Websites, apps and videos

You may not have noticed but over the last 9 months the AStretch committee have been trying to be more committed to putting new and relevant content onto our website on a regular basis. We made a decision last November for each committee member to be responsible for producing an article on a monthly basis and our web master Will, set up a rota – this seemed like a brilliant and fair idea, especially as my name came quite far down the list and September 2018 seemed like a long way off. Then the other committee members started to produce their excellent articles, and I started to get worried – what would I write about? Then at a meeting I met a young man who was attending the meeting as a “patient representative” and I was very impressed by how articulate he was and he mentioned that he had a You Tube presence and he usually “vlogged” about his climbing exploits, but he had also vlogged about being a young person with AS and he was delighted about how well received and popular it was.

This got me thinking, as any of the AStretch Committee will tell you, I am a dinosaur when it comes to social media, I am not on Facebook, I am not on twitter, nor do I follow anyone on twitter I am not on instagram but I occasionally may go onto You Tube, but one of the reasons I avoid social media is because I know I am very easily distracted (how many times have I thought about writing this article and found something else to do?!), and as the national press reported at the beginning of August that on average we check our smart phones every 12 minutes - I haven’t got time. But unless I had had the good fortune to meet Max Poplawski I would never have found his vlog. So I thought there are probably other physios out there who may not be checking their phones every 12 minutes and so may not realise there are in fact quite a number of apps and great websites etc that are specifically developed for AS / AxSpA patients that we could be recommending to our patients, to help them self-manage their condition long term.

So I thought I would make a start on an AStretch resource that perhaps you can add to if you  know about or indeed you yourself have developed an app for AS patients. I have been told there are a lot of great apps out there that can be used generally for helping to keep patients motivated with their exercise, but I think for now this resource should be limited to websites / apps / You Tube videos etc that are specifically designed with AS / AxSpA patients in mind. So here to get the ball rolling are a few suggestions that I find useful... (scroll down to "Useful Links Regarding...")

Claire H

Supporting the supporters

Working within the field of AxSpA over the past 20 years has given me the opportunity to look at many different amazing projects to try and enhance the care and services that patients have locally in my area. From service redesign to patient education sessions, hydrotherapy exercises groups to community engagement programmes. All of these interactions are continually aimed at supporting patients to self-manage their condition long term. The fact that patients spend only 3 hours a year with health care professionals and then have to “self-mange” for the remaining 8757 hours of the year is a great reminder of how our input can be invaluable to help support patients to live a happy life with their condition. But what about the other people in the patients’ life ? The ones who spend the majority of the 8757 hours with them. The people who may, or may not (!), help support our patients – their family and friends. What input and role do they play?
Within our roles we have the scope and “permission” to spend time working with our patients, trying to educate and support them in self-management but do we spend enough time educating their family and friends to help them support our patients during all those hours when they are not with us? Are we allowed to spend time specifically educating & supporting the patients’ friends and family? Do “we “ [healthcare managers] acknowledge that time educating and seeing the family and friends maybe an essential part of the patients’ overall care and support strategy? What we are really asking then is……”Do we invest enough time supporting the supporters?” So to give food for thought I want to share a few experiences of how my work includes different ways of supporting the supporters…….
Starting at the basics, when I reflect back and look at when I first started work within this field most of the patients attended their treatment and clinic reviews on their own. I will happily admit that back in those times I loosely asked what support a patient had at home from their family and friends but it certainly was not always the focus of our discussions. Fast forward to the last 5 years and there is a whole new world! My personal recognition that friends and family are key in supporting patients to self manage in all elements of their disease is now paramount to my communication and support that I give to patients. To that end in my local area we actively encourage all patients to bring a family member to every consultation that they have with us. Through our appointment letters, patient clinic information and in person, the offer is always there.  Within the clinic some family members just sit, listen and learn about the condition and its management. This can be invaluable for them to then offer moral support and encourage self management to the patient through their greater understanding of the condition. As an example the wife of a patient in clinic become very emotional when we discussed the fatigue element of the condition and she commented: “I never realised this could be part of his disease…I thought he had just stopped wanting to go out as he was so grumpy, tired all the time and using work as an excuse…”.

