Morning Habits with Ankylosing Spondylitis

Ask anyone who lives with ankylosing spondylitis about their morning and I can predict how they’ll answer. You might see a grimace spread across their face or their forehead furrow with frustration. You might hear candid responses like “Mornings suck” or “I can’t” or “I dread them” or — perhaps more nicely — “I’m just trying to get things moving.”

Ankylosing spondylitis is a type of inflammatory arthritis known for causing pain, inflammation, and stiffness in the back and sacroiliac joints, where the spine connects with the pelvis. Morning stiffness is a key characteristic of AS. Though there are many ways to describe this morning stiffness, the one that resonates best for me is that it feels like I am waking up in the Tin Man’s body. My lower back, along with plenty of other joints throughout my body, generally feel like someone came in overnight and superglued them together.

On bad days, it can be an effort to literally sit up and get out of bed. The notion of walking around my apartment to start the different parts of my morning routine — making coffee, brushing teeth, showering, getting dressed — can feel downright daunting.

Suffice to say, mornings are slow and often uncomfortable.

Even Worse: Mornings with a Time Crunch

When I used to work a 9-to-5 job, my mornings were particularly brutal. I had a harder time finding mobility and getting moving that early because I was racing against the clock and pushing my body to do something it didn’t instinctively want to do.

This was precisely the time I started developing my AS morning rituals.

I knew that if I had to face the day I couldn’t just wake up, hop out of bed, and move as quickly as the rest of New York City, where I live. My younger, pre-AS self could entertain the notion of setting my alarm clock, say, for 8 AM and being able to leave the house by 8:45 or so. Now, the thought of putting my body through that kind of stress is unthinkable.

Even though I work from home as a full-time writer and author these days, my morning rituals have remained a key part of my life. They’ve gone from essential to pleasurable, always intentional, and always put in place to support my physical, mental, and emotional well-being.

I worry that without these morning rituals to guide me and look forward to, I would seriously struggle to start my day. They give me the structure and the motivation to start anew each morning.

Because when you wake up stiff and fatigued — fatigue being another all-too-common hallmark of AS — it’s all too tempting to roll over and fall back asleep. I’m so tired, I think to myself. Just another hour, even if I do physically morph into a statue version of myself.

The thing is, AS feeds on my being sedentary. It wants me turn to stone. My AS would be happy if I didn’t push myself — so I have to fight back. I have to get up and take action. Moving is the antidote to the morning stiffness and fatigue that want to lure me back into bed.

Here are the five things I do every morning to nourish my mind and body. The time I spend on them may vary per morning, how early I wake up, and what my schedule for the day looks like.

My Morning Rituals for AS

I make coffee or tea time intentional

Rather than making coffee and then getting right onto my phone or computer, I try to enforce a 15- to 20-minute coffee or coffee and reading routine. The goal is to start the day with intention and joy and softness — to gradually push myself into the chaos of the day, and to literally start forcing my muscles and bones to wake up.

For me, there are few things sweeter in this life than a cup of coffee, so I want to enjoy it — not rush through it. When I’m already in pain (and maybe cranky about it), why not do something nice and soft for myself? I usually read a book or write a few pages in my journal while drinking the coffee. I’ll also walk around the house with my coffee for a few minutes and just sort of loosen up my body. It may sound all too simple, but being with my body in silence, without a cell phone or TV to distract me, is a chance to commit to myself and my well-being.

I do a soft and gentle stretch routine

I don’t know how I managed to avoid this for so long. For years before my diagnosis — even when I suspected I could have AS — I just sort of threw myself into the day. When it got to the point when the morning pain was just too real to ignore or push past, I started putting on some music and just stretching before work. Even 10 minutes of stretching does the trick. You might want to stretch while you drink your coffee, too — sometimes I do. The goal, again, is be intentional and focused.

Because stress can impact the progression of the disease (my AS flare-ups are always tied to stress), I really try to integrate as much stress-free, calm time into my day as possible. I love these gentle stretches from Cara Ann Senicola, a certified yoga instructor and physical therapist at Hospital for Special Surgery in New York City.

I journal about goals and intentions for the day

This may not be something you do every single day (or even right away when you wake up), but I find that it helps for me to get a few thoughts out early in the day. I usually journal about how I’m feeling, any key plans and To-Dos I need to get out of the way, and any other goals I’d like to hit.

The reason? With AS fatigue and general unpredictability, I really never know what my energy is going to look like.  It can be really hard to plan for a workout class or time to go out with a friend, but if I prioritize what absolutely needs to get done and what I’d like to do, I feel like I have a little more autonomy over my energy and what I end up doing with it.

I dance for happiness and clarity

If I’m really feeling good when I wake up and after I get moving, I’ll put on some music and just dance. (Gently, of course.) Not only does this count as a good stretch, it kicks up your happy hormones. According to an article from the Neuroscience Institute at Harvard, dance comes with tons of perks: “Studies show that dance helps reduce stress, increases levels of the feel-good hormone serotonin, and helps develop new neural connections, especially in regions involved in executive function, long-term memory, and spatial recognition.”

And because brain fog is also so prevalent in AS, why not take a bit of a cognitive boost where you can get it? The truth is, life can feel short, challenging, lonely, and sort of blurry when you’re dealing with chronic pain. I like to combat all of that with joy. Just pure joy — even if it’s for a few moments.

I make time for gratitude

Perhaps this sounds like a cheap, empty, or pointless addition to this list. But the reality is that AS has made me feel alone, frustrated, exhausted, and — let’s be honest — pretty much any other crappy adjective out there. I know many other patients feel this way too.

When I settle down to take a few moments to think of what I’m grateful for, I believe it is helping rewire my brain. It reminds me that I don’t have to constantly think in the negative or feel bad for myself. It gives me perspective, strength, and helps me focus on what I can do or do have versus what I can’t or don’t.

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Keep Reading

Dancing and the Brain. On the Brain. Harvard Mahoney Neuroscience Institute Letter. https://neuro.hms.harvard.edu/harvard-mahoney-neuroscience-institute/brain-newsletter/and-brain-series/dancing-and-brain.