Rheumatology

Inflammatory vs. Mechanical Back Pain: Understanding the Difference 

We’ve all felt it at one time or another—a twinge in your lower back, maybe after a day of lifting moving boxes or playing with your kids at the park. Sometimes, you may even wake up with a sore back and have no idea why.

Back pain—especially in the lower back—is incredibly common. Around 80% of people will experience pain in their lower back at some point in their lives. For many, the pain will go away after a few days of rest, but others may find their pain never seems to leave. 

Understanding the type of back pain you’re dealing with can help you find more effective ways to manage it. Dr. Natalie Faith, a rheumatologist at Florida Medical Clinic, explains the difference between the two most common types of back pain: inflammatory and mechanical. 

The Difference Between Inflammatory and Mechanical Back Pain 

Inflammatory back pain is a type of chronic pain (pain that lasts more than 3 months) that is associated with spondyloarthritis, a type of arthritis that causes inflammation in the spine. 

Mechanical back pain is a type of acute pain (pain that lasts less than 4 to 6 weeks but can reoccur) that occurs when the joints, bones, and soft tissues of the lower back are injured or strained from trauma or overuse. 

The majority of those experiencing back pain have mechanical back pain. The prevalence of pain in the spine lasting less than 3 months in the United States for those between 20 and 69 years of age is approximately 19%. Inflammatory back pain affects an estimated 5 to 6% of adults in the United States.

Read on to learn more about each type of back pain, their symptoms, and how they’re treated. 

What is inflammatory back pain?

The key characteristics of inflammatory back pain are: 

  • Early onset (typically under 45 years old)
  • Localized pain in the lower back and/or buttocks
  • Chronic pain, meaning pain that lasts longer than 3 months
  • Pain that occurs at night and/or early in the morning
  • Pain that improves with movement and exercise
  • Pain that improves after taking over-the-counter anti-inflammatories (such as ibuprofen)
  • Insidious onset of symptoms (pain that comes on slowly and is not obvious at first)

Other symptoms that may come with inflammatory back pain include fatigue, abdominal pain, heel/ankle pain, and inflammation of the eye.

What causes it?

Inflammatory back pain is strongly associated with a group of conditions called spondyloarthritis, meaning “arthritis of the spine”. 

There are several types of spondyloarthritis that can cause back pain, including: 

  • Ankylosing spondylitis. Ankylosing spondylitis is a rare inflammatory disease that causes your spine to fuse together over time. Symptoms typically appear in early adulthood and include pain, stiffness, and reduced flexibility.
  • Non-radiographic axial spondyloarthritis. Symptoms of this condition typically appear in early adulthood and are similar to ankylosing spondylitis, but does not involve the spine fusing.
  • Enteropathic arthropathy. This type of inflammatory arthritis is strongly linked to inflammatory bowel conditions like Crohn’s disease or ulcerative colitis. While the main symptom is abdominal pain, this type of arthritis can also affect the spine and cause back pain.
  • Psoriatic spondylitis. When people with psoriatic arthritis feel pain in their spine and sacroiliac joints (the joints that link your pelvis to your lower spine), it’s called psoriatic spondylitis. Psoriatic spondylitis pain typically occurs in the lower back.
  • Reactive arthritis. Reactive arthritis is an inflammatory response triggered by an infection in another part of the body. This can cause swelling and pain in your joints and lower back.

The exact cause of spondyloarthritis is unclear, but researchers believe that genes play an important role, as it tends to be inherited.

What is mechanical back pain?

The key characteristics of mechanical back pain are: 

  • Acute pain (pain lasting less than 4 to 6 weeks)
  • Localized pain in the lower back that may radiate to other parts of the body, such as the legs
  • Lower back spasms
  • Symptoms that are more noticeable when lifting heavy objects or bending forward
  • Pain that improves with rest

What causes it?

