Yoga guide
Yoga can be a good way to do the exercise that's part of treatment for ankylosing spondylitis (AS) and axial spondyloarthritis (axial SpA). The National Institute for Health and Care Excellence (NICE) asks for a programme of deep breathing, posture work, bending back, moving the whole spine and strengthening, and yoga covers much of that. In 4 small trials, yoga helped people a little with daily tasks and with how active their AS felt, compared with usual care, and did about as well as other exercise.
It won't cure AS or straighten a fused spine, and it works alongside your medicines, physiotherapy and aerobic exercise, not instead of them.
This guide explains what AS does to the spine, ribs and bones, what the yoga trials found, why breathing and back bends earn their place, which poses to change or leave out with a stiff or fused spine or thin bones, how to choose a class, and when to get help. It includes a free 25-minute class with no weight on your neck.
NICE asks a specialist physiotherapist to set a programme of stretching, strengthening, posture, deep breathing, bending back and moving the whole spine, plus aerobic exercise. The National Axial Spondyloarthritis Society (NASS) calls exercise "the single most important thing you can do to help yourself". No guideline names yoga, but NASS lists yoga among suitable classes.
Four small randomised trials (33 to 109 people, 8 weeks to 3 months) found that yoga helped a little with daily tasks and with how active AS felt, compared with usual care or a waiting list, and did about as well as conventional exercise in the one trial that compared them. Nobody in the trials was blinded to their group.
No trial has measured whether yoga slows the fusing of the spine, and across 59 exercise trials no type of exercise improved spinal mobility scores. The NHS says the damage can't be reversed. Controlling inflammation with medicines matters, because more active disease goes with more new bone.
Deep breathing keeps your ribs moving, and NASS's guidance for instructors says "The emphasis is on promoting extension of the spine", but also that "it will not be beneficial or possible to force the spine into a range that is uncomfortable".
A fused spine can break after a minor knock, most often in the neck. Leave out weight on your head and neck, rolling on your spine and forced end-range poses, keep a hand on a wall for balance, and say no to hands-on adjustments.
A painful red eye needs an eye check the same day. New or worse back or neck pain after a fall or knock needs checking the same day. Numbness around your genitals or bottom, or new bladder or bowel trouble, needs 999. The full list is in the warning signs below.
The NHS: "Ankylosing spondylitis (AS) is a long-term condition in which the spine and other areas of the body become inflamed. It's a type of axial spondyloarthritis." When the changes can't be seen on an X-ray it's called non-radiographic axial SpA, and the symptoms and treatment are similar. It usually starts in teenagers and young adults, and NICE says axial SpA "affects a similar number of women as men".
Back pain and stiffness that is "worse in the morning and at night", and that "gets better with exercise, but does not improve or gets worse with rest". Inflammation where tendons attach to bone can affect the ribs, and the NHS says that if your ribs are affected you may find it "difficult to expand your chest when breathing deeply". Tiredness is common.
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About 3 in 1,000 adults in one UK area had axial SpA. In UK records, the median time from first back pain to diagnosis rose to 8.3 years by 2017, longer in women, and NASS campaigns to cut an average delay of 8.5 years. Our exercise for AS guide lists NICE's reasons to see a GP.
Inflammation can lead to new bone that joins parts of the spine together (fusion). In one group of people with AS, 61% already had bony bridges between vertebrae, more with longer disease. How fast it happens varies widely: over about 4 years, 23% of people showed no progression and 43% progressed fast, and more active disease went with more new bone. The NHS says fusion "does not lead to severe disability in most cases".
NASS: "The ribs can become inflamed where they attach to the spine. This is painful and can lead to stiffness and even fusion." Stiff ribs rise and fall less, so more of the breathing work falls on the diaphragm. Limited chest expansion is one of the signs doctors check.
Across 28 studies, about 1 in 7 people with AS had osteoporosis and about 1 in 7 had a broken vertebra. Within 10 years of AS starting, about half had low bone density in the lower spine. NICE suggests considering a bone density check every 2 years.
About 1 in 4 people with AS have eye inflammation (uveitis) at some point. It usually affects one eye, which becomes red, painful and sensitive to light, and it needs treating quickly.
There's no cure, but treatment relieves symptoms and helps delay progress: anti-inflammatory painkillers first, then biological medicines if they aren't enough, plus physiotherapy and exercise. The 2022 European recommendations (ASAS-EULAR) call exercise "a cornerstone" of care. NASS suggests seeing a physiotherapist when you're diagnosed "and at least once a year after that".
