By Dr Irwin Lim, Rheumatologist
If you present with back pain to your GP, your physiotherapist, your chiropractor, your osteopath, your kinesiologist, your acupuncturist, your massage therapist, etc…....chances are that they’ll try to ask questions and examine you to rule out worrying causes of back pain.
Causes such as compression of the nerve roots. Or even fracture or an occult tumour. Thankfully, these occur infrequently.
Most back pain is then treated as being non-specific.
This means that the health practitioner cannot be absolutely certain of the cause. It's assumed to be due to a mechanical or degenerative problem, usually due to some strained ligament/tendon/muscle. And in many cases, this is the correct assumption.
The cause which is often missed or overlooked is Inflammatory Back Pain (read here about the distinction between inflammatory vs mechanical pain).
Part of the reason is that this is a difficult type of pain to understand and the terms used to classify inflammatory-type back pain are confusing.
The natural history of this type of back pain is also not clearly worked out.
How many people with inflammatory-type back pain progress to developed Axial Spondyloarthritis?
How many with non-radiographic Axial Spondyloarthritis (what does this term even mean! Read about it here) eventually progress to get damage on their X-rays and get diagnosed with Ankylosing Spondylitis?
I think these graphics help:
You can access the original article at: http://link.springer.com/article/10.1007%2Fs10067-014-2740-x
Does this tree make it clearer for you?