| What We Treat
Ankylosing Spondylitis
Back pain that is worse with rest and better with movement, in someone under forty, is inflammatory until proven otherwise. It is frequently missed for years.
Overview
What It Is
Ankylosing spondylitis, now often called axial spondyloarthritis, is an inflammatory condition affecting the spine and sacroiliac joints. It typically begins before forty, produces prolonged morning stiffness, and characteristically improves with exercise and worsens with rest — the reverse of mechanical back pain. Diagnostic delay averages several years, which is why recognising the pattern matters.
Better With Movement
Worse with rest, better with exercise, morning stiffness over thirty minutes, onset under forty. The opposite of mechanical back pain.
Symptoms
How It Tends to Feel
These are the features that point towards this diagnosis rather than another:
Morning Stiffness Over Thirty Minutes
Often considerably longer, and a key discriminator.
Better With Movement
The reverse of mechanical back pain. People often pace at night.
Night Pain
Particularly in the second half of the night, forcing them out of bed.
Onset Under Forty
Almost always. Inflammatory back pain starting after forty-five is unusual.
Alternating Buttock Pain
Shifting from side to side, reflecting sacroiliac involvement.
Response to Anti-Inflammatories
A good response is characteristic and diagnostically useful.
Causes & Risk Factors
What Drives It
The usual contributors, in rough order of how often they turn out to matter:
HLA-B27
Present in the large majority, though most carriers never develop the condition.
Family History
A strong familial pattern.
Immune Dysregulation
Inflammation at entheses and the sacroiliac joints.
Associated Conditions
Inflammatory bowel disease, psoriasis and uveitis frequently coexist.
How We Can Help You
Treatment & Management
Treatment is built around what the assessment finds, but generally follows this shape:
When to Seek Help
Red Flags — Don’t Ignore These
Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:
⚠ Seek Medical Advice If You Notice
- New eye pain, redness or blurred vision — uveitis needs same-day assessment
- New neurological symptoms in the arms or legs
- Sudden severe spinal pain after minor trauma — fracture risk is raised in a fused spine
- Persistent unexplained fever or weight loss
If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.
Common Questions
Frequently Asked Questions
How is it different from ordinary back pain?
Mechanical back pain is worse with activity and better with rest. This is the opposite: worse with rest, better with movement, with prolonged morning stiffness and night pain.
Why did it take so long to diagnose?
Because it starts young, imaging is often normal early, and the pattern is easily mistaken for mechanical pain. Average delay is several years, which is precisely why the pattern is worth knowing.
Will my spine fuse?
Far less commonly now than historically. Modern medical treatment combined with consistent daily mobility work has changed the outlook substantially.
Not Sure If This Is What You Have?
An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.