Some family members become very involved in the clinic discussions and offer invaluable opinion on how they see the patient is really doing at home and in life. Perhaps giving us a true insight when the patient simply tells us they are “doing ok”. Along side this the discussions can often mean the patients’ themselves have “light bulb” moments when something is raised that they had not recognised or acknowledged as affecting them and their condition. In a recent clinic for example one of my patients attended an urgent appointment on his own describing what seemed to be an acute flare of symptoms even though he had been stable on a biologic treatment for the previous year. He could not identify any changes that may have caused the acute flare and raised concerns that his biologic was no longer working. Inflammatory markers were normal and full dose of drug had been taken. There were no other medical concerns to potentially warrant the change. On a 3 week follow up review he attended again and having seen his pain increase and coping ability decrease his wife came with him as she was concerned. Bloods were still normal (not unusual for some AxSpA patients), so we looked at alternative possible causes for the increased pain and fatigue. Although he had not felt it significant at the time, his wife did mention the recent death of his father………….a sudden event that she stated “had knocked him [our patient] for six” at the time. That he had not been sleeping well since the death as she was aware that he was constantly restless at night. That he had increased his working hours to “stay busy” and not focus on the death of his father. Through conversation after on how stress, work, and lack of sleep can affect his condition there seemed to be a real lightbulb moment for our patient on how this event could have been the cause of his apparent increase symptoms. This insight from his wife certainly positively influenced the patients treatment choices moving forward…his discussion moved from wanting to switch biologic to looking at counselling for his bereavement, sleep hygiene strategies and pacing of his work hours!

Some family members then go one step further and ask what else they can actively do to help support their loved ones. From agreeing in discussion what exercise classes or activity they may do together moving forward every week, to agreeing a strategy at home on how the patient can advise they are having a bad day without making a fuss and the family chores or activities for the day being modified accordingly. This latter point worked well for a family where the mum [our patient] would simply blue tack a picture of a happy face or a slightly sad face to the fridge door to indicate that it was a good or not so good day. Her husband would then offer to cook dinner for example or come up with alternative activity ideas for the kids for the day, being mindful that his wife may not be able to do as much as normal but would still want to be involved.
As a final note, any family involvement within an appointment has to be at the explicit consent of the patient of course. If they are happy though and the family are happy, any level of involvement from a family member in a clinical appointment I feel can be invaluable in the patients overall self management.

Along with my work at a local level with family and friends I have had the great honour of working with NASS on delivering the friends and family sessions at several of their members days. The last was a recent as June this year. All of the days prove to be diverse, humbling and emotional sessions. The format of the sessions each year changes: mini presentations on elements of the disease, open floor questions and answers and this year the AS game of life. This last session saw family and friends move round a game board answering and discussing elements throughout life that may or may not affect their game board character (who just happened to have AS!). Discussing the use of turmeric, what you would do if you won £5,000 on a prize draw or what you would do if you were approached to be part of a new drug clinical trial – all sorts of medical, social, positive and negative elements of life were discussed as the game progressed and allowed us as facilitators to have open discussions with those there. Inevitably, as was the intention of the game, the statements on the game cards led to other topics as the family and friends opened up more, asking questions that were important to them. We even discussed if different high tension TV shows could influence how a patient with AS may feel through somebody feeling emotional or tense when watching TV! 

Being a member of NASS can prove invaluable to our patients but also to the family and friends as they have access to these member days and the specific sessions that are hosted for them. Acknowledging that not all will be able to attend the days though, at my unit we try to recreate the family and friends session each year for our local district. A small donation of money for refreshments from our charitable funds, invitations to all via our NASS group and clinic patients are organised. Scheduled as an early evening session of 2 hours we normally coincide it with our NASS group evening as a sneaky bit of branch promotion for these who may not be members! Supported by the wonderful team I work with we try to get the lead NASS physio, a nurse and consultant along to our session but any combination of staff can make a successful event.

I guarantee that some of the NASS group and their family and friends will insist that after living with the condition for years they do not need to attend any sessions as what could they possibly learn?. I would beg to differ though especially considering the rapidly changing world of medicines management and our increased knowledge about associated conditions and their management. I recall clearly during one of our events the shocked wife of one of our NASS members who had been with the group for 19 years. We were discussing the recommendation for patients to exercise daily for their AS  – “you mean he should be doing more than just coming to NASS once a week? He could / should have been exercising daily?….he could be using our gym at home for example??”.  I think after the session the member had no choice but to increase his exercise regime with the support of his wife!!!

