Introduction
Low back pain is one of the most common reasons patients seek physiotherapy. However, not all back pain is the same. Clinically, distinguishing between mechanical vs inflammatory low back pain is essential for accurate assessment and appropriate management.
Although symptoms may overlap, their causes, behavior patterns, and treatment approaches differ significantly.
Correct identification prevents delayed referral and ensures effective rehabilitation.
What Is Mechanical Low Back Pain?
Mechanical low back pain originates from the musculoskeletal system. It often involves:
- Muscles
- Ligaments
- Facet joints
- Intervertebral discs
It is the most common type of low back pain.
Key Characteristics:
- Pain increases with movement
- Pain improves with rest
- Localized discomfort
- Short morning stiffness (less than 30 minutes)
- Pain triggered by posture or load
Examples include muscle strain, disc irritation, and facet joint dysfunction.
What Is Inflammatory Low Back Pain?
Inflammatory low back pain results from systemic inflammatory conditions such as spondyloarthritis.
Unlike mechanical pain, inflammatory pain involves immune-mediated processes affecting spinal structures.
Key Characteristics:
- Gradual onset before age 40
- Morning stiffness lasting more than 30–60 minutes
- Pain improves with movement
- Pain worsens with rest
- Night pain, especially during second half of sleep
Inflammatory pain requires medical management in addition to physiotherapy.
Comparative Overview
| Feature | Mechanical Pain | Inflammatory Pain |
|---|---|---|
| Onset | Sudden or activity-related | Gradual |
| Age group | Any age | Often < 40 years |
| Morning stiffness | Short duration | Prolonged |
| Effect of movement | Worsens | Improves |
| Effect of rest | Improves | Worsens |
Understanding this contrast improves clinical reasoning.
Subjective Assessment Clues
During history taking, clinicians should ask:
- When did symptoms begin?
- How long does morning stiffness last?
- Does exercise relieve or worsen pain?
- Is there night pain?
- Any family history of inflammatory disease?
Pattern recognition guides differentiation.
Objective Examination
Mechanical Pain Findings:
- Pain reproduced with specific movements
- Local tenderness
- Restricted range of motion
- Normal systemic findings
Inflammatory Pain Findings:
- Global stiffness
- Reduced spinal mobility
- Possibly elevated inflammatory markers (medical evaluation)
Physiotherapists must recognize red flags for referral.
Management of Mechanical Low Back Pain
Treatment focuses on:
- Movement correction
- Strengthening
- Mobility exercises