NICE, the European recommendations and the US guideline all put exercise at the centre of care. Supervised exercise did better than home exercise in the European review, and the US guideline prefers active exercise to passive treatments. None of them names yoga.
In a Cochrane review of 14 trials (1,579 people), exercise programmes improved function by about 1.3 points, disease activity by 0.9 and pain by 2.1 on 0 to 10 scales, compared with no exercise (moderate to low certainty). Against usual care, the gains were small. A 2025 review of 20 trials found similar modest gains.
In an Indian trial (109 people analysed), 3 months of online yoga improved disease activity by 0.79 points and function by 0.86 points on 0 to 10 scales, compared with usual care. In a Turkish trial (55 analysed), online classes 3 times a week for 8 weeks improved function and several other measures compared with a waiting list, though only p values were reported. Pooled, the 2 trials gave about 0.9 points' improvement in each. Both were small and unblinded, and one came from the team that designed the yoga programme.
In 33 people, yoga and conventional exercise at home 3 days a week for 8 weeks improved by similar amounts, with no difference between them. In 51 people, adding 30 minutes of yoga-based exercise to 12 sessions of aerobic training improved chest expansion, a spinal mobility score and walking distance more than aerobic training alone, but that group also had more supervised time.
In a 2026 analysis of 59 exercise trials (3,404 people), yoga eased pain, but no type of exercise improved spinal mobility scores, and "no modality was definitively superior". We could read only its summary, which doesn't say how many yoga trials it included or which pain scale was used.
In Germany, 8 weeks of weekly online hatha yoga improved a spinal mobility score a little (by 0.31 points) while routine physiotherapy didn't, with better mental wellbeing. People chose their group, and anyone with a completely fused spine was left out.
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The trials are small (33 to 109 people), short (8 weeks to 3 months) and unblinded, and none measured fusion or fractures. They left out people with a completely fused spine or severe disability, so there's no trial evidence for them. No harms were reported, but only about half of exercise trials in axial SpA report harms at all.
Anti-inflammatory painkillers and, when needed, biological medicines treat the inflammation that drives AS, and more active disease goes with more new bone over time. Yoga adds to this care; it doesn't replace it.
NASS: "Breathing exercises encourage you to maintain your rib movements so you do not have to rely entirely on your diaphragm muscle." NICE includes deep breathing in its programme, and NASS's guide suggests breathing exercises daily "to keep your rib cage flexible". In 54 men, breathing-muscle training added to exercise improved chest expansion (3.6 against 3.2 cm).
Sitting or standing, every day and before any back-bending work (our suggestion, from NICE and NASS):
Fast, forceful breathing such as kapalbhati raised blood pressure while 20 adults did it, and US health advice tells people new to yoga to avoid it. A small programme of breathing with breath holds, cold exposure and meditation lowered an inflammation marker in 24 people, but it wasn't yoga and needs testing properly. Slow, wide rib breathing is enough.
NASS's guidance for instructors: move "in a gentle controlled way with a hold at the end of range", and "it will not be beneficial or possible to force the spine into a range that is uncomfortable. The emphasis is on promoting extension of the spine". Once range is lost, "it may not be possible to get back to a neutral position". When lying on your back, if your head doesn't rest easily on the floor, put a folded towel under it.
Spinal fractures are more common with AS, though estimates of how much more vary widely between studies, and a fused spine can break even after a minor injury.
In the newer and larger studies, broken vertebrae were about 2 to 3 times as likely with AS: across 28 studies, the odds were 2.26 times higher, and in a population study of 2,321 people, new spinal fractures were 2.55 times as likely. These are observational studies with wide ranges around their estimates. In 345 published cases, most fractures in a fused spine were in the neck after a small injury, and many were found late.
About 1 in 7 people with AS have osteoporosis, often younger than you'd expect. With thin bones, bend from your hips rather than folding deeply: spinal fractures followed deep forward bending in yoga in people with osteoporosis (a case series, not in AS). Our yoga for osteoporosis guide has the safe swaps.
NASS: "Manipulative therapies are not recommended for people with axial SpA." The US guideline strongly recommends against spinal manipulation with a fused spine or advanced spinal osteoporosis, and one man with undiagnosed AS broke his neck and was paralysed after a massage (a single case). Tell your teacher you'd rather not be adjusted.
