracture is a persistent decrease in range of motion due to changes in the soft tissues and other structures around the joint. This condition interferes with everyday activities and can significantly worsen quality of life.
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Can You Run with Osteoarthritis?
When running with arthrosis is possible, in which cases it is strictly not recommended, and what alternatives should be considered in order to maintain movement without harm to the joints - says Vasily Mellen, orthopedic surgeon and traumatologist of Mashtaler Ortho&Trauma Clinic.
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What Are Compression Stockings?
When people think about treatment of the musculoskeletal system, they usually imagine surgery, fixation, and exercise. However, there is another component that works almost unnoticed while significantly affecting the recovery process: compression stockings.
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Rehabilitation and Life After Hip Replacement
The pain that caused sleepless nights, restricted movement, and changed daily habits disappears. In the first days after surgery, patients notice that it becomes easier to stand up and sit down. It is a relief to stop thinking about every step.
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Innovative Bikini Approach for Hip Replacement Surgery
Bikini approach is a relatively new, minimally invasive method that is distinguished by its delicacy, less trauma and expressive aesthetics.
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Donor Meniscus Transplantation
This is an important milestone, as the procedure has been performed only eight times in Ukraine.
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Anterior Cruciate Ligament (ACL) Tear
The anterior cruciate ligament connects the femur and the tibia, helping stabilize the knee during bending, pivoting, and walking.
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Super Inductive System
Super Inductive System (also known as High-Intensity Magnetotherapy) is a modern, effective, and safe method of pain treatment that works without invasive intervention.
Ankylosing spondylitis, also known as Bechterew’s disease, is a chronic inflammatory condition that affects the spine and sacroiliac joints. Over time, it can limit mobility and significantly affect quality of life. In modern medical literature, the term ankylosing spondylitis is used more often, while the name Bechterew’s disease is gradually becoming less common. In the early stages, the condition is often mistaken for overuse, degenerative spinal changes, or ordinary back pain.
Below, we explain how the disease develops, its early symptoms, diagnostic methods, treatment options, and the warning signs that should not be ignored.
What Is Ankylosing Spondylitis and How Does It Develop?
Ankylosing spondylitis is a systemic rheumatological disease that belongs to the group of axial spondyloarthritis conditions. In international practice, the term ankylosing spondylitis is commonly used, while the broader modern term is axial spondyloarthritis.
The inflammatory process usually begins in the sacroiliac joints, where the pelvis connects to the lower spine. It may then spread to the intervertebral joints, ligaments, and the areas where tendons attach to bone.
In ankylosing spondylitis, the immune system maintains chronic inflammation. This leads to pain, stiffness, reduced spinal mobility, and, over time, the formation of bony bridges between the vertebrae.
Causes and Risk Factors of Ankylosing Spondylitis
There is no single everyday cause of ankylosing spondylitis. The condition develops gradually and is associated with several risk factors, including:
genetic predisposition, particularly the presence of the HLA-B27 marker;
a family history of spondyloarthritis, psoriasis, uveitis, or inflammatory bowel disease;
onset of back pain between the ages of 15 and 45;
male sex, although women can also develop the condition and are often diagnosed later;
smoking, which may worsen the disease course and increase the risk of structural spinal changes.
HLA-B27 is an important genetic marker, but its presence does not confirm the diagnosis. Some people carry this marker and never develop the disease. For this reason, diagnosis is based on a combination of symptoms, physical examination findings, and diagnostic imaging.
Early Symptoms of Ankylosing Spondylitis
The symptoms of ankylosing spondylitis usually develop gradually. A person may live with lower back pain for months and attribute it to sedentary work, sports, or fatigue while the inflammatory process continues.
A typical early sign is back pain lasting longer than three months. It becomes worse at night, may wake the person in the early morning, is accompanied by morning stiffness, and improves after movement.
Inflammatory back pain has several characteristic features:
onset at a young or middle age;
gradual development without one specific injury;
improvement after stretching, walking, or exercise;
little or no relief from rest;
pain in the buttocks that alternates from one side to the other.
If back pain and discomfort improve with movement rather than lying down, the condition is less likely to be caused by ordinary mechanical strain.
Main Symptoms and Signs of the Disease
The main symptoms are associated with the spine, joints, and the areas where ligaments and tendons attach to bone. Some patients also develop symptoms outside the joints, which are important for diagnosis.
The most common signs include:
pain in the lower back, sacrum, or buttocks;
stiffness after sleep lasting longer than 30 minutes;
limited ability to bend or rotate the torso;
pain in the thoracic spine;
reduced chest expansion during deep breathing;
pain and swelling in large joints, particularly the hips, shoulders, and knees;
heel pain caused by enthesitis;
persistent fatigue associated with active inflammation.
A separate warning sign is sudden redness of the eye accompanied by pain and sensitivity to light. This may indicate uveitis, which is often associated with spondyloarthritis and requires urgent examination by an ophthalmologist.
How Ankylosing Spondylitis Progresses
The course of the disease depends on the activity of inflammation, how quickly the diagnosis is established, the effectiveness of treatment, and lifestyle factors. Without proper control, the disease may gradually progress from functional pain to permanent structural changes.
Several stages can be distinguished:
Early inflammatory stage. Pain, stiffness, and nighttime awakening are present, but imaging may not yet show significant structural changes.
