Rachael Butterworth has a special interest in sacroiliitis, Ankylosing Spondylitis, and Spondyloarthritis, and has treated hundreds of clients with these conditions. She is dedicated and responsive to the needs of her clients and loves building continuing relationships with people who have long-term conditions. Rachael offers both online appointments and clinic appointments; for more information about ONLINE appointments click here.

Click on the picture below to hear Rachael discuss her background and experience treating inflammatory arthritis.



A Rheumatologist is a specialist physician who has expertise in diagnosing and treating arthritis, musculoskeletal conditions and autoimmune diseases. This includes diseases related to joints, muscles, tendons and bones, and also many other parts of the body including eyes, skin, internal organs and the nervous system.

One of the major groups of conditions that a Rheumatologist treats is arthritis (joint inflammation). There are hundreds of forms of arthritis and one of the subgroups is called Spondyloarthritis. Ankylosing Spondylitis (AS) sits within this group of conditions.

AS is an inflammatory rheumatic condition characterized by inflammation of the joints of the spine.  Inflammation particularly affects the sites where tendons or ligaments attach to bone. The most commonly affected joints are the sacroiliac joints that are part of the pelvis at the base of the spine. AS, however, is not just limited to this area. Any joints of the body can be affected, for example joints of the fingers or toes. Also, inflammation can occur within organs such as the eyes, intestines, heart and lungs.

AS is present in approximately 0.5-2% of the population. Although this may seem like a small amount, it is often under recognized in those suffering with back pain and historically has taken 5-10 years to be diagnosed.

The cause of AS is not yet completely understood. There is a strong genetic component with the protein HLA B27 being present in a high percentage of persons diagnosed with AS. This protein plays an important role in the action of the immune system. Confusingly, this gene can also be present in people who never go on to develop AS so this is not a definitive way to diagnose the condition. There continues to be advances in medicine as to possible other genetic factors related to this disease.


Diagnosis of AS comes from a number of clinical and radiological features. Unfortunately, there is no one single test available to diagnose AS.

Clinical criteria

  • Low back pain and stiffness for more than 3 months which improves with exercise, but is not relieved by rest

  • Limitation of motion of the lumbar spine in both sagittal (front-back) and frontal planes (side-side)

  • Limitation of chest expansion relative to normal values correlated for age and sex

Radiological criteria

  • Sacroilitis grade 2 or more bilaterally or grade 3-4 unilaterally

Definite AS is diagnosed if the radiologic criterion is satisfied with the presence of at least 1 clinical criterion.

There are a number of other investigations that are helpful for a Rheumatologist in the assessment of AS even though they may not be necessary for diagnosis. These involve the likes of blood tests, ultrasound imaging and MRI. These may be helpful towards diagnosing early inflammatory arthritis (Spondyloarthritis) which has not yet or may not progress to AS. 



As previously mentioned, the common feature of AS is inflammation of the pelvic joints. The thoracic spine (midback), lumbar spine (lower back) and cervical spine (neck) can become affected as the disease progresses. The Assessment of Spondyloarthritis International Society (ASAS) has given signs and symptoms suggestive of an inflammatory (Spondyloarthritis) cause of pain.

  • Age at onset <40 years

  • Insidious onset

  • Improvement with exercise

  • No improvement with rest

  • Pain at night with improvement upon getting out of bed

When at least 4 out of 5 features are present, the pain is essentially related to an inflammatory cause (Spondyloarthritis).

There are also some other features that may indicate an inflammatory process. These include:

  • Duration of back pain extending beyond 3 months

  • Morning stiffness lasting more than 30mins

  • Alternating buttock pain

  • Waking during the second half of the night only

  • Stiffness and loss of movement of the spine

  • Fatigue

  • Enthesitis (inflammation of tendon attachment to bone)

  • Dactylitis (inflammation of an entire digit – finger or toe)

  • Uveitis/Iritis (inflammation of the eyes)

  • Crohn’s Disease/Ulcerative Colitis (inflammation of the bowel)

  • Aortitis (inflammation of the aortic valve)

  • Pneumonitis (inflammation of the lung)


Treatment for AS is essentially divided into two groups which compliment each other and must work together for optimum outcomes. Firstly, there are the pharmatological treatments that have the aim of managing the disease through symptom control. Treatments include anti-inflammatory medication, disease modifying anti-rheumatic drugs (DMARDs) and more recently TNF inhibitors. Your rheumatologist manages this part of treatment.

The second part and as equally as important as the first, is exercise therapy. Although some physiotherapists may be aware of Ankylosing Spondylitis, very few have had exposure to the treatment of this disease. This is a very important factor to consider when searching out a Physiotherapist to help you. Here at Auckland Physiotherapy we have Rachael Butterworth, who has expertise in this field.

The role of physiotherapy in AS is to:

  • Provide education on the treatment of the condition

  • Provide progressive, tailored, specific exercise programs

  • Constantly be in contact with all persons involved in your treatment at your consent, including your rheumatologist

  • Provide continued long-term support and treatment

  • Be a central point of contact for you

The outcomes of such physiotherapy involvement have been shown to reduce pain and stiffness, increase mobility and function and have a positive effect on mood, attitude, health and quality of life.

If you are interested in further information regarding AS, please click on this link and at the bottom of the page you can download a free ebook.


Click on the picture below to hear Rachael explain how online appointments work. If you have any questions please feel free to contact us. 



Who is This For?

Any person who has been diagnosed with sacroiliitis, Ankylosing Spondylitis or Spondyloarthritis, and would like the best care available, without having to travel. Online consultations are ideal for those who have limited resources local to them. This may include difficulty accessing services due to your location, cost or travel challenges. If you are newly diagnosed, then online consultations are perfect for you, to get you on the right path early. 

What Do I Need?

All you will need is an internet connection or wifi and a webcam on your computer, or you can use the camera on your phone or tablet.

How Do Online Physiotherapy Consultations Work?

It may seem a bit unusual to have a physiotherapy consult via video conference, and it is understandable that you may be apprehensive regarding the viability of how this may work. For the most part, it will work exactly the same as an in-clinic consultation.

Prior to your scheduled appointment, you will receive questionnaires to fill out that give invaluable information to your physiotherapist about you and help to set baseline measures. Your initial consultation will take just under one hour. Within this time, Rachael will listen to your story, find out how you came to requiring physiotherapy services, and will ascertain your goals to work with you to achieve the outcomes you desire. Treatment will be provided within the scope of education, emotional support, online exercise programs, self-help techniques and personalized coaching, all with the aim of helping you to better self-manage your arthritis.

What Happens Once I Book an Appointment?

Once you book an appointment, you will receive a welcome email. This email will contain the following:

  • self-reported questionnaires for you to fill in

  • personal information and consent forms

  • information on what to bring/prepare for your consultation

You will receive a separate email with a link inviting you to your online consultation.

How Do I Know If I am Getting Better?

For your first appointment your physiotherapist and you will set personalized goals for what you want to achieve. Nothing is more powerful or accurate than you assessing your outcomes for yourself. You certainly will feel and know whether you are getting the outcomes you desire. You will also fill out self-reported questionnaires which are repeated at regular time intervals to assess changes and improvements. As you reach your goals you can then make new ones as you become more and more capable at managing your condition or decide to cease treatment if you are where you want to be.

How do I Pay if I Book an Online Appointment?

We will email you an invoice and you can pay online via bank transfer.