Possible causes of mechanical back pain include:

  • Injury. Trauma, such as a fall, strain caused by lifting something heavy, or a sudden awkward movement are all common causes of mechanical back pain. Minor injuries typically heal on their own with rest, but severe injuries may require physical therapy to fully heal.
  • Poor posture. If you work at a desk, you’ve probably experienced back pain due to poor posture at some point. When you slouch, the muscles in your back have to work harder to keep you balanced, and that strain can lead to pain over time. Correcting your posture and adding appropriate back support to your chair can help alleviate this type of pain.
  • Herniated/slipped discs. When the rubbery discs between the vertebrae in your spine become damaged from wear and tear or as the result of an injury, they can slip out of place and press on a nearby nerve, causing intense pain and in some cases, numbness. Herniated discs can occur anywhere along the spine, but are most common in the lower back.
  • Osteoarthritis (OA). Common in older patients, osteoarthritis occurs when the protective cartilage that cushions our bones gradually wears down over time. While arthritis is commonly associated with inflammatory back pain, OA is actually a type of noninflammatory arthritis—while the condition can result in joint inflammation, it is caused by normal wear and tear.
  • Scoliosis/kyphosis. Scoliosis is an “S” shaped curving of the spine, while kyphosis is defined by a more “C” shaped spinal curvature. In severe cases, these conditions can lead to pinched nerves, muscle problems, or compressed discs—all of which can cause mechanical back pain.

How does treatment differ between inflammatory and mechanical back pain? 

The most effective treatment for your back pain depends on what’s causing it. For example, rest may be an effective way to relieve mechanical back pain, but it can make inflammatory back pain worse. 

Inflammatory Back Pain Treatment

There is no single cure for inflammatory back pain caused by spondyloarthritis, but symptoms can be managed through a combination of exercise, physical therapy, medication, and alternative treatments.

If your doctor suspects that you have inflammatory back pain, they will refer you to a rheumatologist, a doctor who specializes in spondyloarthritis and related conditions. A rheumatologist may prescribe a stronger anti-inflammatory medication than what you can get over the counter to help relieve your symptoms.

Unlike mechanical back pain, inflammatory back pain does not typically improve with rest. Instead, patients are advised to stay physically active in order to engage and strengthen the muscles around their back. 

Mechanical Back Pain Treatment

Taking it easy for a day or two will help relieve most cases of mechanical back pain. During this time, don’t lift heavy objects or bend down a lot. 

For mechanical back pain that doesn’t go away with rest, a licensed physical therapist can help create a plan that strengthens your muscles, corrects your posture, and helps relieve your pain. 

In very serious cases, a back injury may require surgery. However, your doctor will only recommend this if other treatment options haven’t worked for you, or if your back pain is caused by a more complex condition such as scoliosis. 

When to See a Doctor for Back Pain 

Regardless of the cause, it’s important to see a doctor right away if your back pain is severe or isn’t going away. Go to a doctor immediately if:

  • The pain doesn’t go away with rest or OTC pain relievers (such as acetaminophen or ibuprofen)
  • It’s hard to stand up, sit up, or walk because of the pain and discomfort
  • You feel numbness or tingling that spreads down into your buttocks or legs
  • Your pain is accompanied by sudden problems with your bowels or bladder
  • You develop a fever after the pain starts

The above signs and symptoms may indicate a severe injury or infection that requires medical treatment. Ignoring severe back pain for too long can lead to other problems down the road, so it’s important to see a medical professional as soon as possible.

Back pain can be a major disruptor of everyday life, but it’s possible to find relief with the right treatment. If you suspect that you may have inflammatory back pain, seeking treatment early is crucial—to learn more, schedule an appointment with Dr. Natalie Faith today. Virtual appointments are also available.

About Natalie Faith, MD, RhMSUS, RMSK

Born and raised in Tampa, Florida, Dr. Natalie Faith is a rheumatologist specializing in rheumatoid arthritis, spondyloarthritis, osteoporosis, and musculoskeletal ultrasounds. Dr. Faith works with patients in Seminole Heights, Land O’ Lakes, and Zephyrhills to diagnose the cause of their pain and find treatment solutions that address both the underlying disease and the symptoms that affect daily life. 

Disclaimer: This blog is not intended to substitute professional medical advice. Always talk with your doctor before starting or stopping medications or treatments. 

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Rheumatology

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