If you have a bad back, you might be tempted to see a chiropractor. Many people do, and often find it helpful. But it's important to get a proper diagnosis before having your spine manipulated. Adjusting the backbone might make some causes of back pain worse. For example, spinal adjustments are controversial if you have a type of arthritis called ankylosing spondylitis (AS). The condition causes inflammation of the spinal joints, called vertebrae. Over time, this can trigger new abnormal bone tissue to form. Parts of the spine may join together (fuse) and no longer move correctly, or at all. Symptoms include low back pain and stiffness, which gets worse with inactivity. Controversial Care? Some people with AS say a trip to the chiropractor helps them feel better. However, there's little published research to show that it's actually safe for such patients. The Spondylitis Association of America says doctors do not recommend chiropractic treatment for ankylosing spondylitis. Why It Might Help The American Chiropractic Association says gentle spinal adjustments provide some pain relief when you're in between flare-ups (in other words, during the" non-inflammatory phase" of the disease). One type of adjustment they suggest is flexion distraction. Knee-to-chest movements are done to help take pressure off nerves and stretch ligaments in the spine. The organization also recommends range of motion and stretching exercises to keep your joints flexible. However, some say chiropractic care could help those with advanced ankylosing spondylitis, too. A single case report involving just one man with the condition showed he got better after three months of spinal adjustments and physical therapy. Why It Could Be Dangerous Studies have long reported on the potential danger of chiropractic care for patients with AS. If you have limited spinal movement, opponents say you should never have your back or neck manipulated—whether from a massage therapist or chiropractor. Doing so could lead to: Nerve damage, which could be permanent Spinal fractures How does this happen? Moving the spine the wrong way could cause abnormal bone growth to shift and push on nearby structures, like a nerve. You could have pain, numbness, tingling, or even paralysis (an inability to move). Research specifically involving AS patients has shown that chiropractic treatment has resulted in long-term spinal cord injuries. A panel of 40 experienced chiropractors agrees that it might be dangerous in some cases. They do not recommend quick (high-velocity) adjustments to the lumbar spine if you have a flare-up of AS. What You Should Do Often times, symptoms of AS don't show up for a long time. You may have already sought help from a chiropractor for your back pain. If you're pain continues for more than 3 months and chiropractic care isn't helping, make an appointment with your primary care doctor or a rheumatologist to rule out AS or another inflammatory condition. Sometimes, a chiropractor might be the first person to suspect you have AS. Remember: It's important to take a proactive part in your healthcare. Talk to all of your doctors to determine if chiropractic care will help or harm you. They should discuss the potential risks and benefits of spinal manipulation. Before you have an adjustment, your chiropractor should carefully review your health history and symptoms.