Ankylosing Spondylitis vs. Mechanical Back Pain: Key Differences & When to Seek Help

by | Feb 9, 2025

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Back pain is incredibly common, affecting about 75% of people at some point. However, not all back pain is the same. Some cases are caused by mechanical issues like muscle strain or aging, while others result from autoimmune diseases such as ankylosing spondylitis (AS). Understanding the difference is crucial for getting the right treatment.

What Is Ankylosing Spondylitis (AS)?

Ankylosing spondylitis is an autoimmune condition where the immune system mistakenly attacks the spine and sacroiliac joints, causing chronic inflammation. Over time, this can lead to spinal fusion, stiffness, and mobility issues.

Signs of AS:

  • Pain worsens with rest and improves with movement
  • Morning stiffness lasting more than an hour
  • Nighttime pain that wakes you up
  • Commonly starts between ages 20 and 40
  • Genetic link—HLA-B27 gene may increase risk

What Is Mechanical Back Pain?

Mechanical back pain is the most common type of back pain, caused by factors like poor posture, muscle strains, herniated discs, or spinal arthritis. It results from wear and tear, injuries, or stress on the spine.

Signs of Mechanical Back Pain:

  • Pain worsens with activity and improves with rest
  • Stiffness that lasts only a few minutes in the morning
  • Usually does not cause nighttime pain
  • Can occur at any age but more common as people get older
  • No clear genetic link

Diagnosis: How to Tell the Difference

If you have persistent back pain for more than three months, it’s important to seek medical evaluation. Doctors will assess your medical history, symptoms, and conduct tests to determine the cause.

Key Diagnostic Tools:

  • Blood Tests – AS may show elevated inflammatory markers (CRP, sedimentation rate) and a positive HLA-B27 gene
  • Imaging – X-rays or MRIs can reveal inflammation, spinal fusion (AS), or degenerative changes (mechanical pain)

Treatment Options for AS vs. Mechanical Back Pain

Ankylosing Spondylitis Treatment

  • Exercise & Movement – Regular physical activity helps maintain spinal flexibility
  • Physical Therapy – Focuses on stretching and posture correction
  • Anti-Inflammatory Medications – NSAIDs like ibuprofen and naproxen reduce symptoms
  • Biologic Medications – Target the immune system to control inflammation and prevent progression

Mechanical Back Pain Treatment

  • Strength Training – Strengthens the core and back muscles for better spinal support
  • Posture Correction – Ergonomic chairs and avoiding slouching help reduce strain
  • Physical Therapy & Manual Therapy – Includes stretching, strengthening, and hands-on treatments
  • Heat & Ice Therapy – Heat relaxes muscles, while ice reduces swelling
  • Regenerative Medicine – Prolotherapy and PRP (Platelet-Rich Plasma) can aid in stability and healing

When to See a Doctor

  • If your pain lasts more than three months
  • If you wake up in pain at night or experience prolonged morning stiffness
  • If you have a family history of AS and persistent back pain
  • If your pain began suddenly after an injury and doesn’t improve over time

Conclusion

While both conditions can cause back pain, their causes and treatments are different. AS is an autoimmune disease that requires immune-modulating treatment, while mechanical back pain results from wear and tear, often benefiting from regenerative medicine.

If you’re struggling with back pain and need an accurate diagnosis and personalized treatment plan, contact us to book a consultation.

Inflammatory vs. Degenerative Back Pain: Key Differences You Need to Know

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10 Early Signs of Ankylosing Spondylitis You Shouldn’t Ignore!