When is back pain more than just back ache?

This blog post is inspired by a few talks that were given at the Royal College of Chiropractors annual conference which I attended a couple of weeks ago. It is about a certain type of inflammatory arthritis (Axial Spondyloarthritis) that can cause back pain and stiffness in the spine. The talks focused on how Chiropractors can help identify these patients and enable them to get diagnosed earlier. They outlined the role Chiropractors can have in the management of patients with this type of inflammatory arthritis so they can be helped with Chiropractic care in our clinics.

Professor Karl Gaffney, Consultant Rheumatologist giving a talk
Professor Karl Gaffney, Consultant Rheumatologist

I always enjoy attending these events and one of the reasons I do is that they do not just have talks by Chiropractors but other health professionals from outside the Chiropractic profession. These talks provide valuable insights into what is happening in health care in a wider context. They give invaluable information which I can use to help my patients.

This year there were three talks that I found especially interesting by consultant Rheumatologists- so interesting in fact I decided to write this blog post on the topic.

Inflammatory arthritis of the spine causing back ache and stiffness

These three talks were on an inflammatory type of arthritis that cause back pain and stiffness called Axial Spondyloarthritis. It can also be known as AS. You may have never heard of it as it is not all that common. However it is far from rare. It is just as common at multiple sclerosis and most people will have heard of that.

One of the main presenting symptoms are back pain and stiffness. Which is very common! In fact when it comes to back pain it is more common to have had back pain than not, as it will effect 80% of people at some point. For this reason many people with Axial Spondyloarthritis go undiagnosed for many years as it is assumed it is normal back ache. In fact a scary statistic that was highlighted was that the average duration of time from onset of symptoms to diagnosis is eight years!!

How to spot the difference between normal “mechanical “pain pain and inflammatory arthritis back pain

As a Chiropractor I will see many people with back pain who are seeking treatment and will come to my clinic for help. Back ache and stiffness are the main symptoms of this type of arthritis so how can I differentiate it from “normal back ache” That is why a thorough and comprehensive case history  and past medical history are very important as it will provide valuable clues.

Information on the type of back ache and stiffness- for example AS tends to be stiff in the mornings and last for over 30 minutes. It is a made a lot better with NSAID medication such as ibuprophen.

There will be other clues in the past medical history as AS can also be accompanied by inflammation of the eye (iritis or uveitis), irritable bowel syndrome, psoriasis, peripheral arthritis (arthritis in the fingers), dactylitis (appearance of a fat finger or toe).

How is a diagnosis made?

A diagnosis is not simple and just because someone has these symptoms does NOT mean they will have AS. A combination of these however do raise the possibility and warrant referral for further investigation. A fantastic tool that was shared to help facilitate this was the SPADE tool. It is a tool for health professionals such as Chiropractors to help identify if an appropriate referral needs to be made.


The referral will be made to a consultant Rheumatologist who will be able to make a formal diagnosis after more tests.

How can Chiropractors and Chiropractic help Axial Spondyloarthritis

One way Chiropractors can help reduce the impact AS has on patients is helping to facilitate a quicker diagnosis. AS is a progressive condition that can have a big impact of the quality of someone’s life. That is why it is important to identify if someone has it so they can get appropriate medical treatment. Medical advances in the type of drugs available are making a huge difference to patients back pain and activity levels.

Can Chiropractors help even if someone has been diagnosed?

Yes. Although certain chiropractic techniques need to be used with caution or even not at all there are many ways which Chiropractors can help. Using muscle techniques to decrease muscle tension, mobilisation to maintain movement in the spine and reduce muscle ache. Guidance on exercise and prescription of specific exercises. Education and letting people know where to go for further help. One place where people can go which I already send patients to and is a fantastic resource is the National Ankylosing Spondylitis Society NASS.

Their website is https://nass.co.uk/

A key value of our Clinic is that we keep up to date on the latest knowledge and research to help improve the treatment that I, as a Chiropractor give to my patients.

One of the ways I achieve this is by being a member of the Royal College of Chiropractors and every year I go to their conference. It is a great opportunity to meet fellow Chiropractors and discuss lots of Chiropractic related topics as well catch up with friends and colleagues.

I always come back to the clinic with valuable tools and insights I use. This year was no exception and I hope I will be able to help more people with AS get diagnosed earlier and play my part helping them get the help they need to be able to live better.

Mark – Chiropractor at Prime Therapy Clinic