A 26-year-old Italian-American man comes to your office for the evaluation of low back pain. He has had this pain for the last eight months, and it is progressively getting worse. The pain is worse in the morning and gets better as the day progresses. He denies any history of trauma in the past. He works as a chef at a local restaurant. His father and uncles also have "back problems." His physical examination reveals a limited range of motion of his lumbosacral spine and markedly reduced chest expansion. The rest of his physical and musculoskeletal examination is unremarkable. The patient is given a prescription for non-steroidal anti-inflammatory agents. He returns for a follow-up visit after two weeks, and says that he feels a lot better. His pain and stiffness have almost resolved with daily intake of medications. He used to swim and exercise regularly before his symptoms developed a few months ago, and he wants to resume these activities, but he is concerned that his disease may get worse if he does so. Which of the following is the most appropriate response?

Question

A 26-year-old Italian-American man comes to your office for the evaluation of low back pain.  He has had this pain for the last eight months, and it is progressively getting worse.  The pain is worse in the morning and gets better as the day progresses.  He denies any history of trauma in the past.  He works as a chef at a local restaurant.  His father and uncles also have "back problems."  His physical examination reveals a limited range of motion of his lumbosacral spine and markedly reduced chest expansion.  The rest of his physical and musculoskeletal examination is unremarkable. The patient is given a prescription for non-steroidal anti-inflammatory agents.  He returns for a follow-up visit after two weeks, and says that he feels a lot better.  His pain and stiffness have almost resolved with daily intake of medications.  He used to swim and exercise regularly before his symptoms developed a few months ago, and he wants to resume these activities, but he is concerned that his disease may get worse if he does so.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: Regular aerobic exercises such as swimming, walking, and bicycling improve joint stability, muscle strength, and overall functional status without an increase in the disease activity. These also help to prevent bone loss due to immobility and use of medications. The exercise regimen should be tailored to the individual, depending on the exercise tolerance, extent and severity of joint disease, and other coexisting medical conditions. An initial evaluation by a physical therapist should be a part of therapy for ankylosing spondylitis. (Choice A) Supervised physical therapy and exercises can lead to significant improvement of the range of motion of the spine. It does not lead to acceleration of the joint destruction. (Choice B) In ankylosing spondylitis, postural training and extension exercises help to prevent spine fusion in a flexed position. (Choice C) There is no reason to avoid exercise for a year. The patient should be evaluated by a physical therapist and initiate an exercise program as early as possible. (Choice D) Swimming (hydrotherapy) is a type of aerobic exercise with special benefits for patients with rheumatologic disorders. It is associated with less joint stress and weight bearing and is useful for patients with advanced disease. Educational objective: Aerobic exercises improve overall functional status of patients with rheumatologic disorders and should be encouraged.

A 26-Year-Old Italian-American Man Comes to Your Office for the Evaluation