Back pain is a tricky little sucker to say the least. Pretty much everyone experiences it at one point or another and much of the time, in spite of what some claim, therapists and clinicians can’t say with any degree of certainty what’s causing it. It’s also statistically normal to have an episode of back pain every year or two.
There are many causes of back pain and a host factors which influence it, for better and worse. Psychological distress for example more than doubles the later risk of low back pain. Add ‘persistent’ to the mix and the already murky picture of back pain becomes even less clear.
Ankylosing spondylitis (AS) is an uncommon form of arthritis which affects men more than women and typically becomes symptomatic in the early twenties. Part of its name derives from the Greek word ankylos meaning crooked. Not everyone with AS has the same symptoms, the most well-known of which are changes to the joints of the pelvis (sacroiliac joints) and spine. Bamboo spine is the name given to the appearance of the spine if the vertebrae have fused. The picture of a male with an increasingly more rounded back with age and concurrent back pain is what many believe the condition to be. This image *isn’t* the norm though. The average time to diagnose AS, which may present as “back pain” just like anyone else, is 8 years!
As a chronic autoimmune condition, AS is diagnosed by a rheumatologist and because it is systemic, its effects can be widespread, not just isolated to the spine and pelvis.
The changes on x-ray may or may not be present. ‘AS’ is the label given to the condition in patients where changes ARE visible on x-ray. Axial spondyloarthritis or axial SpA (axSpA) is the name given to the condition where changes in the pelvis and spine are NOT visible on x-ray, but ARE visible in (*some types* of) MRI. 70% of people with axSpA show signs of inflammation on MRI, but 30% don’t, and never will. Phew!
Non-axial SpA can also affect the limbs, particularly where muscle and tendons attach to bones (called the enthesis). Someone with non-axial spondyloarthritis may present to a therapist with symptoms which appear to be Achilles tendinopathy, but because it LOOKS like a common tendon issue which frequently affects runners, the underlying inflammatory condition is missed. The individual then bounces between professions and clinicians without relief or accurate diagnosis; hence why the average time to diagnose is 8 years.
It always amazes us how often we hear patients tell us they’ve been receiving the same treatment for weeks, months, even years without any significant improvement or resolution of symptoms. That’s madness. If you’re receiving treatment, you should expect to be getting better or see some significant improvement in function or capacity..
The definition of insanity is repeating the same thing over and over and expecting a different results.
Incidentally, the best non-pharmacological management of AS is, surprise surprise… exercise. At PRIDE Physiotherapy, if we’re unable to improve your symptoms you can expect us to refer you to someone else. If we’re heading down the wrong path with an incorrect diagnosis, we don’t want to delay your recovery if we’ve got it wrong (hopefully we won’t).
Thankfully AS isn’t common and if you have back pain it’s most likely something which *will* go away without any cause for concern at all. If you’re experiencing back pain, we’re available to help get you back on track quickly.
For more information about AS, check out:
Episode #26 of The Physio Matters Podcast with Dr Karl Gaffney http://chewshealth.co.uk/the-physio-matters-podcast/ http://nass.co.uk/just-diagnosed