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  • Q&A with Australian Health Practitioners

    How do I know if the pain in my back is caused by ankylosing spondylitis?

    I have for several months been getting severe pain in my lower back which has not eased with regular massage and chiro treatments. How do I know if this might be ankylosing spondylitis??
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  • 4

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    Jo Charge

    Exercise Physiologist, Yoga Teacher

    Jo is an Accredited Exercise Physiologist (AEP) and qualified Yoga teacher who specialises in working with individuals living with chronic musculoskeletal conditions, including Osteoarthritis, Osteoporosis, ... View Profile

    Ankylosing spondylitis (AS) is a type of arthritis that is found more commonly in males than females. The onset of symptoms typically occurs between the age of 15-45 years. AS is also an autoimmune disease. One key feature of AS is that the pain experienced in the spine and lower buttocks is generally relieved by activity and is aggravated by periods of rest. When people live with AS they will often wake with pain and the pain eases with activity.

    If you do have AS the best thing you can do is get a diagnosis as early as possible to prevent the condition causing any permanent stiffening of the joints of the spine. I recommend you speak with your GP to investigate the cause of the pain. If your GP also suspects AS they can refer you for some blood tests to look at inflammation levels in your blood. There is also a genetic test that can be done to look for the HLA-B27 gene, which is commonly found in people living with AS. If the blood test results indicate AS your GP can refer you to a Rheumatologist whose role is to coordinate the management of the condition.

    Exercise is a very important part of the management of AS, to help maintain mobility and prevent loss of movement in the spine, so anyone who receives a diagnosis of AS should see an Exercise Physiologist or Physiotherapist with a good understanding of AS for advice on how to stay physically active and to be prescribed a home exercise program focusing on spinal mobility and strengthening which should be performed daily.

  • 4

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    Dr Ryan Hislop

    Chiropractor

    Dr Ryan Hislop, Chiropractor is situated in Mudgee with the team from Chiropractic Health and Wellness Centre. He has a special interest in sports chiropractic ... View Profile

    As Jo mentioned, although there is no direct test for AS, the diagnostic criteria relies on a positive HLA-B27 gene test as well as radiological confirmation. Unfortunately due to AS's nature, diagnosis can be quite delayed.

    AS only has a prevalence of 0.25% of the population, therefore you're more likely to have a some sort of chronic spinal injury (could be many many different things). If you're not getting results in both objective and subjective readings, it may be worth seeking a second opinion from either another chiropractor, or other health professional. Sometimes it just needs another brain on the case to think outside the square.

  • 4

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    Helen Potter

    Physiotherapist

    As a Specialist Musculoskeletal Physiotherapist, with extensive experience and highly advanced qualifications, as well as excellent communication skills, I can help you to: Become informed ... View Profile

    Hi,
    the diagnosis of Ankylosing Spondylitis is based on analysing the combination of your symptoms, the limitations of movement we find on testing and a blood test for the HLAB27 factor.
     Prolonged (hours) of morning stiffness, loss of back movement in all directions, reduction of chest expansion leading to breathing restriction and some pain relief with being active are possible symptoms of AS.
    Xrays may show some bony fusion of the pelvis of spinal joints later in the process.  A family history of AS increases the likely hood you have AS but there are many other diagnoses that need to be excluded.

    Because there is now a range of effective medications seeing a rheumatologist to look at your options is vital. If you have AS then there is a support group in most states, access to intensive rehab programs and the option of individual physiotherapy with someone with experience in this problem.
    I have been involved in research for AS, hydrotherapy sessions for those with AS and I also treat some AS clients once a month to assist them with specific pain or limitations and progress their exercise programs.
    Helen Potter FACP
    Specialist Physiotherapist
    In Touch Physiotherapy Subiaco

  • 8

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    Dr Irwin Lim

    Rheumatologist

    Irwin completed his Rheumatology training in 2003. The majority of his time is spent treating inflammatory arthritis and in particular rheumatoid arthritis and the spondyloarthritis. ... View Profile

    The problem is that the diagnosis/classification of AS is based on seeing damage on Xrays of a particular area of the lower back/buttock region, called the Sacroiliac joints. These changes are called sacroiliitis.However, the Xray diagnosis can be very difficult earlier in the disease.It’s also well understood that it may take years for these changes to be apparent, and therefore, the diagnosis is not made for years. It’s delayed.

    So, we need another “label” or classification/diagnosis for those who haven't met the criteria for AS.This concept of Axial Spondyloarthritis was developed by the Assessment of SpondyloArthritis international Society (ASAS group).Axial Spondyloarthritis (axial SpA) refers to inflammatory disease in which the  predominant symptom is back pain, and where radiological changes of sacroiliitis may or may not be present.

    I realise this is quite confusing and these are difficult concepts.

    I wrote a blog post trying to explain this:http://bjcconnectedcare.com/2012/12/the-complicated-concept-of-axial-spa-explained/

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