Definition

Ankylosing spondylitis (‘deforming/stiffening vertebral inflammation’) or Bechterew’s disease is a chronic, inflammatory, rheumatoid disease that involves pain and a stiffening of the joints. Bechterew’s disease belongs to a group of spinal column joint diseases (spondyloarthropathies). It mainly affects the lumbar and thoracic spine and the sacroiliac joints. The iris in the eye can also become inflamed, as can other organs in some rare cases.

Spondyloarthropathies, of which ankylosing spondylitis is one of the most common, affect about 1.9 per cent of the German population. Many of the illnesses associated with comparatively mild symptoms are never diagnosed. It was once thought that the disease was three times as likely to affect men than women. Today we know that both sexes are affected equally. But due to the usually much milder course of the disease in women – at least with regard to the ossification of the spinal column – Bechterew’s disease is not diagnosed as often in women. Among sufferers in western industrialised nations, the initial symptoms usually develop in young adulthood (20-25 years). In only 5 per cent of cases does the onset of the disease begin in those aged over 40.

Causes

Even though the causes of ankylosing spondylitis are not entirely known, they seem to be associated with a disturbance of the immune system. An autoimmune reaction against the proteoglycan aggrecan, which is present in cartilage and is responsible for its elasticity, may constitute a cause. Commonalities in the antigens of proteoglycans could explain the range of the body regions affected. Today it is assumed that ankylosing spondylitis is largely genetic. The HLA-B27 gene is by far the best known marker, but not the sole genetic trigger. The risk of developing Bechterew’s disease is ninety times higher for HLA-B27 carriers compared to the general population.

Consequences

The course of the disease, which varies between different patients, is often relapsing-remitting. The onset of disability can be prevented by doing Bechterew exercises. Ankylosing spondylitis is often milder in women and stiffening of the spinal column occurs less frequently. The course of the disease is highly variable: It ranges from slight stiffness to complete fusing of the vertebra with the accompanying limitation of mobility in the upper body, bilateral arthritis in the hip joints, arthritis in the joints of the limbs and manifestations outside the joints. Patients develop characteristic postural changes when the condition is left untreated. The lumbar lordosis (forward curvature) of the spinal columndisappears, the buttock muscles waste away (atrophy) and the kyphosis (backward curvature) of the thoracic spine becomes more pronounced. The primary aspect of Bechterew’s disease is the inflammation of the tendon insertions, especially in the pelvis and spinal column. This is accompanied by oedema and damage to the bone marrow, which then becomes ossified. Inflammation of the sacroiliac joint (sacroiliitis) is one of the first effects. Both the tendon insertion and the joint capsule are affected. Other damage to the spinal column includes osteoporosis, vertebral body wear on the edges and inflammation with subsequent destruction of the transitions between the intervertebral discs and bones. Fractures within the spinal column constitute a serious complication of the disease. The porous bones can fracture even with slight trauma. This brings with it the risk of spinal cord injury. Acute anterior uveitis (inflammation of the uveal tract) is a common complication in ankylosing spondylitis. It usually occurs on one side only and is accompanied by photophobia and increased tear production. Concomitant phenomena are cataracts and glaucoma. Most patients develop aninflammation of the small intestine and ileum as well. This is usually asymptomatic. However, it progresses to chronic inflammatory intestinal disorders in five to ten per cent of all cases. Rarer concomitant phenomena include lung damage, aortic insufficiency and other functional disturbances in the area of the heart. The effect of ankylosing spondylitis on life expectancy is debatable. Some but not all studies indicate that life expectancy is reduced. Deaths related to ankylosing spondylitis are usually the result of spinal cord injury, respiratory insufficiency, aortic valve insufficiency or the side effects of treatment such as bleeding in the upper digestive tract.

