Back Pain: When to Worry
Most back pain settles on its own. But back pain that is worse at rest, better with movement, and began before 45 can be inflammatory — and it is often missed for years. Here's how to tell the difference.
Most back pain is not serious — but some is different
Back pain is one of the most common reasons people see a doctor, and the vast majority is "mechanical" — from muscles, ligaments or discs — and settles with time and movement. But a smaller group of people have inflammatory back pain, caused by conditions such as ankylosing spondylitis, where the immune system is inflaming the spine. This kind needs a different approach, and it is often missed for years.
Inflammatory vs mechanical: how to tell
The pattern of your pain is the biggest clue:
- Better with movement, worse with rest — inflammatory pain eases as you get going; mechanical pain usually worsens with activity
- Morning stiffness lasting more than 30 minutes
- Waking in the second half of the night because of back pain
- Began before age 45 and has lasted more than three months
- Came on gradually, not after a specific injury
- Sometimes with heel pain, a swollen finger or toe, psoriasis, or a painful red eye
Warning signs that need prompt medical attention
Regardless of type, see a doctor promptly if back pain comes with:
- Numbness in the groin or buttocks, or new difficulty controlling the bladder or bowel
- Weakness or numbness spreading down both legs
- Fever, unexplained weight loss, or pain that is severe and constant, including at night
- A history of cancer, or a recent significant fall or injury
When should you see a rheumatologist?
See a rheumatologist if your back pain has lasted more than three months, began before 45, and improves with movement — particularly if you also have morning stiffness, night waking, or related features like heel pain or psoriasis. Inflammatory back pain is very treatable, but the diagnosis is frequently delayed because it is mistaken for ordinary back pain or a disc problem.
What a specialist assessment involves
- Careful history of the pattern of your pain
- Examination of spinal movement and related joints
- Blood tests including inflammation markers and HLA-B27
- Imaging — often an MRI of the sacroiliac joints, which can show inflammation early, before X-ray changes appear
If inflammatory back pain is confirmed, treatment — exercise, anti-inflammatory medication and, where needed, modern biologic therapies — keeps the spine mobile and prevents long-term stiffness.
Back pain that's better when you move?
That pattern is the opposite of ordinary back strain, and worth a specialist opinion. Consultations are walk-in, no appointment needed.
Clinic timings & location