Stress can trigger ankylosing spondylitis (AS) flare-ups when symptoms like increased inflammation, stiffness, or pain in the neck, back, and pelvis worsen. Living with a chronic illness can be challenging and creates a vicious cycle when stress triggers flare-ups. Managing your stress can be an essential tool to help provide relief.

This article will discuss ways to identify stress triggers and offer stress management techniques.

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Identify Triggers of Your Stress and Ankylosing Spondylitis

Triggers are internal or external factors that cause a stress response. Common triggers include:

  • Coping with chronic disease or illness
  • Finances
  • Home or school responsibilities
  • Major life events
  • Work pressures

Understanding the factors that trigger stress is an essential part of managing flare-ups.

Once you have identified your stress triggers, try reducing or eliminating them from your daily life. Managing stress may include delegating specific responsibilities, or changing your home, work, or school expectations.

Studies show that people living with one or more chronic illnesses feel more stress than those without, which is why managing stress is essential to living with AS. However, stress is also a potential trigger for AS. Therefore, AS can be triggered by stress, but it can also cause stress, creating a vicious cycle.

Follow Your Treatment Plan

Treatment of AS involves medication, exercise, physical therapy, nutrition, and other pain and stress management forms. If you have a severe case of AS, you may require surgery. Following a healthcare provider-prescribed treatment plan will help reduce flare-ups.

Use Breathing Exercises

Breathing exercises, known as diaphragmatic breathing, are a slow and controlled breathing method. Diaphragmatic breathing involves inhaling deeply through the nose into the belly and exhaling slowly and fully.

This breathing method impacts the fight-or-flight stress response by reducing cortisol (stress hormone) levels in the body. Diaphragmatic breathing effectively reduces stress and anxiety and improves overall health and well-being. Deep breathing also helps keep the spine more flexible since it involves contracting and expanding the ribcage.

Stay Active With Low-Impact Workouts

AS primarily affects the spine and can lead to stiffness or loss of mobility in the affected vertebrae. Stretching and movement of the spine are important parts of AS treatment and management.

High-intensity workouts can temporarily increase inflammation, which may worsen AS symptoms. Gentle stretching and strengthening exercises may be a better choice, especially if you are experiencing an AS flare-up.

Exercise With AS

Here are four types of exercise recommended for people with AS:

  • Aerobic or cardiovascular
  • Balance
  • Range of motion or stretching
  • Strengthening

Rely on Your Social Support System

Most experts agree that social and emotional support is vital for well-being. Social and emotional support means having close relationships with friends, family, or mentors who believe in you and see you as capable.

Social support helps improve your ability to cope and manage stressful situations, such as living with a chronic illness like AS or experiencing painful flare-ups.

Practice Mindfulness

There is some evidence that mindfulness practices can be beneficial in reducing stress and anxiety for people with different types of arthritis.

Mindfulness practice focuses on what is happening in the present with acceptance and without judgment. Practicing mindfulness can help you:

  • Stay present
  • Gain awareness of what is happening in your body, mind, and emotions
  • Increase your ability to manage stress
  • Regulate your emotions
  • Improve your overall well-being

Prioritize Self-Care

Self-care is taking the time to do things that help you live and feel better regularly. It is a way to care for your physical and mental health. Ways to incorporate self-care could include:

  • Eating a balanced diet
  • Exercising regularly
  • Getting enough sleep
  • Listening to music
  • Reading or writing
  • Doing a hobby that you enjoy

Practicing self-care can help you learn to reduce or manage stress. Self-care looks different for everybody; what works for one person won't necessarily work for the next.

Starting slow and trying different strategies to find self-care that works for you and your life can lead to long-term benefits of reduced stress. Overall, reduced stress can help decrease the frequency and duration of AS flare-ups.

Consider Seeing a Mental Healthcare Provider

If you feel that your stress is unmanageable on your own, a mental healthcare provider may be able to help. Mental healthcare professionals, such as psychiatrists, are experts in human behavior and can work with you to create an individualized plan with strategies to manage your stress.


Flare-ups are unavoidable when you have a chronic condition such as ankylosing spondylitis. However, stress is a common factor in causing flare-ups, making managing stress an important aspect of treatment. There are many strategies for coping with a stressful illness that can help lower your stress, help you become more resilient during stressful situations, and ultimately help reduce AS flare-ups.

A Word From Verywell

There is no denying that living with a chronic condition is stressful, especially when stress triggers symptoms, creating a vicious cycle. If you feel that your stress and resulting AS flare-ups have become unmanageable, reach out to a trusted healthcare provider. Your healthcare provider or a mental healthcare professional can support you to better cope with AS and stress.

Frequently Asked Questions

  • How does stress cause ankylosing spondylitis flares?

    Stress activates an immune response that causes the release of hormones epinephrine and cortisol. These hormones exacerbate inflammation and can worsen symptoms of ankylosing spondylitis. Stress can trigger an ankylosing spondylitis flare by increasing inflammation and pain.

  • What else can trigger ankylosing spondylitis?

    Researchers are uncertain of what exactly triggers ankylosing spondylitis, but genetics are thought to play a role in the disease along with an environmental trigger, such as bacterial infection.

  • What does an ankylosing spondylitis flare-up feel like?

    An ankylosing spondylitis flare-up can include stiffness or pain, most commonly in the neck, low back, hip, and buttock, but could affect other joints. You may also experience a systemic response, including mild fever and mood changes. Symptoms vary from person to person and can change depending on how long you've had the condition.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Rebecca Valdez, MS, RDN

Rebecca Valdez is a registered dietitian nutritionist and nutrition communications consultant, passionate about food justice, equity, and sustainability.

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