On a much larger scale locally we also host full multi condition, off site education days for patients and their family and friends. Although planning and financial support is key for such an event the benefit is unquestionable. For most of the days (inflammatory arthritis, connective tissue, osteoporosis day) we see anywhere between 300 -400 people attending. We take advantage of the inflammatory arthritis day to offer specific breakout sessions for AxSpA. In these sessions we encourage patients and family together. We find these sessions are really effective for those who do not work or are retired but also those who feel they benefit from taking annual leave to have a day of education about their condition, medicines management, diet, podiatry and everything else in between. We often have one to one slots with the team as well during the day that people sign up for  – with one patient this was undertaken in the relaxed atmosphere of a refreshment area with comfortable sofa chairs, coffee and cake – quite different to the sterile clinic room setup and proved just the alternative atmosphere that both our patient and his wife needed to really communicate with us. Indeed this one session with us saw a complete shift  in discussion for the patient and his wife – for the first time he openly talked to her about his stress at work, his want to reduce some of his hours but the self inflicted pressure that he felt to continue as the bread winner for the family. His sadness that he could not play with his young girls easily due to his pain and fatigue and for the first time his confession to his wife that he felt “down” in mood most days but had been trying to shield her and his girls from his true emotions. Pleasingly as a result of our gathering at the event this couple now come to clinic appointments together, both realising the value and commenting that the appointments provide great support to both of them. Work modifications, open communication and an overall happy life together has been the most satisfying result for them.

So, the value of supporting the supporters I think is unquestionable for all of our AxSpA patients. We all become invested in the care and overall well being of our patents and a significant part of that can be our interaction and support with their family and friends. My 3 top tips to get you thinking:

1)      Start with the basics – encourage your patients to bring a family member to their appointments – this may even be as simple as a leaflet drop to all of your patients, encouraging their attendance. 

2)      Consider hosting a family and friends event – no patients, no secrets, no question is too silly! You may plan some specific education points that you want to get across to them such as the aetiology of the condition or the developments in mediation. You may just want to open the floor to their questions. 

3)      Get in contact – NASS and AStretch have a wealth of experience in supporting the family and friends of AxSpA patients – we are all happy to share our experiences or give you any support we can to set up programmes or events in your area

Claire J

Sleep and AS: do we consider the implications of the quality of sleep on our patients?

For several years now as part of my routine assessment of all our AS and Axial SpA patients, I have been asking how well people felt that they had slept over the past week.  I use a simple verbal VAS scale from zero to 10 with 10 being ‘I have slept wonderfully’ and zero being ‘I haven’t slept at all’.  There is no science behind the question but it is meant to open a conversation and it does. 

I hear a varied range of explanations as to why sleep has been interrupted and poor  which have included a full spectrum ranging from menopausal flushes, stress at work, trips too frequently to the toilet, babies and children in general of all ages and early waking pets etc. etc. 

However what I listen for is the waking in the middle of the night with pain and stiffness as this gives us an opening to ask what (if any) coping strategies people employ.  From listening to our patients over the years I now advise not fighting the pain and or stiffness and stubbornly lying there but to get up and stretch. 

I say ‘go down stairs (if you have them), put the kettle on (you don’t need to make a drink and if you do steer away from caffeine) and stretch whilst it boils.  If you are sore, heat your wheat pack in the microwave and stretch as it warms then take it back to bed with you.’ 

Alas we have no science to ensure that people sleep better.  The best I have is to advise on ‘sleep hygiene’ which is a term that I confess I squirm when saying. Poor sleep is blamed for increasing fatigue and generally lowering our mood and resilience in coping with life in general.  A very recently published study on sleep in AS authored by Alison Wadeley (Clinical Rheumatology (2018) 37:1045-1052) is the first of it’s kind in the UK and is well worth a read.

 It is a large cross sectional, observational, single centre study using the data of 659 patients with both AS and Axial SpA .  Key messages are that not unsurprisingly poor sleepers have higher disease activity and fatigue scores and more night-time back pain than good sleepers.  Poor sleepers also had poorer quality of life, general health, mood and work-related measures.  Poor sleep was also associated with poor mood, female gender, greater fatigue, greater disease activity (specifically, spinal pain and stiffness) and better mobility although the direction of causality between poor sleep and markers of active disease was undetermined.  A further thought is that we need to standardise the measurement of sleep disturbance.

