When people typically feel back pain, the problem comes from a mechanical origin – that is, from a strain to the muscles, ligaments or bones of the spine caused by trauma or overuse.
However, in some cases where there is no specific event, the pain can be caused by inflammation of the tissues of, and surrounding, the spine. Medical professionals refer to this type of back pain as ‘spondyloarthritis’ and its most common form is Ankylosing Spondylitis.
Distinguishing between mechanical back pain and ankylosing spondylitis
The most important reason to distinguish between mechanical back pain and ankylosing spondylitis is that their treatments are very different. Acute mechanical back pain often goes away over time and responds well to rest and short-term NSAIDs (Non-Steroidal Anti Inflammatory Drugs.) However, inflammatory back pain often persists over months or longer, and may require more aggressive drug treatment for relief. In both cases, exercise is an important component during recovery but differences between these conditions make it important that you do not adopt a “one size fits all” approach.
Mechanical low back pain is usually diagnosed by clinical exam that may include imaging (such as x-ray, CT or MRI) to rule out other causes. Sufferers experience localized pain that is often direction-specific (e.g., when you bend forward but not backward). Although some may experience pain that radiates into the leg, the source of the discomfort comes from pressure on tissues of the spine.
Diagnosing ankylosing spondylitis is a much more difficult process because there are many illnesses that share similar symptoms. It not only affects the tissues of the spine, but also can involve the sacroiliac joints, hip joints, tendons, ligaments and may include other areas such as the internal organs, skin, and eyes. Although AS has historically been thought to affect men more frequently than women, we now know that women’s symptoms can be very different, making them much more difficult to diagnose. Further blood and imaging tests are required to diagnose AS, or rather to rule out other illnesses, making it very important to seek medical consultation early – the average delay in diagnosis in Canada is 9 years.
iPAIN
In order to identify those at risk, doctors and clinicians often refer to the useful acronym “iPAIN”, which lists the best criteria for identifying those with greater odds of being diagnosed with AS. Specifically, it stands for:
- Improvement with exercise;
- Pain during the second half of the night;
- Age at onset is less than 45 years;
- Insidious onset (no specific injury or cause for the pain), and;
- No improvement with rest.
Staying Active
The pain and movement restriction caused by Ankylosing Spondylitis can have a significant effect on your quality of life and ability to be physically active. Aside from experiencing pain, many people with AS can also feel uneasy during activities which makes them feel unsafe. These feelings can cause you to limit the exercises or sports that you enjoy. Despite these feelings it is important to keep active as being too sedentary can contribute to increased progression of the disease and stiffening of the spinal joints.
The best approach to manage progression and get consistent results is regularly-scheduled monitoring and follow-up with your health professional. While x-rays and blood work are important for diagnosis, your health practitioner may use one or more measurement scales such as the BASMI (Bath Ankylosing Spondylitis Measurement Index), BASDI (Bath Ankylosing Spondylitis Spine Disability Index), or BASFI (Bath Ankylosing Spondylitis Spine Functional Index) to track the progress of your condition. These tests provide meaningful measurements of your physical condition during treatment so that your program can stay on track and to help make sure that the treatment is providing you with the best possible outcome.
The role of exercise
In Part 2 of this series, we will discuss the role of exercise in maintaining your strength, mobility, and managing pain. For more information on inflammatory back pain, or to ask how we might be able to help you, please contact us at 416 925 4687 or physio@orthophysio.com
Did you know?
The Orthopaedic Therapy Clinic is proud to be a clinical research partner with the Toronto Western Hospital to improve the diagnosis of Ankylosing Spondylitis.