Conventional therapy

• Exercise and physiotherapy
  With Bechterew’s disease, it is important to exercise regularly and to systematically perform physiotherapy and stretching exercises such as yoga and Pilates to augment the Bechterew exercises in order to keep the joints mobile and prevent hyperkyphosis. This is often very painful for the affected individuals. However, doing so often helps patients to maintain adequate physical mobility.
• Medications
• Surgery
  In cases where the disease has progressed very far, there is also the option of reverting to surgery. The rigid spinal column can be ‘broken’ in several places and then fixed in a more upright position with metal plates in a difficult operation associated with numerous complications. Even though this does not improve the mobility of the spinal column, quality of life can be significantly improved since the affected individual’s field of vision becomes significantly larger. If the hip joints are badly affected, an operation to implant artificial hips can be helpful as well.
• Alternative therapies
  Starch-free diet
  Radon baths (analgesic and anti-inflammatory)

The kybun principle of operation – being proactive

• The soft, elastic sole dampens impact from hard surfaces and thereby protects the joints. This is especially comfortable for those who suffer from painful inflammatory conditions.
• Patients can walk longer distances again and improve their level of fitness. The joy of movement returns and pain is reduced thanks to greater endurance, strength and mobility.
• The effects of kybun are quickly felt, especially in the foot: The foot can move freely in all directions on the soft, elastic material. This strengthens the core stabilising foot musculature and improves the mobility of the tendons and joints. Pain in the sole of the foot and the Achilles tendon is reduced, and foot rollover becomes easier again.
• You automatically assume a more upright posture on the soft, elastic material in order to keep your balance. The hips and back are straightened and you can actively counteract postural deterioration (kyphosis of the spinal column).
• Balance is improved and you can react to environmental influences more quickly.
  Thanks to the soft, elastic sole of the kybun shoe, you also have a better feel of the ground you are walking on, which improves foot sensitivity.

Application tips

• Since Bechterew pain is relapsing-remitting, kybun shoe training should always be adapted to the user’s condition each day. It is important for the affected individual to find out over time how much kybun training is helpful and when it is time for a break. On some days, it may well be that only short and gentle kybun shoe training is required (or even skipping a day), while walking longer distances in the kybun shoe may be possible on other days.
  

  Sometimes more pain is felt after kybun shoe training due to the mobilisation of the tendons, muscles and joints. However, this pain should be limited and should disappear again no more than two to three hours after training. If pain is ongoing or severe, the duration of use must be reduced. This is of particular importance with all inflammatory diseases. With regular walking in the kybun shoe/standing on the kybun mat, the body will adjust over time (greater mobility of the connective tissue and joints). Complaints/initial reactions will occur less quickly and frequently.

  More helpful tips:

• If the rollover causes severe pain in the foot, you can reduce the tensile stress on the plantar tendons and Achilles tendon as follows:
  1) Take shorter steps
  2) Put a stiffer, thin insole into the kybun shoe. This reduces the softness of the kybun shoe sole, therefore limiting the mobilisation of the foot.
• If you feel ‘new’ pain in the kybun shoe or on the kybun mat, or if your existing pain gets worse, this may be due to various reasons (e.g. unfamiliar, more upright posture, tense muscles, movements that are unfamiliar for the body). Adjust the duration of use and take a short kybun break if needed.
• We advise you to perform the kybun exercises regularly every now and again. They loosen the muscles and straighten the body. This relieves strain on the joints.
  Choose the kybun exercises that are good for you! Some customers prefer easier movements while others find the more intensive exercises helpful; this is highly individual.
• Choose a kybun shoe with a lower rebound effect. It provides you with greater midfoot stability. Ask your kybun dealer to show you the various models.
• If you feel unstable wearing the kybun shoe or are looking for an additional training device to use at home, the kybun mat is the ideal alternative. You can strengthen the foot, leg and back musculature at home on the soft, elastic springy mat. You can hold on to a fixed object if you feel unstable. The kybun mat is also available in a choice of different thicknesses (the thicker, the more intensive the training). Ask your local kybun dealer for advice.
• If you get very fatigued in spite of the kybun exercises, or if you feel pain or in case of lateral/medial rolling of the ankle joint on the kybun sole, we advise you to take a short kybun shoe/kybun mat break until the symptoms go away.
• Be sure to maintain an upright postureas much as possible and, if you can, keep your gaze forward(do not look at the floor). You should walk straight on the kybun shoe sole and correct any lateral/medial rolling of the ankle joint!
• If you have further questions or concerns, please contact us or a kybun dealer near you.