Having now begun to absorb the messages from this study, as a clinician this all makes perfect sense. Wouldn’t it be wonderful if we could use a short questionnaire that would help us to understand the implications that sleep quality has had on our patient’s lives and then be able to have the intervention to help to improve this.  Frustratingly I fear that several years may need to pass and a lot of hard and dedicated work to reach this stage. 

For the time being, I will continue to ask about sleep and do my best to suggest how this may be improved without ‘proper science’.  My thanks go to Alison and her co-authors for highlighting sleep as an important and integral aspect of a person’s life as they live with their AS.  I would encourage our Rheumatology community to at the very least to have a conversation with their patients about the quality of their patient’s sleep. At the very least this would acknowledge that we are aware of the impact that this could be having on the way that they are currently coping with their condition.

Jane

The Perils of Ignorance

By the time I was 27 years old in 1991, I had had AS for 16 years although I had only been diagnosed for 8 years.  

I had been living in New Zealand for nearly 4 years, working as a physiotherapist in different parts of the country.  At this point, I was living in beautiful Takaka in the north of the South Island.  I had been pursuing a very active lifestyle and I had learnt to live with recurrent pain determined not to let this hold me back.   Pursuits included mountain Climbing, Canoeing, and Windsurfing. I had also made friends with a local dolphin and we would play regularly together off the beach at Onekaka.  Life was going swimmingly and I had no intention of that changing.  Two more months to go and I would gain NZ citizenship.  My dream was nearly a reality. 

One day, I had the misfortune of being offered milk straight from a cow (via a jug!) and with no idea of the consequences, I drank it.  It was warm and fairly unpalatable.  This little sip was to change the course of my life forever.  

Within 48 hours, I was laid up in bed with swollen knees and ankles.  I felt really ill and I suffered from abdominal pain and diarrhoea.  One of my eyes fogged over with uveitis but I had no idea that this was serious.  Takaka was full of well meaning locals and doctors who had never come across a case like mine.  It meant that I had to endure bad advice, enemas, special diets, the lot. After 3 weeks and no improvement, my twin brother (who also has AS) was despatched to bring me home.  My heart ached as I left the country of my dreams. 

It took me the best part of 2 years to recover and for most of that time, I was living back at home with my parents which was not easy.  Active disease, pain and lack of sleep made me depressed.    I had lost my friends, my independence, my income, and my active lifestyle.  It took me almost a year to walk without crutches and another year before I could work and live independently. 

Why had this happened? 

I had contracted Campylobacter from the unpasteurised milk.  Not only had my life radically changed, but 2 years later, I was diagnosed with post-infective Crohns disease. 

Why am I telling you this?

If I had been warned about the possible consequences of being exposed to unpasteurised milk products this would not have happened and  my life would have taken a very different path. I believe that not enough information is given to AS patients about the risk of developing a reactive arthritis when exposed to common bacterial such as Campylobacter and Salmonella.  Perhaps this should be a subject that is shared more widely with patients not just by the medical staff but by health professionals too. Please spread the word!

In the next instalment, I would like to share the positive side that this experience has had on my life. 

Juliette

BSR Conference 2018, Liverpool 1st-3rd May

Tuesday lunchtime: already lots if highlights from the conference and only one sixth of the way through. We've had some information on work in SpA from the BSRBR-AS register - the poster / abstract made it as one of the "Jewels in the Crown" at conference, presented earlier this morning. They compared a cohort of AS on biologics vs a cohort not on biologics. Using the WPAI as an outcome measure the data extraction has found those on biologics had greater improvements in presenteeismand overal activity impairment; improvememnts for presenteeism were similar for both groups. 
We've seen the creeping progress of the Escape-Pain programme as it aims to see as many as 50% of those in the Uk with knee OA go through one of it's education ans exercise groups. To hit as many targets as possible Prof Mike Hurley has been knocking on a lot of doors and it looks like progress is now more rapid, look out for a programme near you run by exercise instructors in local exercise facilities, or opt to run one in house ideally staffed by well established physiotherapy assistants (he suggests at band 4 level). Really impressive reuslts from the programme, but challenges to getting it adopted across the country. We've seen how this kind of programme fits into a 4-tiered approach to physical activity in rheumatic diseases, from the broad public health messgaes all the way to one-to-one tailored physiotherapy input.

Will

Portfolio Careers in Physiotherapy

When I was asked to contribute a piece to the AStretch website this week I was happy to. Having been a committee member for 3 years I had seen the resources of AStretch grow and grow to provide support to clinicians interested in Spondyloarthritis (AS). I just had to look at my own diary and decide on when I could do this.

