OpenHealth Q&A

In Search of Guidance: Chronic Pain in Back, Heels, and Knees – Is it Ankylosing Spondylitis?

Hello everyone, I was encouraged to share my situation here in hopes of getting some insights. At 21 years old and an athlete currently in recovery from an injury, I’m feeling quite overwhelmed and desperate for some guidance. As a physiotherapy student with a background in musculoskeletal conditions, I find myself grappling with a range of persistent pain and symptoms without a clear diagnosis. I hope that someone here might provide valuable advice or share similar experiences. ### Symptoms Overview (I experience these symptoms at varying intensities, generally mild to moderate but sometimes severe): - **Chronic Lower Back Pain:** This has been affecting me for over six months. It frequently disrupts my sleep, worsens after periods of rest (especially in the morning), and improves when I move around. - **Bilateral Heel Pain:** Experiencing heel pain in both feet began about a week ago and has been inconsistent in severity. - **Knee Discomfort:** I have developed pain in the front and inner side of my knee, along with soreness in the quadriceps tendon. This could relate to my recent meniscus surgery conducted five months ago, as I am currently in specific rehabilitation for that. - **Severe Fatigue:** Lately, I have been feeling extremely fatigued throughout the day, despite getting enough sleep. This fatigue is persistent and seems to occur even during less stressful times, which is unusual for me. - **Additional Symptoms:** I’ve also noticed a slight decrease in appetite along with occasional sensations of tightness or pain in my chest. ### Recent Medical Consultations and My Discontent - **General Practitioner (GP):** I approached my GP about my issues, who prescribed Mesulid (an NSAID). For two weeks, I noticed slight relief in my back pain and heel discomfort, but this did not last. Upon stopping the medication, my pain returned to its previous state. The GP brushed off my concerns regarding heel pain by claiming that "tendon pain at the bone doesn't need further investigation," which felt incredibly dismissive, especially since my chronic back pain seemed largely ignored. To add to my frustration, they were handling phone calls during our appointment. - **Orthopedic Surgeon (my knee surgeon):** During my last consultation, he primarily addressed my knee, stating that the medial pain was acceptable and that the front knee pain was probably due to "overuse." He also attributed the heel pain to overuse and suggested physical therapy for it. My chronic back pain went largely unacknowledged, and I felt too intimidated to advocate for my suspicions about a possible systemic inflammatory condition. ### My Concerns and Reasons for Posting I’m feeling quite defeated and fatigued with this situation. My goal is to uncover what’s truly happening so I can find appropriate treatment. As a physiotherapy student, I understand the concept of "red flags" and the significance of identifying inflammatory pain patterns. Considering my age, the nature of my pain, the bilateral heel issues resembling enthesitis, and the debilitating fatigue, I suspect there may be an underlying chronic inflammatory issue, such as Ankylosing Spondylitis or another spondyloarthritis. - Should I be advocating for a referral to a rheumatologist? - What specific points should I stress when discussing my situation with a new physician to ensure my concerns are taken seriously? - How can I manage this overwhelming fatigue and frustration as I await further insights? I appreciate any insights or advice you can provide. Thank you!

Answers (1)

7/8/2025, 7:31:13 PM

OpenHealth AI

Thank you for sharing your experience and concerns. It sounds like you’re navigating a complex situation with multiple symptoms that can indeed feel overwhelming, especially given your background in physiotherapy and your desire for clarity. Let's address your key points and provide some actionable steps.

Main Points:

1. Potential for Inflammatory Condition: Your symptoms, particularly the chronic lower back pain that improves with movement, bilateral heel pain, and severe fatigue, might suggest an underlying inflammatory condition such as Ankylosing Spondylitis (AS).
2. Advocacy for Your Health: It's important to advocate for yourself to ensure your concerns are taken seriously and addressed by healthcare professionals.
3. Managing Fatigue and Frustration: While seeking answers, there are strategies you can employ to cope with the fatigue and emotional stress you're experiencing.

Explanation:

• Chronic Back Pain: Pain worsening after rest and improving with activity is often associated with inflammatory back pain, characteristic of conditions like Ankylosing Spondylitis.
• Bilateral Heel Pain: This could indicate enthesitis, common in spondyloarthritis.
• Fatigue: Persistent fatigue can be a sign of inflammation and should be evaluated further, especially given your symptoms.

Considering your situation, a referral to a rheumatologist would be a critical step because they specialize in chronic inflammatory conditions, including AS.

Specific Next Steps:

1. Request a Referral to a Rheumatologist:

   • Express your concerns clearly to your GP. Highlight the persistence of your lower back pain, the bilateral heel pain, and the severe fatigue. Mention your familiarity with inflammatory patterns and the possibility of AS, which you believe warrants a specialist’s input.

2. Prepare for Your Next Doctor’s Appointment:

   • Symptoms Documentation: Keep a log of your symptoms, noting when they occur, their intensity, and any patterns you notice (e.g., worsening after rest). This can provide valuable information to your doctor.
   • Prioritize Concerns: Start with the most disruptive symptoms (e.g., lower back pain affecting sleep, bilateral heel pain) and emphasize how these impact your daily life.

3. Managing Fatigue and Stress:

   • Gentle Exercise: Engage in activities like stretching, yoga, or light walking, which can help alleviate stiffness and fatigue.
   • Balanced Nutrition: Ensure you're eating a balanced diet to support your energy levels; consider small, frequent meals if your appetite is low.
   • Rest and Recovery: Listen to your body. While activity is important, ensure you rest adequately, especially if fatigue becomes overwhelming.

4. Stress-Relief Techniques:

   • Consider mindfulness or relaxation techniques such as deep breathing exercises, meditation, or journaling, which can help manage frustration and emotional stress.

Lastly, remember that you're not alone in this journey. Chronic pain can be frustrating, but actively participating in your care will empower you. Don’t hesitate to reach out for support from peers or mental health professionals if needed. Let me know if you have more questions or if there’s anything else you’d like to discuss.