International Standards of Care

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of the spine and sacroiliac joints. International guidelines (ASAS-EULAR 2022, BSR 2023, ACR) recommend a treatment approach that combines targeted medication, structured rehabilitation, and long-term self-management.

The key pillars are:

• Anti-inflammatory and disease-modifying medication prescribed by rheumatologists

• Tailored physiotherapy and structured exercise

• Lifestyle and pacing strategies to preserve mobility

• Mind–body practices that support resilience and coping

Medical Management

Rheumatologists oversee the medical side of axSpA care. Treatments may include:

• NSAIDs as first-line for inflammation and pain

• Biologic therapies such as TNF inhibitors or IL-17 inhibitors, which can slow progression and reduce inflammation

• JAK inhibitors, an oral option for selected cases

• Analgesics and adjunct medications for pain management

Medication is effective at controlling inflammation, but it does not prevent stiffness, loss of mobility, or deconditioning on its own. This is where rehabilitation becomes essential.

Exercise as the Core of Long-Term Management

Unlike fibromyalgia, where exercise helps retrain a hypersensitive nervous system, in axSpA exercise is about protecting movement and preventing stiffness from becoming permanent.

Research shows that regular exercise improves posture, spinal mobility, chest expansion, and overall function. It also lowers cardiovascular risk, which is higher in people with axSpA due to chronic inflammation.

The challenge is not knowing what to do, but knowing how to do it safely and consistently over years. A generic gym programme will not address the unique needs of axSpA. Without guidance, it is easy to neglect spinal extension, breathing mechanics, or pacing — all of which are central to preserving independence.

A specialised physiotherapist can help you:

• Maintain extension and upright posture to reduce long-term fusion risk

• Strengthen hips, shoulders, and core to support spinal health

• Improve breathing mechanics through targeted chest and rib mobility work

• Integrate pacing so that fatigue and pain are managed alongside progress

• Develop a sustainable home programme that fits into your life

This is not about short bursts of exercise. It is about learning how to keep your spine and body moving in ways that will serve you for decades.

Somatic and Mind–Body Approaches

AxSpA is immune-driven, but it is also shaped by how the nervous system and stress response interact with inflammation and pain. Somatic and mind–body practices complement exercise by supporting whole-body regulation.

• Yoga therapy improves flexibility, posture awareness, and spinal mobility while reducing stiffness.

• Breathwork directly supports rib cage expansion, which is often limited in axSpA. Techniques such as diaphragmatic breathing improve lung capacity and reduce the feeling of chest tightness.

• Guided relaxation and mindfulness reduce the stress response, which can worsen fatigue and inflammation.

• Somatic awareness practices help patients reconnect with safe, efficient movement patterns, reducing tension and guarding.

These approaches make exercise more effective by reducing background stress, improving recovery, and reinforcing positive body awareness.

Education, Self-Management, and Coping

Education is a treatment in itself. People with axSpA need to understand how inflammation and stiffness interact, why movement is protective, and how to balance activity with rest.

Psychological support can also play a role:

• Cognitive Behavioural Therapy (CBT) helps patients sustain exercise habits and manage pain more effectively.

• Acceptance and Commitment Therapy (ACT) supports living in line with personal values, even when symptoms persist.

Rehabilitation at Neurokinetica

At Neurokinetica, we know what it means to live with a spine that feels heavy, stiff, or locked. Many of our patients tell us they feel as though their body is closing in on itself, and they are afraid of what the future holds. We work with those fears directly.

Our approach is built on the principle that movement is not optional in axSpA — it is essential. But not just any movement. We help you build the specific mobility, strength, and breathing patterns that keep your spine open and resilient. We guide you through tailored programmes that protect your joints, support your posture, and improve your breathing mechanics.

Alongside this, we integrate yoga therapy, breathwork, guided relaxation, and mindfulness to reduce stiffness, restore nervous system balance, and make movement feel safe again. Patients often report not only improved flexibility and less pain, but also more energy and confidence in their ability to manage flare cycles.

Our role is to guide you step by step until you can carry these practices into your life with independence. The goal is not just to reduce symptoms but to preserve mobility, strength, and confidence for the long term.

If you are looking for axial spondyloarthritis treatment in Cork and want a tailored approach that combines exercise, breathwork, and specialised physiotherapy, book a session to get assessed and learn more about our rehabilitation.