Is My Pain Due to a Bone Issue or Ankylosing Spondylitis?

Am I experiencing a bone issue or ankylosing spondylitis?

Hello Dr.
Chen,
Three weeks ago, I went hiking, and after descending, I noticed that I experience lower back pain when I stand up after sitting.
I have since undergone rehabilitation.
During this time, I typically sit for long periods in the office, and I feel the most discomfort when I stand up after sitting.
Lying down is usually the most comfortable position, and I notice that the pain eases in the morning after I wake up.

However, about a week ago, I suddenly noticed changes in the location and nature of the pain.
My lower back still hurts (though it seems like the left side is a bit better), but now I also have soreness in my right side, including my buttocks, thigh, and calf.
Even my big toe feels a bit strange—not numb or painful, but just odd.
The most painful moments are when I get up in the morning or after sitting for a long time; getting out of bed or a chair causes significant lower back pain, to the point where I hesitate to move.
While lying in bed, I don’t feel pain, but the act of getting up triggers the pain, especially if there is any twisting motion involved.
I read online that ankylosing spondylitis can cause back pain in the morning.
As far as I know, there are no close relatives with this condition, but I am very concerned that I might have ankylosing spondylitis.
Could you please advise what condition my symptoms might indicate and which specialist I should see? I apologize for taking up your time, and I appreciate your professional insight in advance.
Best regards,
Judy

Judy, 30~39 year old female. Ask Date: 2022/06/26

Dr. Chen Bochen reply Orthopedics

Hello, based on your age and the symptoms you described, the most likely issue is intervertebral disc disease caused by poor posture and lack of exercise.
Most of the time, engaging in light exercise (such as slow jogging for 20 minutes), using a lumbar support, taking short-term pain relief medication, and avoiding prolonged sitting can lead to recovery.
If you are concerned about ankylosing spondylitis, you can consult a specialist in allergy, rheumatology, and immunology for blood tests; however, your symptoms do not closely align with ankylosing spondylitis, and this condition is more commonly found in males (approximately a 9:1 ratio).

Reply Date: 2022/06/26

More Info

Hello Judy,
Thank you for reaching out with your concerns regarding your pain. Based on the symptoms you've described, it seems you are experiencing significant discomfort, particularly after prolonged periods of sitting and upon rising from a seated or lying position. This pattern of pain, especially if it improves with lying down and worsens with movement, can indeed be indicative of several conditions, including potential musculoskeletal issues or inflammatory conditions such as ankylosing spondylitis (AS).

Understanding Your Symptoms:
1. Pain Characteristics: The fact that your pain is most severe when transitioning from sitting or lying to standing is a common symptom in conditions affecting the spine and surrounding musculature. The pain radiating to your buttocks, thighs, and even your toes suggests that there may be involvement of the lumbar spine or possibly nerve irritation.

2. Morning Stiffness: You mentioned that your pain seems to improve throughout the day and is particularly bothersome in the morning. This is a classic symptom of ankylosing spondylitis, which often presents with morning stiffness that improves with movement. However, it is essential to note that not all back pain with morning stiffness is due to AS.

3. Duration and Onset: The sudden onset of your symptoms following a hiking trip could suggest an acute injury or strain, but the persistence and nature of your pain raise the possibility of an underlying inflammatory condition.

Next Steps:
1. Consultation with a Specialist: Given your symptoms, I recommend seeing a rheumatologist. They specialize in autoimmune and inflammatory conditions and can provide a thorough evaluation. They may perform blood tests to check for markers of inflammation (such as C-reactive protein and erythrocyte sedimentation rate) and specific tests for ankylosing spondylitis, such as the HLA-B27 antigen test.

2. Imaging Studies: Depending on your examination findings, your doctor may recommend imaging studies, such as X-rays or MRI of the lumbar spine and pelvis, to look for signs of inflammation or structural changes associated with ankylosing spondylitis.

3. Physical Therapy: In the meantime, continuing physical therapy may be beneficial. A physical therapist can guide you through exercises that improve flexibility and strengthen the muscles supporting your spine, which can help alleviate pain and improve function.

4. Pain Management: Over-the-counter anti-inflammatory medications (like ibuprofen or naproxen) may help manage your pain and inflammation. However, consult with your healthcare provider before starting any new medication.

Conclusion:
While your symptoms could suggest ankylosing spondylitis, they could also be due to other musculoskeletal issues or even a simple strain from your hiking activity. A thorough evaluation by a rheumatologist will be crucial in determining the exact cause of your pain and guiding appropriate treatment. Early diagnosis and intervention can significantly improve outcomes, especially in inflammatory conditions like AS.

Please take care and don't hesitate to seek medical attention soon. Your health and comfort are paramount, and addressing these symptoms early can lead to better management and relief.

Best wishes,
Doctor Q&A Teams

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