Back and Hip Pain

The structures of the lower back and the hip are interconnected, as nerves and blood vessels pass from one region to the other, and because certain muscles connect from one region to the other. The pelvis itself is held in place by the SI Joints (sacroiliac joints), which are rigid but semi-mobile joints that connect the pelvis to the sacrum - the bottom of the spine. The hip defined includes the top of the femur, hip joint, and hip bone. Some of the muscles responsible for the movement of the hip include gluteus, adductors, iliopsoas, and lateral rotators. There are a variety of musculoskeletal conditions that may make movements of the hip structure still, painful, and weak, including arthritis, muscle spasms, and entrapments of the nerves. Let's take a look at some of the medical and orthopedic conditions that may cause both back and hip pain.

Ankylosing Spondylitis: Ankylosing spondylitis (AS) is like rheumatoid arthritis of the spine. This condition is also known as Marie-Strümpell disease or Bechterew's disease. This is one of several inflammatory forms of arthritis that has a strong association with the HLA-B27 genotype. HLA-B27 is a molecule found on the surfaces of cells that bind to antibodies that circulate throughout the bloodstream. For people with certain inflammatory conditions, their body's immune system is extra aggressive, causing a surge in antibodies to bind to these sites and destroy normal, healthy tissues. This aggressive response by the body's immune system may result in irreversible changes to healthy tissues such as the joints and the surfaces of bones.

Arthritis conditions that are associated with the gene HLA-B27 include seronegative spondyloarthropathies such as ankylosing spondylitis as well as Isolated acute anterior uveitis, Undifferentiated spondyloarthropathy (USpA), Reactive arthritis, enteropathic spondylitis or spondylitis associated with inflammatory bowel disease.

Not all people with ankylosing spondylitis are positive for HLA-B27, though nearly 90% are. In addition, most people who suffer from AS also test positive for IL-1 and Tumor necrosis factor-alpha (TNF ?).

There is no one blood test available to immediately diagnose this condition, though there are a couple of blood tests available to use during outbreaks. Outbreaks of AS include periods during which there is a strong inflammatory response in which the body during which the patient is vulnerable to joint and bone damage. These outbreaks are clinically described as acute inflammatory periods.

During acute inflammatory periods, there is an increase in the erythrocyte sedimentation rate (ESR) and the blood concentration of C-reactive protein (CRP).

Progression of the Disease: As the AS disease progresses, parts of the vertebrae will begin to fuse together, causing it to become more rigid and inflexible. This may significantly decrease mobility and may also have an effect on breathing, respiratory, and the performance of the heart and aorta. After all, the chest is a mobile cavity which is designed to expand during respiration and contract during expiration. The back of the ribs connect to the thoracic vertebral and may also fuse to the vertebrae affect by AS, greatly restricting movement capability.

During acute inflammatory periods, the bone may be progressively worn down. When the inflammation subsides, new bone growth occurs, but this new growth results in fusions between the bones, ligaments, and tendons rather than processes which return its anatomy back to normal.

Ankylosing Spondylitis may affect any of the joints of the body, though those in the spine are the most commonly affected.

Treatments for Ankylosing spondylitis include joint replacement surgery, physical therapy, and medications. The medications that are used that are associated with this disease are classified as either those that are designed to relieve pain or those that are used to treatment progression of the disease.

Medications used to decrease inflammation and pain includes Anti-inflammatory drugs and Opioid analgesics.

Medications used to treat the progression of the disease include Anti-interleukin-6 inhibitors, tumor necrosis factor-alpha (TNF?) blockers (antagonists) , and Disease-modifying antirheumatic drugs (DMARDs).