For patients and families

Movement, treatment and everyday life

Build an individualized plan for activity, symptom relief, daily tasks and preparation for procedures.

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Chapter 4 of 6

Start with a practical goal

Treatment usually focuses on the problem that is limiting you: discomfort, restricted movement, reduced endurance or a difficult daily task. Choose one or two goals that you can recognize, such as dressing with less difficulty, taking a regular walk or turning more comfortably during daily activities. Agree with your clinician or physical therapist how to judge progress.

Existing bony bridges remain in place, but muscles, balance, comfortable movement and activity habits can still be addressed. A plan should account for your degree of spinal rigidity, other painful joints, nerve symptoms and overall health. It may need adjustment when your circumstances change.

Develop a movement plan you can sustain

Depending on your assessment, suitable activities may include gentle mobility work, strengthening, balance practice and an activity that builds endurance. A physical therapist can help you find a manageable starting point and alternatives for movements that are difficult. Tell them about DISH, any known bridging, prior fractures and recent symptoms before treatment begins.

The small DISH exercise study most often cited used a daily program for 24 weeks, including 14 supervised sessions during the first eight weeks. Some measures improved, with the clearest statistical improvement in one measure of lower-back flexibility. The study gives a reason to try individualized rehabilitation and review its results, while leaving uncertainty about which program works best for a particular person.

Start at a level you can repeat comfortably. Discuss symptoms that repeatedly become substantially worse or remain worse after activity. New spinal pain after an injury, weakness or a major unexplained change calls for medical assessment before continuing the usual routine. Avoid forceful spinal manipulation or attempts to bend a rigid segment to “break up” the bridges.

Adapt the task as well as the exercise

Illustrative example: a person has trouble putting on socks because the spine and hips move less freely. The plan might combine appropriate hip and leg exercises with a seated dressing position and a suitable dressing aid. Progress is assessed by how safely and comfortably the person gets dressed. A harder stretch is not always the useful next step.

Look at the activities that repeatedly cause strain. Changing a work surface, bringing frequently used items within reach, taking movement breaks or using an appropriate aid may help. An occupational therapist can assess daily tasks and equipment. Choose adaptations that make an activity safer and easier to continue.

Limited neck rotation can affect driving, particularly checking traffic. Discuss this specifically rather than assuming that a general exercise plan settles driving safety. If balance or falls are a concern, review footwear, vision, sedating medicines, trip hazards and the need for a mobility aid with the appropriate team.

Use medication with a clear purpose

Pain relief may help some people participate more comfortably in daily life. The choice depends on the likely pain source, kidney and heart health, stomach or bleeding problems, and other medicines. Ask what improvement to expect, how long to try the treatment and when to review it. Report side effects and bring over-the-counter products to the medication review.

Check before combining pain medicines, since different brand names can contain the same ingredient or similar drugs. Treatment for a coexisting inflammatory disease should follow that diagnosis. If you already take an immune-modifying medicine, discuss its purpose with the prescriber before making changes.

Keep general health care on track

Blood pressure, diabetes, cholesterol, smoking, nutrition and sleep deserve attention according to your individual needs. These measures support overall health and your ability to remain active. Claims that a supplement, restrictive diet or commercial program will dissolve DISH bridges should be treated cautiously and discussed with your clinician.

Bone health also matters. Additional bone around the spine does not rule out osteoporosis or eliminate fracture risk. Ask about appropriate assessment if you have had a low-trauma fracture or other risk factors.

Before surgery, anesthesia or another procedure

Tell the team in advance about DISH, limited neck movement, swallowing difficulties, changes in voice, diagnosed sleep apnea and any previous difficulty placing a breathing tube. The anesthesia team can assess airway and positioning needs and decide whether additional information is required. Keep relevant imaging reports accessible.

Before hip replacement, mention DISH to the orthopedic surgeon. They can consider it alongside other factors when discussing postoperative bone formation, rehabilitation and any preventive measures. Do not begin preventive medication on your own. DISH does not mean that an operation or an endoscopic procedure must automatically be canceled.

Review what is helping

At follow-up, return to the original goals and describe changes in function, symptoms and treatment burden. If the plan is difficult to follow or gives little benefit, explain why. A useful review adjusts the next steps and clarifies when to seek help for a new problem.

Evidence reviewed as of October 30, 2026

Sources and further reading