By Dr Anindita Santosa, Consultant Rheumatologist
If your back pain behaves opposite to the usual “strain pattern” — worsening with rest, improving when you move — it’s a red flag.
Recognising When Back Stiffness Means Something More
We’ve all woken up with a stiff back and blamed it on a bad night’s sleep, an old mattress, or poor posture. But what if the stiffness doesn’t fade after a few stretches — and instead greets you every morning? When back tightness or pain becomes part of your daily routine, easing only after a warm shower or gentle movement, it may be more than just muscle strain. It could be ankylosing spondylitis (AS), a type of inflammatory arthritis that affects the spine and the sacroiliac joints — where your spine connects to your pelvis. In this post, we’ll look at how AS differs from ordinary back pain, what signs to watch for, and why recognising it early can make a lasting difference.What Is Ankylosing Spondylitis?
Ankylosing spondylitis is a chronic autoimmune condition that causes inflammation in the spine and other joints. Over time, this inflammation can lead to stiffness, fusion of spinal bones (“ankylosis”), and a loss of flexibility. It is part of a group of conditions called spondyloarthritis, which can also affect the hips, shoulders, eyes, and even the gut.Key Signs and Symptoms
- Persistent lower back or buttock pain lasting more than three months
- Morning stiffness that improves with activity
- Pain that wakes you at night or early in the morning
- Better with movement, worse with rest
- Fatigue or alternating buttock pain
- Occasionally, eye redness or pain (uveitis)
Who Gets Ankylosing Spondylitis?
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Age and Gender
AS typically starts in young adults (teens to 40s) — often long before most people think of arthritis as a cause of back pain. While it used to be thought of as a disease that affects men, we now know women can get it too, though sometimes with milder or atypical symptoms that delay diagnosis. -
Genetic Link
A strong genetic marker called HLA-B27 is found in many (but not all) people with AS. Having it increases risk, especially if there’s a family history of autoimmune conditions. -
Other Risk Factors
- History of inflammatory bowel disease or psoriasis
- Recurrent eye inflammation (uveitis)
- Family members with spondyloarthritis
How It Differs from Mechanical Back Pain
| Feature | Mechanical Back Pain (e.g. poor posture, muscle strain) | Ankylosing Spondylitis (Inflammatory Back Pain) |
| Age of onset | Any age, often after exertion | Usually less than 45 years |
| Pain pattern | Worse with activity | Worse with rest, improves with movement |
| Morning stiffness | Short (<15 min) | Prolonged (>30–60 min) |
| Night pain | Rare | Common, might wake you in early morning |
| Response to rest | Improves | Worsens |
| Response to exercise | Minimal | Progressively better |
Diagnosis and Treatment
How We Diagnose
A rheumatologist might recommend:- A physical examination for spinal flexibility and tenderness
- Imaging: MRI is more sensitive than X-ray for detecting early inflammation in the sacroiliac joints
- Blood tests: HLA-B27 and inflammatory markers (ESR, CRP)
Treatment Goals
The aim is to reduce inflammation, maintain mobility, and prevent fusion of the spine. Treatment options include:- Exercise and physiotherapy: Core strengthening and posture training are key.
- Medications:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for pain and stiffness
- Biologic therapies (anti-TNF or anti-IL-17 agents) to control inflammation and prevent progression
- Lifestyle adjustments: Quit smoking and vaping, maintain healthy weight, and stay active.
How Aaria Rheumatology Can Help
At Aaria Rheumatology, we’ve seen too many people live with years of “back pain” before discovering it was ankylosing spondylitis all along. As rheumatology specialists, our approach combines:- Comprehensive assessment to distinguish mechanical from inflammatory back pain
- Advanced imaging and genetic testing when indicated
- Targeted, evidence-based therapy to reduce inflammation and maintain flexibility
- Patient education on movement, ergonomics, and long-term spine care
Conclusion: Don’t Dismiss Persistent Stiffness
- Morning stiffness that lasts for months is not simply a result of “ageing” or “poor posture”. It could be your body’s signal of inflammation. With early recognition and appropriate care, discomfort caused by ankylosing spondylitis can be managed, allowing you to regain control of your mornings and improve mobility.
Related Articles:
- Osteoarthritis vs Rheumatoid Arthritis – What’s the Difference
- When Joint Pain Isn’t Just Age – Recognising Early Signs of Arthritis
- Why Your Joints Hurt More When It Rains
