For patients and families

Pain and stiffness: finding the relevant cause

Describe symptoms in useful detail and build a plan around the activities that matter to you.

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Chapter 2 of 6

What does the stiffness feel like?

When bone bridges connect parts of the spine, movement at those segments can become restricted. You may notice difficulty turning your head, bending to put on shoes or reaching comfortably. Other joints and muscles still contribute to movement, so people find different ways to manage the same task. The examination helps identify which movements are limited and which remain useful.

Pain and stiffness can change together or separately. A study of older men living in the community found less reported back pain in those with DISH than in those without it. Other studies of people seeking care have described substantial stiffness and disability. These findings show why your own symptoms and function deserve attention even when an image looks similar to someone else’s.

Where might the discomfort come from?

Symptoms can arise around a less mobile area or where tendons and ligaments attach. The shoulders, elbows, hips and heels may be relevant as well as the spine. At the same time, osteoarthritis, disk problems, nerve compression and muscle pain can occur alongside DISH. Finding the main contributor helps select useful treatment.

Describe the location with your hand if that is easier than finding the right medical term. Explain whether it is a local ache, pain traveling along an arm or leg, burning, tingling or loss of feeling. Mention a change in strength or coordination. These details may lead to a different examination from the one used for a familiar stiff back.

Describe the pattern over an ordinary day

For a few days, notice when symptoms are most troublesome, what brings them on and what helps. Include whether you wake because of pain, how mornings feel, and what happens during walking or prolonged sitting. There is no need for a lengthy diary unless your team specifically asks for one.

Morning stiffness alone cannot identify a particular kind of arthritis. Its duration, the overall symptom pattern, examination and imaging all matter. Tell the clinician about other relevant diagnoses, including psoriasis or inflammatory bowel disease, and about any previous inflammatory arthritis assessment. This helps them decide whether a separate problem needs review.

Give one comparison that captures the change: “I used to walk around the block, but now I stop at the corner,” or “I can still reach the shelf, but looking over my shoulder has become difficult.” If the symptoms come and go, a note made during an episode can help you remember them at the appointment.

Sleep, mood and fatigue belong in the discussion

Pain that repeatedly interrupts sleep can make the following day harder. Tell the team about daytime sleepiness, medication effects and fatigue as well as pain intensity. If a partner has noticed loud snoring, pauses in breathing or gasping during sleep, ask whether a sleep assessment is appropriate. Sleep apnea has several possible causes and requires its own evaluation.

Ongoing symptoms can also affect confidence, mood, work and relationships. These are valid reasons to ask for help. A useful plan may need more than a prescription: physical therapy, practical support, a review of sleep or a change in how a demanding task is performed can each have a role.

Choose a measure that matters to you

A pain score is one useful piece of information. Add a functional measure, such as walking time, the ease of getting dressed or the ability to sit through a meal. Record what you have tried, how regularly you used it, and what changed. “This let me walk ten minutes instead of five” helps the clinician judge benefit.

Explain problems with a treatment as well: dizziness, stomach upset, cost, difficulty remembering a dose or an exercise that repeatedly aggravates symptoms. A plan can then be adjusted to fit your health and circumstances. Agree when to review it and whom to contact if it is not helping.

Symptoms that need a quicker assessment

New neck or back pain after a fall or impact deserves urgent assessment the same day, even if the injury seemed small. Tell the assessing team about DISH and any known spinal bridging. Avoid trying to force the painful area through its normal range before it has been assessed.

Get emergency help for new weakness, rapidly worsening numbness, sudden difficulty walking, numbness around the groin, or a new problem passing or controlling urine or stool. Persistent swallowing difficulty, coughing during meals or an unexplained change in voice also needs medical review. Severe breathing difficulty or inability to swallow saliva requires emergency help.

If symptoms are gradually worsening without an injury, arrange an earlier appointment rather than waiting indefinitely for the next routine review. Describe what has changed, when it began and how it affects a specific activity. That information helps the team decide how quickly you should be seen.

Evidence reviewed as of October 30, 2026

Sources and further reading