Axial Spondyloarthritis Seminar

Axial Spondyloarthritis Seminar: Inaugural meeting between NASS, Osteopaths and Chiropractors held at the Norfolk and Norwich University Hospital.

Last week I was delighted to be involved in the inaugural meeting between the National Ankylosing Spondylitis Society (NASS), osteopaths and chiropractors. Forty osteopaths and chiropractors attended to listen to a variety of speakers updating them on Axial Spondyloarthritis (AS).

The main aims of this seminar were to help reduce the delay to diagnosis of AS (currently an average 8.5 years!) through increasing awareness of the symptoms, improving screening of patients with back pain and improving the links for referring patients for relevant investigations. We also aimed to improve the care for people with AS by updating manual therapists on recent research and treatments, including different ways osteopaths and chiropractors can help people with AS.



Dr Karl Gaffney, Consultant Rheumatologist in Norwich.

Dr Karl Gaffney is a consultant rheumatologist at the Norfolk and Norwich University Hospital and trustee of NASS. Dr Gaffney gave an engaging presentation explaining the symptoms of AS and how to recognise the ‘extra-articular manifestations’ such as uveitis, inflammatory bowel conditions, joint pains and enthesitis (such as heel pain or tennis elbow).

He then explained the relevant investigations needed to diagnose AS. If an osteopath or chiropractor thinks a patient may have AS, they should refer them to the GP to be referred on to a rheumatologist for these tests.

Finally, Dr Gaffney then explained the recent research around AS and how this has informed the development of treatments. It’s really reassuring that new developments have improved the treatment of AS, but it shows how essential it is to diagnosis this condition swiftly to reduce the risk of bony changes in the spine before treatment begins.


Panel discussion about the referral pathway.

We then undertook a panel discussion with input from the audience, discussing the current barriers osteopaths and chiropractors face when trying to refer patients with suspected AS. It seems everyone has had mixed experiences of this process.

It felt very positive to then brainstorm ideas to reduce the difficulties we face when referring patients. I’m looking forward to improving this process to make it easier to refer patients quickly for the right investigations or to see a rheumatologist.


Andrea Lucchetti and Mandy Rush, Chiropractors in Wymondham and Diss.

Andrea and Mandy’s talk about the chiropractor’s perspective gave a really important insight into recognising the symptoms of inflammatory back pain, including an interesting case study of a current patient. They emphasised that because chiropractors and osteopaths are primary healthcare practitioners, patients often self-refer to us and their symptoms haven’t been screened by anyone else. This highlights the need to be vigilant for these symptoms and to ask patients specific questions to screen for the extra-articular manifestations of AS and family history.

Chiropractors and osteopaths also have a lot of time to spend with patients, putting us in the unique position to get to know patients and provide help for their overall health. Andrea then directed us to the SPADE tool and showed how this can be used in clinic when we’re considering AS as a cause for someone’s pain. It can also be used when we’re considering referring a patient to their GP for investigations.


Zoë Clark, Osteopath in Norwich and Diss.

I spoke about the osteopath’s perspective, then focused on the long-term management and help we can provide for people with AS. I explained how osteopaths and chiropractors can play an important part of someone’s health team, with care always focused on the patient at the centre. I also explained how we can empower patients and educate them about their own health, so they can manage symptoms well without our help, but also recognise the role each person plays in their mutli-disciplinary team to know who is best to contact when they require support.



We can also really get to know our patients and learn what activities and hobbies their symptoms are currently stopping them from doing. This way we can help them form achievable goals and a plan to improve their quality of life.

Through hands-on treatment and tailored exercises, we can help people reduce their pain and improve/maintain their mobility and function. I highlighted specific treatments and areas to focus on. Finally, I ran through the red flags that can occur for patients with AS and the need to look out for them and refer patients on when necessary.


Sally Dickinson, Information and Communications Manager for NASS.

Sally Dickinson is Information and Communications Manager for NASS and explained the fantastic work that NASS do providing free information about AS, support for patients and pushing for research developments and improved treatments. NASS is a very small charity, but the work they do is excellent and really important. For osteopaths and chiropractors, NASS can provide lots of information about diagnosing and treating AS, as well as free resources we can pass on to patients to help them manage their health.



I’d like to give a big thank you to everyone at NASS involved with organising this event, Dr Karl Gaffney, the Institute of Osteopathy and the Royal College of Chiropractors. Of course, a big thank you to everyone who attended and got involved with the evening. Hopefully this is just the first step to improving the care for people with AS via osteopaths and chiropractors.




Zoë Clark is an Osteopath and Naturopath trained at the British College of Osteopathic Medicine in London. Practicing in Howe near Norwich (01508 558373) and Diss (01379 644407) in Norfolk.

Call me on 07532 283649
Email zoeclarkosteopath@gmail.com
'Like' my Facebook page www.facebook.com/ZoeClarkOsteopathy
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