The kinds of back trouble that have been described so far derive from some dysfunction of the spine or from a congenital deformity, or from a violent injury, or from gradual deterioration with use and age.
There are other kinds of back trouble. Some of them affect the spine mainly or solely; others affect various parts of the body, the spine being just one of them. A third category includes disease which produces back pain without necessarily involving the spine.
Ankylosing spondylitis-This is a chronic inflammatory condition or arthritis, predominantly affecting spinal joints. It tends to run in families (but not always so that every member is afflicted). It affects men more than women, and symptoms often start young, in the teens. It is a systemic disease; the person feels ill when the disease is active, and other parts of the body (for example the eyes) may be affected.
In ankylosing spondylitis, the same process of laying down calcium deposits which creates osteophytes may continue to the point of fusing together some vertebrae, so that the spine in that region becomes completely stiff.
It starts usually in the lining of the sacroiliac joints and spreads gradually upwards to the other joints of the spine; it sometimes also spreads downwards into the hip joints and, more rarely, other leg joints. Over a period of time the inflammation may cause the ligaments of the joints to calcify, so that the joints become ankylosed (rigid) producing, in the worst cases, a spine locked permanently in a bowed posture. The ligaments joining the ribs to the spine may also harden, flattening the rib cage and making breathing difficult. This is one of the early symptoms. Others are pain and stiffness in the hip joints, which feel worst in the morning, because they are made worse by lying still and are relieved by movement. Pain-killers and anti-inflammatory drugs as prescribed by the doctor will help considerably. Controlled exercise is invaluable: it should be taught by a physiotherapist. Done regularly, it may help to keep the joints flexible and avoid severe deformity. Many patients take up squash, tennis, swimming and other sports and prefer this to the repetitive use of formal exercises over many years.
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