Back Pain
Most back pain settles on its own. But when back pain wakes you at night, stiffens you in the morning for more than 30 minutes, or keeps returning despite rest and physiotherapy, I want to take a careful look. It matters to me that we do not miss an inflammatory cause hiding under the label of a simple bad back.
What back pain is
Back pain is a symptom rather than a single diagnosis. In most patients it is mechanical, coming from muscles, ligaments, discs and small spinal joints, and it improves within a few weeks. In a smaller but important group it is inflammatory, coming from conditions such as axial spondyloarthritis or ankylosing spondylitis. The pattern of your pain, its timing, and how it responds to rest and movement tells me a great deal.
Symptoms to look out for
Lower back pain that comes on gradually and lasts more than 3 months
Stiffness in the back that is worse in the morning and eases with movement
Pain that wakes you in the second half of the night
Pain that improves with exercise rather than rest
Alternating buttock pain, or pain that shifts from one side to the other
Associated stiffness in the neck, chest wall or hips
History of psoriasis, uveitis, or inflammatory bowel disease in you or your family
Why this matters to a rheumatologist
As a rheumatologist, my job is to separate mechanical back pain from inflammatory back pain, because the treatments are very different. Inflammatory back pain in a young adult can be an early sign of axial spondyloarthritis, and if we catch it early we can protect the spine and quality of life with the right medication and physiotherapy. I use a careful history, examination, blood tests such as HLA-B27, ESR and CRP, and imaging (X-rays or MRI of the sacroiliac joints) to piece the picture together.
Signs I would like you to seek care for
For emergency symptoms please seek urgent or emergency care first rather than waiting for a WhatsApp reply.
Numbness or weakness in the legs, or difficulty passing urine or stool, which needs emergency care
Fever with back pain
Unexplained weight loss with back pain
Back pain after significant trauma
New back pain in someone with a history of cancer
Back pain that is severe, unrelenting and not improving with usual measures
What a specialist review looks like
In clinic I listen to how your back pain behaves through the day and night, examine your spine, hips and posture, and where relevant order blood tests and targeted imaging. If your pain is mechanical, I will guide you on activity, physiotherapy and pain relief. If the pattern points to inflammatory back pain, I will explain the diagnosis clearly and discuss modern treatments including exercise, NSAIDs and biologic therapies when appropriate.
Questions my patients often ask me
Speak with me
If your back pain is not settling, is worse at night, stiffens you in the morning, or you have a family history of psoriasis or inflammatory arthritis, please seek specialist care. I would like to help you find the cause and the right plan.
Other conditions I treat
This page is for general education only and does not replace medical advice. Please consult a qualified healthcare professional for diagnosis and treatment.