The symptoms caused by these lifestyle factors (generally referred to as ‘nonspecific’ back pain) can become persistent and chronic. But in five per cent of cases, there’s an inflammatory cause of unresolved, long-term back pain that remains lesser-known.
Ankylosing spondylitis — that’s a mouthful, so we’ll just go with AS — is arthritis of the back. It causes inflammation of the spinal joints, which then cause the bones to fuse (in other words: very painful).
Unfortunately, it takes an average of 10 years for the condition to be diagnosed. This is largely due to the lack of AS awareness among the public and even health professionals, says Sydney rheumatologist Dr Irwin Lim.
“Most of the patients that have this have seen multiple physios, chiros, osteopaths, their GP, and it’s not thought about,” he explains.
Watch: A strong core can keep your back healthy and happy. Try this core exercise from Paper Tiger. (Post continues after video.)
AS is hereditary and three times more common among men than women, particularly those in the 20-40 year age bracked.
“Because these are young guys, [the symptoms] are usually blamed on sport or their job or lifting or doing something silly, and they typically don’t really go looking very hard for the cause of it,” Dr Lim says.
This complicates matters for female AS sufferers, because it’s typically perceived as a ‘male’ disease and thus isn’t often considered as a cause for their painful symptoms.
“If you’re female and have chronic back pain, it’s almost always blamed on the fact that you might be overweight or you’re picking up children or multiple pregnancies. There’s always something else to blame,” Dr Lim says.
Constant pain is just the start of life with AS. Dr Lim explains that a sufferer's spine will continue to stiffen, making even the most basic tasks progressively uncomfortable — especially those that require long periods of sitting or lying down. So yes, even driving or sleeping become painful.
If you, or someone you know, is experiencing ongoing back pain, there's a simple online screening test that can help you determine whether the cause is nonspecific or inflammatory. The website Don't Turn Your Back On It, which aims to raise awareness of AS, has five yes/no questions that will help you make the distinction.
"These are [symptoms] like waking up in the middle of the night with back pain that is actually worse when you’re resting and better when you’re active, which can be quite different from the usual types of back pain," Dr Lim says.
It's also important to highlight that AS is genetic, so if chronic back pain runs in your family it's worth seeking some medical attention. There's a measurable genetic marker called HLBA27 that's common among sufferers of AS. (Post continues after gallery.)
Although AS is a chronic disease, Dr Lim says the first line treatment is relatively simple. It involves a combination of anti-inflammatory medications, which serve to calm the excessive inflammation in the spine, and an exercise program designed to maintain the back's mobility and prevent it from stiffening.
Once upon a time, if these treatments were unsuccessful there wasn't much else that could be done to improve an AS patient's quality of life. However, Dr Lim explained medications known as biologics became available around 10 years ago, and have been revolutionary in the treatment of inflammatory back pain.
"When everyone looks at back pain as a single entity, then no one gets the appropriate treatment. You have to have an idea of what type of back pain it is to then have the right treatment for it," he adds.
"Of course it’s a big deal being told you have a chronic disease, but at least knowing will allow you to empower yourself with information and then getting the correct treatment."
Ultimately, Dr Lim says anyone experiencing recurring back pain — particularly if "no one can really give you a good reason for it" — should seek medical attention. You don't have to live with it.
Have you ever experienced back pain?