Which pain is improving with exercise? [Essential Orthopaedics/Maheshwari/3rd Ed./Pg. 251] A. Osteoarthritis C. Neurogenic joint B. Ankylosing spondylitis D. Rheumatoid arthritis
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The answer is B. Ankylosing Spondylitis.
Ankylosing spondylitis (AS) is the classic condition where pain improves with exercise and is not relieved by rest — this is one of its hallmark distinguishing features.
Key features of AS pain:
- Insidious onset of low back pain lasting >3 months
- Worse with rest / inactivity (especially early morning stiffness)
- Improves with exercise / physical activity
- Morning stiffness that resolves with movement
This inflammatory back pain pattern is in direct contrast to mechanical causes (like osteoarthritis), where pain typically worsens with activity and improves with rest.
Why the other options are wrong:
| Option | Pain behaviour |
|---|---|
| A. Osteoarthritis | Pain worsens with activity/weight-bearing, improves with rest |
| C. Neurogenic joint (Charcot joint) | Painless or minimal pain due to loss of pain sensation |
| D. Rheumatoid arthritis | Morning stiffness improves somewhat with movement, but RA primarily causes joint swelling/pain — not classically "improves with exercise" the way AS does |
The inflammatory nature of AS means cytokine-driven pain is reduced by movement (which temporarily suppresses inflammation locally and improves blood flow), while immobility worsens stiffness and pain.
Answer: B. Ankylosing Spondylitis ✓
— Goldman-Cecil Medicine; Gray's Anatomy for Students; Rosen's Emergency Medicine
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