Ankylosing Spondylitis

Ankylosing spondylitis is inflammatory arthritis of the spine. Alongside rheumatology care, we address gut-immune links, movement, posture, and inflammatory load.

What you may be noticing

Low back and buttock pain that began before age 45, came on gradually, and is worse in the morning or after rest. Stiffness that eases with movement and exercise. Pain that wakes you in the second half of the night. Over time you may notice a stiffer spine, reduced chest expansion, heel pain, or eye inflammation.

A painful red eye with light sensitivity needs prompt eye care, because it may be uveitis. Fever with severe back pain, new numbness in the saddle area, or changes in bladder or bowel control need emergency care.

Why it is rarely one thing

Ankylosing spondylitis belongs to the spondyloarthritis family. Inflammation targets the sacroiliac joints, the spine, and the places where tendons and ligaments attach to bone, and over years it can lead to new bone formation that stiffens the spine. The IL-23 and IL-17 pathways are central, which is why several biologic medications target them.

Genetics play a strong role, especially HLA-B27, yet most people with HLA-B27 never develop the condition. The gut appears to be a key link. Many people with spondyloarthritis show microscopic gut inflammation, and the condition overlaps with inflammatory bowel disease. One long-studied hypothesis proposes that certain gut bacteria, such as Klebsiella, may resemble self-tissue and provoke cross-reactive immunity; this remains a hypothesis.

I approach it on two layers at once. The functional medicine layer works upstream on the microbiome-immune axis and barrier biology: gut permeability, bacterial endotoxin, and short-chain fatty acids such as butyrate that help keep immune signaling calm. The functional neurology layer works on the body that has adapted around pain: breathing mechanics, thoracic expansion, diaphragm function, and how the balance system and spinal muscles coordinate posture. Not only a spine problem, but a gut-immune conversation that settles in the spine.

Patterns we look for

• HLA-B27, CRP, and sedimentation rate.
• Gut inflammation markers such as calprotectin.
• Microbiome balance and intestinal permeability.
• Inflammatory bowel symptoms.
• Vitamin D, omega-3 status, and bone density.
• Chest expansion, spinal mobility, and posture over time.
• Breathing pattern and diaphragm function.
• Eye inflammation history.
• Sleep, fatigue, and smoking, which is linked with faster progression.

How I evaluate it

The comprehensive functional neurological exam measures spinal mobility, chest expansion, wall-to-head distance, posture, balance, gait, vestibular and spinal coordination, and how chronic pain is affecting central processing.

Functional labs may include HLA-B27, CRP, sedimentation rate, a complete blood count, vitamin D, omega-3 index, a comprehensive metabolic panel, and a comprehensive stool analysis with calprotectin. Standard activity and function questionnaires and repeated mobility measurements show whether the plan is preserving movement. I coordinate with your rheumatologist on imaging and medication.

How we address it

1. Keep rheumatology care central, including biologic medications when indicated.
2. Move every day: mobility, extension, breathing, and strength work.
3. Repair the gut barrier and rebalance the microbiome, supporting butyrate-producing fiber where tolerated.
4. Reduce inflammatory load with an anti-inflammatory eating pattern.
5. Replete vitamin D and omega-3 fats, and protect bone health.
6. Retrain diaphragm function, rib cage expansion, posture, and balance with brain-based rehabilitation.
7. Protect sleep and calm the stress response.

A spine that keeps moving keeps more of its freedom. Every day of movement counts.

Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.