Then it dawned on me that my working week is made up of ‘many different bits’ and when put together they make up a whole …..to me more interesting than 1 job……… maybe that was worth writing about!

6 months ago…a respected colleague of mine asked if I would speak to an audience of multiprofessionals at a conference about my ‘Portfolio Career’. My genuine first question was:
‘What is a Portfolio Career?'
A Portfolio career is … instead of working a traditional full-time job, you work multiple part-time jobs (including part-time employment, temporary jobs, freelancing, and self-employment) with different employers that when combined are the equivalent of a full-time position. Portfolio careers are usually built around a collection of skills and interests, though the only consistent theme is one of career self-management. 
If you’re still interested ……….read on here.
Mel

Why Tai Chi in Axial Spondyloarthritis?

I have been teaching Tai Chi to this patient group for more than fifteen years; the thing that strikes me is how much they enjoy it and how it enables them to increase their function very quickly.

Why should this be? certainly not magic!!

If we think about the symptoms that most of these people experience, pain, stiffness, postural changes, fatigue, sometimes reduced chest expansion and general mobility (walking).

It is generally agreed that exercise has a beneficial effect on these symptoms.

“I was afraid to go out, my pain had become intolerable and I was afraid of falling. The Tai Chi classes have given me a reason to get out of bed on a Monday morning, I now go for a walk after class and at six weeks I can now manage two hours after the forty-minute class, thank you”.

This lady had obviously been struggling for some time and had tried many other forms of exercise, swimming and daily strenghtening and stretching, often recommenend in Spondyloarthritis and also afford benefits such as improved mobility, muscle strength and subsequent pain and fatigue management.

However, these exercises do not fully address the issue of balance.

Balance is the ability of the body to remain steady in a chosen position; to move smoothly and safely through small body adjustments. Postural control requires complex interactions within the musculoskeletal system, sensory and cognitive systems. Joint stiffness at spinal, hip, knee and ankle joints reduces the body’s ability to right itself and reduces proprioceptive awareness. Postural changes also affect balance due to the alteration in the centre of gravity. Ankylosing Spondylitis patients have been found to have a poorer balance in comparison to healthy subjects and it is recommended that postural awareness be included in early treatment plans.

So, we get back to this lady and her fear of falling, a fear of falling is one of the biggest predictors of a fall, and the increased propensity to osteoporosis in this patient group will increase the fracture risk. Inactivity reduces one’s ability to compensate and contributes to other problems, including loss of bone and muscle mass, heart disease, and obesity as well as social isolation.

Tai Chi is practiced in a normal balanced standing position, constant movement of the limbs and weight transference improves flexibility and strength in the lower limbs particularly around the knees and ankles has a positive effect on proprioception and balance reactions and on circulatory systems to joints muscles and vital organs. Co-ordinating arm movements challenges balance and improves positional awareness giving better sense of position in space, over time this is translated into daily activities. Slow repetitive movement helps to re-educate neural pathways improving the system interactions and therefore normal movement patterns.

What else? Well; this lady obviously enjoyed her Monday morning classes, certainly social interaction can have a positive psychological effect which cannot be overplayed. Tai Chi is a “mindful” exercise. Participants are encouraged to concentrate on the here and now and only on their breathing and development of their movements. This can have a calming and relaxing effect which in turn aids concentration and memory which improves pain and fatigue. Of course, the inclusion of breathing exercise throughout the programme has the added value of increasing chest expansion and vital capacity.

In short Tai Chi is an integrated form of exercise which can be included in exercise prescription at any stage of the disease.

Sue

Singing

I have always enjoyed singing. At school we made records (we are talking about the 70s), sang in concerts and managed to get on Songs of Praise! Over the years wherever I lived, I joined a choir or operatic society and performed in various shows.

One day a female Barbershop Chorus called Spinnaker Chorus came to my town and they sang acapella style (without sheet music) in four-part harmony. I listened and marvelled at the sound. Their faces expressed the passion of the song, their bodies swayed with the music and they stood tall. What fabulous postures they all had. To top it all, they really looked like they were enjoying themselves! I joined up immediately. That was 10 years ago.