No guideline names poses and no study has tested inversions in AS. But a fused neck breaks more easily than most, and headstands, shoulder stands and hand stands were the practices most often linked with short-term harms in a survey of 1,702 yoga practitioners. So we suggest leaving out headstand, shoulder stand, plough and fish, as our exercise and Pilates guides for AS already advise.
The US guideline recommends checking fall risk, and NASS includes balance in what exercise should train. Keep a hand on a wall or chair for one-leg poses, step rather than jump, and roll to your side to get up from the floor (our suggestion).
NASS describes hatha, vinyasa, ashtanga, Iyengar and hot (Bikram) yoga, and its older exercise guide says hatha "is perhaps the most relevant to people with AS". NASS: make sure any instructor "is aware of your axial SpA and any limitations you may have", and "Always start with a beginners' class."
No study has tested hot yoga in AS. NASS: "Check with your GP before trying a Bikram class as the heat could potentially be a problem for someone with poorly controlled blood pressure or heart problems. Take water and sip it regularly throughout the class and make sure you stop if you feel dizzy." Warm-water exercise eased pain and disease activity in 8 trials, though not mobility. A warm bath or shower beforehand is a simpler way to ease stiffness, and NASS's instructors' guidance calls it "good preparation".
NICE includes "self-care (for example, exercises, stretching and joint protection)" in a flare plan. NASS suggests avoiding high-impact exercise during a flare and asking your physiotherapist which gentle stretches suit you. Keep the breathing and a few small-range moves going, and save full classes until it settles (our suggestion).
Two or 3 yoga sessions a week, with a few minutes of the breathing and spine moves on the other days. The trials used 1 to 3 sessions a week for 8 weeks to 3 months; the NHS says "some daily stretching and exercise is also important" even if you do other sport; and NASS says exercise needs to be "regular, consistent and kept up over the long term. So, it's important to choose something you enjoy."
NICE's programme includes aerobic exercise, which yoga doesn't give you. Adults are advised to build up to 150 minutes of moderate activity a week, with strength work on 2 days: walking, swimming or cycling alongside yoga covers it.
Mountain pose: 5 to 10 slow breaths, 2 or 3 times (the move's page). Not forcing the head back follows NASS's guidance for instructors, and NASS's safety advice says "The mirror is your friend" for checking posture.
See the movement on the 3D figure: Mountain pose (Tadasana)
Slow breathing: 2 minutes in a session (our 25-minute class), or at least 5 minutes on its own (the move's page). Breath reach: 5 breaths, breathing out for longer than in (the move's page). Doorway chest opener: 2 holds of 30 seconds each side, elbow at or below shoulder height (our AS daily routine).
Chin tucks: 10 holds of 5 seconds; wall angels: 8 slow slides, a small range is fine (our AS daily routine). Mountain pose: 5 to 10 slow breaths, 2 or 3 times (the move's page). Seated upper-back lift: 3 to 5 holds of 3 to 5 seconds, at least twice a week (the move's page, from the UK osteoporosis consensus), and the back bend to use if lying face down is hard.
Sphinx: 2 holds of 3 to 5 breaths; low cobra: 5 lifts held 3 to 5 seconds; locust: 3 to 5 lifts held 3 to 5 seconds, neck long (our yoga for posture class). Prone press-up: 10 slow reps, within comfort (our AS daily routine). Stop if a back bend sends pain, tingling or numbness down a leg.
Thoracic rotation: 6 each side, moving with the breath; overhead side bend: 3 slow bends each side; cat-cow: 8 slow waves (the move's page for each). Open book: 8 each side with a pillow under your head (our AS daily routine; the move's page gives 8 to 10). Do cat-cow sitting on a chair if kneeling is hard.
Hip flexor stretch: 2 holds of 30 seconds each side, knee padded; strap hamstring stretch: 2 holds of 30 seconds each leg, a pillow under your head if you need it (our AS daily routine). Tight hip flexors can pull the spine forward, NASS's instructors' guidance says.
Chair pose: 3 holds of 5 breaths; warrior II: 5 breaths each side; tree pose: 3 to 5 breaths each side, twice, fingertips on a wall (our yoga for osteoporosis class). Single-leg stand: 2 holds of 20 seconds each leg beside a counter (our Pilates AS class). Bird dog: 5 each arm and leg, holding 3 to 5 seconds; glute bridge: 8 to 10 slow lifts (our yoga for posture class).