Stage of sacroiliitis. MRI may reveal active inflammation in the sacroiliac joints. X-rays may show structural changes if they have already developed.
Stage of spinal involvement. Persistent limitation of movement develops, and pain may spread above the lower back.
Late structural stage. Bony bridges, fusion of the vertebrae, and significant loss of spinal mobility may occur.
In the later stages, a person may lose the ability to bend normally, rotate the torso, or fully expand the chest. For this reason, early diagnosis is essential for preserving mobility in the future.
Spinal and Joint Involvement in Ankylosing Spondylitis
Ankylosing spondylitis most commonly affects the sacroiliac joints, lumbar spine, thoracic spine, and cervical region. The inflammation spreads along the axis of the body, which is why the condition is described as axial.
Over time, structures other than the joints may also be affected. These include ligaments, joint capsules, intervertebral connections, and entheses, where tendons and ligaments attach to bone.
Peripheral symptoms are also important. In some patients, joint pain appears before back pain or develops at the same time. Inflammation of large joints can significantly reduce the ability to walk, work, and tolerate physical activity.
Modern Diagnostic Methods for Ankylosing Spondylitis
Diagnosis requires a comprehensive approach. It is based on symptoms, physical examination, laboratory results, and diagnostic imaging.
During the examination, the doctor assesses:
the pattern of back pain;
the duration of morning stiffness;
spinal range of motion;
chest mobility;
pain in the sacroiliac joints;
signs of enthesitis, arthritis, uveitis, psoriasis, or bowel symptoms.
Functional tests may be used to assess mobility, including:
forward bending;
measurement of chest expansion;
assessment of the distance between the back of the head and the wall;
evaluation of posture and walking pattern.
These tests show how the disease affects the body in practice and help determine the next steps in treatment.
Laboratory Tests and Diagnostic Imaging
Laboratory tests help assess inflammatory activity and rule out other causes of pain. Basic tests may include:
a complete blood count;
C-reactive protein;
erythrocyte sedimentation rate;
HLA-B27 testing.
Normal C-reactive protein or erythrocyte sedimentation rate results do not rule out the diagnosis. In ankylosing spondylitis, structural changes may be visible on X-ray, while active inflammation may be detected with MRI.
Diagnostic imaging may include:
X-rays of the sacroiliac joints to identify structural changes;
MRI of the sacroiliac joints and spine when indicated;
CT when a more detailed assessment of bone changes is required;
ultrasound of the joints or entheses in patients with peripheral symptoms.
Treatment Methods for Ankylosing Spondylitis
Modern medicine cannot completely cure ankylosing spondylitis. However, appropriate treatment can reduce pain, suppress inflammation, preserve mobility, and lower the risk of severe vertebral fusion.
The main treatment approaches include:
Nonsteroidal anti-inflammatory medications. These reduce pain and stiffness, particularly when inflammation is active.
Physical therapy. The program may include spinal extension exercises, breathing exercises, posture training, and controlled strengthening of the back and abdominal muscles.
Biological therapy. TNF inhibitors and IL-17 inhibitors may be prescribed when disease activity remains high and standard treatment does not provide sufficient control.
Targeted synthetic medications. JAK inhibitors may be included in modern treatment plans for selected patients with active axial spondyloarthritis.
Local injections. Corticosteroids may be injected into an inflamed peripheral joint or enthesis when there are clear indications.
Medication treatment must be selected by a rheumatologist. Changing medications without medical supervision, interrupting biological therapy, or taking nonsteroidal anti-inflammatory medications for prolonged periods without monitoring can increase risks to the stomach, kidneys, cardiovascular system, and overall disease control.
The Role of Physical Activity and Lifestyle
Movement is an important part of treatment for ankylosing spondylitis. Rest does not relieve inflammatory back pain, while prolonged inactivity accelerates the loss of mobility.
The most beneficial activities include:
daily spinal extension exercises;
breathing exercises to maintain chest mobility;
swimming or walking;
gentle stretching without sudden movements;
posture training;
body weight management;
stopping smoking.
Physical activity should be increased gradually and adapted to the patient’s condition. It is best to exercise under the supervision of a rehabilitation specialist and follow an individualized program.
During an active flare-up, the exercise plan may need to be adjusted. During stable periods, the load can be increased gradually to maintain muscle strength, breathing function, and spinal mobility.
Possible Complications and Prognosis
The prognosis of ankylosing spondylitis depends directly on how early the diagnosis is established and how effectively inflammation is controlled. A person who starts treatment in the early stages has a much better chance of maintaining normal posture and mobility.
Without treatment, the disease can lead to persistent pain, loss of mobility, ankylosis, spinal deformity, and an increased risk of fractures after a fall. A fused spine becomes less flexible and is more vulnerable to injury.
Possible complications include:
fusion of the vertebrae, or ankylosis, leading to severe limitation of spinal mobility;
significant restriction of bending and rotation;
hip joint involvement;
recurrent episodes of uveitis;
osteoporosis;
inflammatory bowel disease;
reduced chest function caused by stiffness of the joints between the ribs and spine.
You should see a doctor if back pain lasts longer than three months, becomes worse at night, is accompanied by morning stiffness, or improves after movement.
In ankylosing spondylitis, early medical evaluation is the most effective way to control pain, preserve mobility, and maintain quality of life.
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