Since joining Spinnaker Chorus ( www.spinnakerchorus.co.uk ) I have never looked back. At last, I was taught how to sing effectively. Using the mouth, larynx, facial muscles, rib cage and good posture, we are taught how to perfect the sound. Then in time to the music, and maintaining our posture, we move with the rhythm. The work out begins. For some of the songs choreographed moves increase the work out still further. We learn how to breathe, holding onto the breath throughout a phrase, then snatching a breath in unison at certain intervals. By the end of the song, the rib cage has moved to its limit and we are breathless from the aerobic nature of the exercise.

There have been articles written about singing and its positive effect on our physical and mental health. The release of endorphins certainly plays its part, the work out another. So too does being part of a group of people with the same passion. If you are thinking about singing in a choir or a chorus, it has to be worth a try. The physical, emotional and psychological benefits can be dazzling.

Juliette

The power of the Voice

Having been diagnosed with a Chronic life changing condition is not an easy thing to accept.

One of my hobbies has always been music, when my lungs became a problem I decided to take up singing seriously. I sat my theory exams with young children. I had better mention that at this time I was 60 years old. For the singing exam I waited patiently with these youngsters who were brimming with confidence. Me? I was shaking in my shoes. However, I passed all my exams with distinction. I did notice as I studied and practiced during those hours, was that my pain became less pronounced, I became so focused.

I still belong to a choir “The Melody Makers” we practice once a week. I’ve found that I have gone to practice feeling unwell and in pain. Once I start singing the pain recedes, it becomes less dominant. It does make me feel tired but when I get home I am able to totally relax.

I find it is not just the music that helps it is also contact with other people. Many of the choir members have got physical problems but there love of music seems to help.

After finding how much my music had helped me to control my pain I joined other groups, art and a swimming club. The time spent with all these groups I actually feel normal. All I have to do is prepare for each activity in advance and realise there is a small price to pay; the next day I rest.

Jan.

Bollywood Dancing and Ankylosing Spondylitis (AS)

Dance is reported as the UK’s fastest growing art form with more than 4.8 million people regularly attending community dance groups each year in England alone. One added advantage in dancing is that while you’re having fun moving to music and meeting new people, you’re getting all the health benefits of a good workout.

As a physiotherapist I strongly feel regular dancing is great for maintaining strong bones, improving posture and muscle strength, increasing balance and co-ordination, beating stress levels and losing weight.

Bollywood dancing: Bollywood dancing stems from the Indian film industry and has increased in popularity throughout the world since the beginning of the 20th century. Bollywood dance is known for being upbeat; it blends the unique traditional Indian dance forms with the modern western hip-hop and jazz dance styles.

Bollywood and AS: My Husband Raj is a music/dance lover and a choreographer, using our whole family effort over the past 5 years we have conducted few local Bollywood programmes. Grimsby NASS group member and Treasurer Jeanne Murray attended our local Bollywood programme and expressed interest in including some dance routines at our NASS group. The members enjoyed the 5 minutes dance work-out and evaluated the session to be different, easy to exercise, enjoyable, fun-filling and did not report any adverse effects. We gradually started including Zumba and line dance forms, we plan to include few more routines in the future.

Big High five to the Grimsby NASS group members! Big Cheers to all the Bollywood dance lovers.

Susimala

Laughter and the love of life

A few weeks ago I had a conversation with a colleague about a patient of hers who I had met in the hydrotherapy pool. This patient had presented in the department suffering from long-term musculoskeletal disease and chronic pain. She was morose and lacking in motivation both with exercise and socially, in fact she rarely left the house. Following initial assessment and treatment she was referred for a course of hydrotherapy.

This lady struck up a friendship with a fellow patient attending the same treatment session as they travelled together on the same hospital transport. This pair soon became the life and soul of the sessions, encouraging other patients and creating havoc and amusement in equal measure. On review, her physiotherapist was amazed at the change in this lady, her posture and physicality had improved dramatically along with her sense of well being and her ability to manage her chronic condition. She is continuing to socialise and exercise with her new friend.

What had brought about this dramatic change? The magic warm water and exercise, skilfully taught by her physiotherapist? Or, the power of friendship, interacting, sharing, offloading and laughing with another human being?

Sue

About us

AStretch is a not for profit organisation; our main aim is to provide a co-ordinated approach to the planning and delivery of education and best practice. Also to support physiotherapists working with people who have Axial Spondyloarthritis (AxSpA) and Ankylosing Spondylitis (AS).

Contact

Email us on astretch@astretch.co.uk for general enquiries

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