3D demoChair pose (Utkatasana)Beginner · No equipment
3D demoWarrior II (Virabhadrasana II)Intermediate · No equipment
3D demoTree pose (Vrksasana)Beginner · No equipment
3D demoSingle-leg standBeginner · A wall
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoGlute bridgeBeginner · No equipmentCorpse pose: 3 minutes in our class, or at least 5 minutes, up to 10, on its own (the move's page). Put a pillow or folded towel under your head so your chin is level, as NASS suggests, and a cushion under your knees.
These rest on the fracture evidence and NASS's guidance rather than trials of particular poses.
Leave out headstand, shoulder stand, plough and fish (which rests the crown of your head on the floor with your neck bent back). Our exercise for AS guide already says to skip yoga poses that load the neck.
Deep back bends such as wheel and camel, deep twists using your arms as a lever, and deep or loaded forward folds. Low cobra, sphinx and locust replace the deep back bends, and with thin bones or fusion, bend from your hips instead of folding (our osteoporosis guide).
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Rocking on your spine (rolling like a ball, or rocking in happy baby) and jumping back or forward in sun salutations: step instead (our reading, as on our Pilates guide for AS).
Use a pillow or folded towel under your head. If lying face down is uncomfortable, do the seated upper-back lift instead.
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Say no to adjustments. Keep breathing slow and easy, without breath holds or fast, forceful breathing.
Start with our 25-minute class 2 or 3 times a week, and do the AS daily routine's breathing and spine moves on other days (our editorial starting point). The Pilates class covers the same ground; the posture and osteoporosis classes add back strength and safe swaps for thin bones; chair yoga suits days when the floor is hard; and the low-impact cardio session adds the aerobic part.
Twenty-five minutes of yoga for ankylosing spondylitis: rib breathing, posture work, standing strength, face-down back bends, gentle rotation and a supported rest.
25 minBeginner18 movesA wallA 20-minute daily routine for ankylosing spondylitis and axial spondyloarthritis: breathing, neck, upper and lower back, spinal extension, hips and posture.
20 minBeginner15 movesA wallA 25-minute Pilates class for ankylosing spondylitis and axial SpA: breathing, spinal extension, rotation and hip work, with no rolling or weight on the neck.
25 minBeginner20 movesA wallTwenty-five minutes of back-strengthening yoga for posture: arm and leg reaches, face-down back lifts and standing poses with the arms raised.
25 minBeginner15 movesNo equipmentA 30-minute yoga class for osteoporosis: standing strength, balance at a wall, back-strengthening holds and hip hinges in place of deep forward folds.
30 minBeginner19 movesA bench or box, A wallA 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesA bench or box, Something with weightA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA gentle way to build towards 150 minutes of activity a week alongside yoga.
These follow our exercise and Pilates guides for AS word for word. This is general information, not a diagnosis. A&E means accident and emergency.
Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
See a health professional, especially if your pain is new or worse: with a fused spine, a minor injury can break a bone. Our editorial advice is to get checked the same day, and to call 999 and keep still if you have numbness, tingling or weakness in your arms or legs, or can't move normally.
Call 999 if someone has hit their head and has been knocked out and hasn't woken up, can't stay awake or keep their eyes open, has a fit, has fallen from a height of more than 1 metre or 5 stairs, has problems with their vision or hearing, has clear fluid coming from their ears or nose, has new numbness or weakness, has problems with walking, balance, understanding, speaking or writing, hit their head at high speed, or their behaviour has changed. Get help from NHS 111 if they're being sick, feel dizzy or take medicine that thins the blood. If you're told to go to A&E (accident and emergency), don't drive yourself there if you have hit your head.
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NICE asks for an eye assessment the same day for symptoms of eye inflammation (uveitis), such as eye pain, redness, sensitivity to light or blurred vision. The NHS says to ask for an urgent GP appointment or contact NHS 111; untreated, it can cause the loss of some or all of your vision.
The NHS says go to A&E or call 999 if you can't see (loss of vision).
Call 999 if:
NASS: inflamed ribs can cause "pains that can be confused with the pain of cardiac or lung problems. Anyone experiencing symptoms of chest pain should seek medical attention to rule out a more serious condition."
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Seek medical advice if you feel faint, short of breath, dizzy or unwell, or get chest pain you're not used to, while you're exercising. NASS also says to get advice if you have more than mild aches and pains afterwards.
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NASS's safety advice suggests checking first if you:
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Never push into a stiff or fused section. Stop any back bend that sends pain, tingling or numbness down a leg, stop a breathing exercise if you feel light-headed, and roll to your side to get up from the floor.
There's no cure, and the NHS says the damage can't be reversed. Yoga's gains in trials are small, about 1 point on 0 to 10 scales against usual care, and no bigger than other exercise.
