Usually, ankylosing spondylitis (AS) starts in the lower spine, but it can also affect the upper spine and neck. For some, the neck is where AS symptoms begin, which may cause stiffness and pain.

AS is a type of arthritis that affects the spine and other parts of the body. It causes the joints and ligaments to become inflamed and stiff. Over time, the vertebrae can fuse, reducing mobility. If this occurs in the neck, or cervical spine, a person may have difficulty moving their neck.

This article will discuss the link between AS and neck pain, including how common this symptom is, how it feels, diagnosis, and treatment.

A man sat at a desk using a laptop. He is rubbing his neck due to AS neck pain.Share on Pinterest
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Neck pain is a common symptom of AS. For some people, it may be where the pain begins. For others, pain in the neck may only develop if the disease progresses.

In a 2022 study of Japanese people with AS, 36.7% reported that their symptoms began in their back, followed by:

  • 26.7% in the hip
  • 15% in the knees
  • 15% in the buttocks
  • 10% in the neck

A few also reported symptoms beginning in the fingers or shoulder.

It is important to note that neck pain may not be due to the AS itself. Sudden neck pain after a fall, knock, or painful movement may also be due to a fracture. Additionally, as the condition progresses, it increases the risk of fractures.

If a person develops neck pain suddenly, they should try to keep the neck still and call 911 or the number of the nearest emergency department.

People with AS that affects their neck report experiencing:

  • pain
  • stiffness
  • limited movement

Other signs and symptoms that people may have with AS may include:

  • pain or stiffness in other parts of the body, such as the back, buttocks, or hips
  • vision changes or eye pain
  • loss of appetite
  • unintentional weight loss
  • abdominal pain or diarrhea
  • fatigue

In AS, these symptoms do not improve with rest. In fact, they may worsen while a person is still and improve as they move around.

Pain from AS can be mild to severe. It may start as milder pain, but as the condition progresses, the spine may become increasingly stiff and painful.

The symptoms of AS can affect a person’s activities or daily living. For example, they may have difficulty bending down, turning their head, or sleeping due to discomfort.

In advanced AS, a person’s neck may permanently bend forward, causing the spine to curve and reducing the ability to look forward. If the bones begin fusing, this can cause difficulty moving the neck in any direction.

Doctors diagnose AS by taking a medical history and performing a physical exam. To look for signs of damage to the bones, they will also order medical imaging tests, such as X-rays or MRI scans.

Some of these scans can help doctors predict neck pain in AS. For example, an X-ray indicating a large T1 slope, which is a measure of certain points of the spine, is a predictor for neck pain, according to a 2021 study. This slope occurs where the last vertebra of the neck meets the top of the spine in the back, or the thoracic spine.

Another predictor for neck pain in AS is a high McGregor slope, which appears at the junction where the head and the neck meet. A deviation from a typical McGregor slope may predict neck pain in AS.

There is no cure for AS. However, treatments may slow its progression and reduce symptoms. For some, AS may never progress to the point that it affects the neck, or it may take a long time before this happens.

Treatments may involve a combination of:

  • Medications: A doctor may prescribe nonsteroidal anti-inflammatory drugs for pain, biologic medications to slow the progression of AS, and in some cases, local steroid injections for inflammation.
  • Behavior changes: This involves maintaining an appropriate posture when sitting and standing. People may also benefit from using ergonomic tools to support the back and neck during tasks, such as desk work. Having a supportive mattress and using as few pillows as possible may also help keep the spine straight during sleep.
  • Physiotherapy: Physiotherapists can recommend physical exercises to maintain spine and neck strength and mobility. They may also advise on safe forms of exercise to maintain fitness and on appropriate sleep positions. -Additionally, exercising in water may help reduce pressure on the joints.

If treatments are insufficient or the disease becomes severe, doctors may consider surgery as a last option.

Doctors will also monitor for complications as part of a person’s treatment. This may involve scans to assess joint damage, bone density, or the risk of fractures.

Learn more about AS surgery.

Physical therapy and exercises are an important part of AS treatment. Before starting any exercise program, people need to speak with a physical therapist to ensure proper form and safety. A physical therapist can help people plan how many repetitions and sets they can safely attempt.

Head turns

To do this exercise:

  1. Sit in a chair or stand up straight.
  2. With the chin in line with the floor, turn the head to one side.
  3. Hold for 10 seconds.
  4. Repeat on the other side.

Head tilts

To do this exercise:

  1. Sit in a chair or stand straight.
  2. With the chin in line with the floor, tilt the head to one side, aiming the ear at the shoulder.
  3. Hold for 10 seconds.
  4. Repeat on the other side.

Taking adequate rest in between exercises is important. Sleep is essential to recovering from exercise.

The outlook for people with AS-related neck pain depends on how advanced the disease is and the effectiveness of treatments.

AS is a progressive disease, so if a person experiences neck pain first, it may indicate the disease is still in its early stages. With an early diagnosis and treatment, people may find that the condition does not progress much or takes a long time to progress.

However, if neck pain is not an early symptom, it may indicate the disease has begun to affect more of the spine. Individuals need to consult a doctor if this is the case, as they may be able to tailor a more effective treatment plan.

Neck pain is common in people with AS. It may be a sign the disease has begun affecting more of the spine or where the symptoms begin. The symptoms may include pain, stiffness, and difficulty moving the neck.

A doctor can determine if neck pain is due to AS by performing a physical examination and ordering imaging scans. Treatment may involve medications, physical therapy, and behavior changes to manage the symptoms.