Geoff Lindsay

Ankylosing Spondylitis Flare Up Treatment

In this blog, I suggest ways to manage your Ankylosing Spondylitis (AS) flares. This also applies to Axial Spondyloarthritis (axSpA), Spondylitis, and any other form of Spondyloarthritis.

  • With yoga modified for your AS.
  • Going into a flare, in a flare, coming out of a flare.
  • For the areas of the body where you are getting that extra challenging pain.
  • Preventing flares - pipedream or possible?


  1. What is a flare?
  2. What to do if you get a sense of going into a flare.
  3. What yoga to practise when in a flare. Flares in different areas of the body.
  4. How to pace when coming out of a flare.
  5. Preventing flares - pipedream or possible?
  6. More help in (during) flares.

What is a flare?

The everyday pain, stiffness and fatigue is one thing. But then along comes a flare of severe pain. I've had flares in both sacroiliac joints, my neck, eyes, knees, mouth. One definition of a flare is when an AS patient says so!  


Everyone with AS gets flares at some time. So the need to manage flares is 100% of us. The Holy Grail question: Can any part of flares be prevented? 


At diagnosis we are told it's painful, it’s incurable, it's progressive, it's invisible, it's systemic. We are advised to “exercise”. 

Why don't we?

A big reason is because in a flare, it hurts even more and exercise can worsen a flare. And then you're on that downward cycle of it hurting, so I won't try that again, so then you don't move at all and that makes your AS symptoms worse. 

That’s why we started Yoga for AS. There are ways you can use yoga for your flares. 

What to do if you get a sense of going into a flare

What to do when you get a sign of that horrible pain in the buttocks and hips. Or are you one who wakes up one day and you are in flare, no warning signs? 

  • Do at least 15 minutes relaxation through Yoga Nidra.
  • Do some relaxing yoga poses like the restorative yoga that can be found in this course. 
  • If it's really bad, take a break for a few days from the poses/asanas, but do practice some breath work to calm your immune system.  
  • If it's a flare of that pain in the lower back, buttocks going down through the hips, that is inflammation of the SI Joints and the entheses around them. Have a look at the most gentle Course on the SI Joints
Man, lying down with legs on a chair.

What yoga to practise when in a flare.
Flares in different areas of the body

You know, when you sneeze you practically scream. You avoid going up the stairs. It really hurts to get up off the settee. 

Basically back off, ease off, but keep up with the yoga breathing and relaxation. 

Breathing excercises and relaxation are recommended if you are in flare. 

You may be able to stretch in areas of your body that are not in flare.

How to pace when coming out of a flare

Balance, not too far, too much, too fast. Don't push it too much too soon. What does this mean in practice? 

Start by going to a point where you feel the stretch but are not overstretching and then each week explore going a little further.

Focus on more restorative practices like Yoga Nidra, Breathwork, Restorative and Yin Yoga (as long as safely modified for AS).

Slowly increase the frequency of your yoga practice.

Give yourself little “stretch tests” - you stretch one day and it is still hurting, but the next day you try the same stretch and it feels a tad better.

It's a stretch not a strain.

Keep going to where you just feel the stretch.  

Become an expert by experience. 

Never push through pain, learn the difference between sensation from a muscle being engaged versus pain and discomfort. 

Preventing flares

100% of us get a flare at some time. 

You can still practise safe Yoga for AS:

The Virtual Library has 20 Courses, with each Course designed for a level of ability and disability, including flares. If you are able to practise at Course 4, when in flare you might go back to Course 2 or 1 or Foundations. You can try Relaxation, Breath work, Meditation, Yoga for Fatigue, Warm ups, 3 Courses for Necks and 3 for Sacroiliac Joints.

When going into, in, or coming out of flare, you can choose a Live Online Class to suit your current needs. Step back from Intermediate to Beginners, or a short 30 minutes gentle start to your week with Express class. Build back up as you come out of flare with Stretch and Relax, which is more restorative.

Prevention of injury is crucial, critical, essential, top priority. Safeguard your yoga practice. People with AS should expect help to practise safely. Absence of injury is the top priority. 

Please understand that the best prevention in AS is avoiding injury. AS may make normal injuries worse, so we may get a double whammy. 

When you are stable, keep up regular safe yoga practice.

Find the balance between doing nothing and overdoing it. You are your own best teacher. Listen and respond to your body. Become an expert by experience, learn how to practise yoga for AS safely.

Let's take a look at 4 AS stages:

  1. Inflammation
  2. Erosion
  3. Boney growths and hardening/shortening of ligaments and tendons
  4. Fusion

Treatments work on the idea that you reduce the inflammation and that intervenes to stop/slow down/amend the other 3 stages, the “disease amending”. My experience is that if you work smart on your yoga practice, you can reduce the inflammation. That is also “disease amending”. 

Since I started yoga in 1990, I got a lot of benefits at first in terms of pain and mobility, but then the disease caught up with me by 2008. Then all the treatments combined with yoga, then developing yoga modified for AS, meant that I have had no further boney growths or fusion in 10 years. Lucky? Maybe. 

But maybe I'm not that untypical in my AS progression. Yoga for AS members say they can still use Yoga for AS Live Online Classes when in flare. 

There really is something in Yoga for AS that we can properly call prevention. 

Regular, safe practice of Yoga for AS when not in flare, and yoga modified for when in flares. 

More help with flares

Go to the NASS Guide to Managing my axial SpA (AS) flares

If you would like to practice Yoga for AS, you can explore a Live Online Class or the Virtual Library.

Both of which you can try for free below.

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