Clinical Rheumatology

, Volume 27, Issue 2, pp 207–210 | Cite as

Exercise therapy for patients with diffuse idiopathic skeletal hyperostosis

  • Adeeba Al-Herz
  • Jan Paul Snip
  • Bruce Clark
  • John M. EsdaileEmail author
Original Article


We evaluated the effect of exercise therapy on back pain, spinal range of motion (ROM), and disability in persons with diffuse idiopathic skeletal hyperostosis (DISH). Persons with symptomatic DISH received a daily exercise program for 24 weeks consisting of mobility, stretching, and strengthening exercises for the cervical, thoracic, and lumbar spine. It included 14 supervised sessions over 8 weeks. Outcomes included visual analogue scales (VAS) for pain, stiffness, and fatigue, 13 spinal measurements, the neck pain and disability scale, the Quebec back pain disability scale, the Bath Spondylitis Functional Index, and the MACTAR patient preference scale. Assessments were made at baseline, 8 weeks, and 24 weeks. Fifteen of 17 completed the study. Comparing week 24 with baseline, Schober’s test improved significantly (p = 0.02), and VAS stiffness and left finger-to-floor test demonstrated a trend to improvement (p = 0.07 each). The physical measures, which were expected to improve with the exercise program, all moved in the direction expected, but had p values > 0.10. At 24 weeks, eight (53.3%) participants rated their status as improved, three (20%) as unchanged, and four (27%) were unsure about the benefit. The exercise program designed for DISH and tested in this study led to small improvements in physical measures which achieved significance only for lumbosacral flexion.


Diffuse idiopathic skeletal hyperostosis Exercise therapy Treatment 


  1. 1.
    Resnick D, Niwayama G (1976) Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119:559–568PubMedGoogle Scholar
  2. 2.
    Littlejohn GO, Urowitz MB (1982) Peripheral enthesopathy in diffuse skeletal hyperostosis (DISH): a radiologic study. J Rheumatol 9:568–572PubMedGoogle Scholar
  3. 3.
    Mata S, Fortin PR, Fitzcharles M-A et al (1997) A controlled study of diffuse idiopathic skeletal hyperostosis: clinical features and functional status. Medicine (Baltimore) 76:104–117CrossRefGoogle Scholar
  4. 4.
    Mader R (2003) Diffuse idiopathic skeletal hyperostosis: a distinct clinical entity. Isr Med Assoc J 5:506–508PubMedGoogle Scholar
  5. 5.
    Utsinger PD, Resnick D, Shapiro R (1976) Diffuse skeletal abnormalities in Forestier disease. Arch Intern Med 136:763–768PubMedCrossRefGoogle Scholar
  6. 6.
    Troyanovich SJ, Buettner M (2003) A structural chiropractic approach to the management of diffuse idiopathic skeletal hyperostosis. J Manip Physiol Ther 26:202–206CrossRefGoogle Scholar
  7. 7.
    Mears T (2002) Acupuncture for back pain in a patient with Forestier’s disease (diffuse idiopathic skeletal hyperostosis)/DISH. Acupunct Med 20:102–104PubMedCrossRefGoogle Scholar
  8. 8.
    Wheeler AH, Goolkasian P, Baird AC, Darden BV (1999) Development of the Neck Pain and Disability Scale. Spine 24:1290–1294PubMedCrossRefGoogle Scholar
  9. 9.
    Kopec JA, Esdaile JM, Abrahamowicz M et al (1995) The Quebec Back Pain Disability Scale. Spine 20:341–352PubMedCrossRefGoogle Scholar
  10. 10.
    Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285PubMedGoogle Scholar
  11. 11.
    Tugwell P, Bombardier C, Buchanan WW et al (1987) The MACTAR Patient Preference Disability Questionnaire—an individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. J Rheumatol 14:446–451PubMedGoogle Scholar
  12. 12.
    Viitanen JV, Kokko M-L, Heikkila S, Kautiainen H (1998) Neck mobility assessment in ankylosing spondylitis: a clinical study of nine measurements including new tape methods for cervical rotation and lateral flexion. Br J Rheumatol 37:377–381PubMedCrossRefGoogle Scholar
  13. 13.
    Moll JMH, Wright V (1972) An objective clinical study of chest expansion. Ann Rheum Dis 31:1–8PubMedCrossRefGoogle Scholar
  14. 14.
    Moll JMH, Wright V (1971) Normal range of spinal mobility: an objective clinical study. Ann Rheum Dis 30:381–386PubMedGoogle Scholar
  15. 15.
    Pile KD, Laurent MR, Salmond CE et al (1991) Clinical assessment of ankylosing spondylitis: a study of observer variation in spinal measurements. Br J Rheumatol 30:29–34PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  • Adeeba Al-Herz
    • 1
  • Jan Paul Snip
    • 2
  • Bruce Clark
    • 3
  • John M. Esdaile
    • 3
    • 4
    • 5
    • 6
    Email author
  1. 1.Division of RheumatologyKuwait University, Al-Amiri HospitalKuwaitKuwait
  2. 2.Treloar Physiotherapy ClinicVancouverCanada
  3. 3.Arthritis Research Centre of CanadaVancouverCanada
  4. 4.Division of RheumatologyUniversity of British ColumbiaVancouverCanada
  5. 5.University of QueenslandBrisbaneAustralia
  6. 6.Canadian Arthritis NetworkVancouverCanada

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