Treatment for ankylosing spondylitis can be divided into two categories: pharmacological and non-pharmacological. Although drug therapy has made leaps and bounds in recent years with the introduction of TNF inhibitors, nonpharmacologic therapies continue to play an integral role in the overall course of AS. Currently, the two main types of non-pharmacological treatment for AS are surgery and physical therapy. In an article published in the American Journal of Medical Sciences, Valle-Onate et al. present the advantages and disadvantages of the two treatments and their applicability to patients, so that physicians and patients can make the wisest choice at the most favorable time. Physical therapy The main symptom of AS is decreased spinal mobility, which is mainly due to poor body posture affecting the biomechanical structure of the spine. Restricted spinal mobility is an important indicator for early diagnosis of AS. These patients should be actively educated to exercise regularly, thus trying to maintain the flexibility of the spine to avoid poor body posture, and also to enhance muscle strength and reduce pain. Patients who had taken TNF inhibitors in turn performed rehabilitation exercises more frequently than before taking the drug. They also found that morning stiffness was reduced and spinal function and movement were improved after rehabilitation exercises. There are many different rehabilitation exercise methods worldwide, but they can be mainly divided into individualized rehabilitation exercise programs, guided group rehabilitation exercise programs, and unguided autonomous rehabilitation exercise programs. The results of the meta-analysis showed that the results of unguided autonomous rehabilitation exercise programs are better than no rehabilitation exercise program at all; guided rehabilitation exercise is more effective than autonomous rehabilitation exercise. For now, the best approach is to be hospitalized for weekly group rehabilitation. Treatment outcomes for ambulatory patients vary considerably. In Western Europe, the majority of patients choose to be hospitalized, but this is not necessarily the case in other parts of the world. In fact, it is difficult for many patients to maintain daily rehabilitation exercises on their own, and group rehabilitation under the guidance of a dedicated person enhances patient motivation and communication between patients. During this process, the physical therapist can ensure that the training is of a certain intensity and that the patient benefits from it. A typical group rehab session consists of one hour of rehabilitation, one hour of physical activity and one hour of hydrotherapy. Hydrotherapy can be an excellent adjunct to rehabilitation and can last for several months. Although many different physical therapy modalities have been studied, it is still not known what is most effective. The author recommends that patients engage in sports that do not involve physical collisions and does not recommend sports that involve physical collisions. However there is no one sport that works for all patients. The physical therapist can examine each patient individually and come up with an individualized program, and then instruct the patient on how to exercise and how to rest, while recommending that the patient do sports that are appropriate for them, such as badminton, volleyball, and swimming; at the same time, the patient is advised to avoid sports that are not appropriate, such as horseback riding and soccer. The individual differences of patients should be considered when developing rehabilitation programs. If the relevant physiological characteristics and biomechanical principles are previously understood, the developed rehabilitation program will be more valuable. Although more in-depth knowledge is needed to develop the best rehabilitation exercise and physical therapy program, there is a set of clinical criteria to judge which rehabilitation program is most likely to be appropriate for a patient. According to research, observing a patient’s pain and functional status is a better indicator of the effectiveness of rehabilitation exercises than previously used indicators such as spinal mobility. Other clinical criteria include: low back pain, neck pain and tension headaches. These criteria can better assist treatment staff in screening for the most beneficial rehabilitation treatment options for patients. Further research is needed in the future to clarify the value of these indicators. Rehabilitation exercises and physical therapy are now well established as an important alternative to pharmacological treatment, but the question that needs to be considered is how they can be applied to patients with AS in order to improve their function and lead a happy life.