No trial has measured fusion, and no type of exercise improved spinal mobility scores across 59 trials. Controlling inflammation with medicines is what links to less new bone.
AS pain "gets better with exercise, but does not improve or gets worse with rest", and exercise is "a cornerstone" of treatment.
In the largest comparison, "no modality was definitively superior". The best exercise is the one you'll keep doing, which is why NASS says to choose something you enjoy.
A stiff or fused spine can break after a minor knock, most often in the neck, and headstands and shoulder stands are among the poses most linked with yoga injuries. We suggest leaving them out.
NASS: "it will not be beneficial or possible to force the spine into a range that is uncomfortable". Move to your comfortable limit, hold and breathe.
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NASS doesn't recommend manipulation for axial SpA, and the US guideline strongly advises against spinal manipulation with a fused spine or advanced spinal osteoporosis.
NICE: axial SpA "affects a similar number of women as men". Diagnosis takes longer in women.
NASS says breathing exercises keep your ribs moving, and breathing-muscle training added to exercise improved chest expansion in a small trial.
One 24-person study of breathing with breath holds, cold exposure and meditation lowered an inflammation marker, but it wasn't yoga and wasn't a full trial, and forceful breathing raises blood pressure while you do it.
It can be a good way to do the exercise that's part of your treatment: NASS calls exercise the single most important thing you can do, and NICE's programme includes the breathing, posture, back bending and stretching that yoga covers. In 4 small trials, yoga helped a little with daily tasks and disease activity compared with usual care, and did about as well as other exercise. Keep your medicines, physiotherapy and aerobic exercise going alongside it.
No trial has compared poses, so the choice follows NICE's programme and NASS's emphasis on bending back: wide rib breathing, posture at a wall, face-down back bends such as sphinx, low cobra and locust, gentle turns and side bends, hip flexor stretches, and standing strength and balance beside a wall. Move to your comfortable limit and never force it.
With a stiff or fused spine or thin bones, leave out poses that put weight on your head and neck (headstand, shoulder stand, plough and fish), rolling on your spine, deep loaded forward folds and anything forced to the end of your range. A fused spine can break after a minor knock, most often in the neck. Ask your teacher not to adjust you by hand.
No. There's no cure, and the NHS says the damage can't be reversed. No trial has measured fusion, and across 59 exercise trials no type of exercise improved spinal mobility scores. Yoga can help you feel and move better, while treatment as a whole, medicines included, aims to slow the fusing.
Neither has been shown to be better. In a 2026 analysis of 59 exercise trials, Pilates had the largest effects against usual care, yoga eased pain, and no type was clearly best. NASS lists both, and says to choose something you enjoy, because exercise only helps if you keep it up.
They're part of NICE's programme, and NASS suggests doing them daily to keep your rib cage moving, because stiff rib joints can limit how far your chest expands. Breathing-muscle training added to exercise improved chest expansion in a small trial. Start with slow, wide rib breathing and no breath holds, and stop if you feel light-headed.
No study has tested it. NASS asks you to check with your GP first if your blood pressure or heart is a concern, to sip water through the class, and to stop if you feel dizzy. If warmth helps your stiffness, a warm bath or shower before you practise is a simpler option.
Gently, if it helps. NICE includes exercises and stretching in a flare plan, and NASS suggests avoiding high-impact exercise and asking your physiotherapist which gentle stretches suit you. Keep the breathing and a few small-range moves going, and if a flare comes with a red, painful eye, get an eye check the same day.
The trials used 1 to 3 sessions a week for 8 weeks to 3 months. Two or 3 classes a week, with a few minutes of breathing and spine moves on other days, is a sensible start, and the NHS says some daily stretching matters even if you do other sport.
Often, with changes, but the trials left out people with a completely fused spine, so there's no trial evidence for you. NASS suggests checking with a health professional first if you have fusions or osteoporosis. Keep every move in your comfortable range, put no weight on your neck, balance with a hand on the wall, and get new pain after a fall checked the same day.
Yes. NASS says to make sure any instructor knows about your axial SpA and any limits you have, and to start with a beginners' class. Ask not to be adjusted by hand, as NASS doesn't recommend manipulation for axial SpA.
Probably not. NICE's programme includes aerobic exercise as well as stretching and strengthening, and adults are advised to build up to 150 minutes of moderate activity a week with strength work on 2 days. Walking, swimming or cycling alongside yoga covers the aerobic part.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
