Question
My artritis doctor never takes x-rays for my AS.  With a resent onset of new pain and flare up of previously controlled pain he sent me to Physical Therapy.....still no x-rays, tried to give me yet another pill.  The Phisical Therapist does not seem to know much about AS.  She said at my last visit that she thinks my C-1 or the top 2 vertebre in my neck are "stuck" Is it safe for her to manipulate my spine? What if it is fused could she break it?  

Answer
Nichole,

I am sorry to hear about the suffering you are living through.

Physical therapy is the preferred treatment of AS. Strengthening the muscles to improve poster is important. I would never let a physical therapist manipulate my spine without current x-rays so show exactly what is going on in the area. Also it is not a physical therapist job to diagnose. It is only to treat specific areas as prescribed by a doctor. A good physical therapist can see that there is a lack of mobility in the top of your neck but you cannot be sure what is causing it without taking a look. Occasionally in AS calcium can build up on the vertebrae and restrict mobility. This can sometimes be treated by a physical therapist properly trained in spinal manipulation but should never be performed until a proper diagnosis is made.

How long has it been sense your last xray and have you had a cat scan or MRI. As is usually a slow progressing disease and xrays are only necessary every few years to monitor the advancement of the disease unless there is an obvious change in your condition.

Various things can cause a flare up of pain such as physical activity, shock trauma to your body (even mildly) and most of all improper use of the affected area. The latter is where physical therapy comes in. It is the best way to prevent future flare ups.

I wish you well,

Rusty