Back pain cases on the rise

In 2016, Pricilla Birungi, a resident of Sonde in Mukono District, was involved in a car accident that that left her with pain on the right side of her back.

The pain gradually increased and by 2017, it had extended to the center of her back, around the spine. It kept varying from the right side of her back to the spine and, sometimes, even around the neck.

By this time, Birungi could hardly turn to the sides, and to do so, she had to move her whole body. She even failed to drive.

When she sought medical care, the doctor sent her for an X-ray, which showed that one of the bones in the spine was dislocated. “The doctor prescribed painkillers and recommended that I undergo physiotherapy,” says Birungi.

So Birungi was assigned to a physiotherapist who took her through eight sessions, each costing sh80,000 for eight weeks. Eventually, the pain disappeared. 

Numbers rising

In reference to Mulago Hospital, Susan Akori, the president of the Uganda Physiotherapy Association and a senior physiotherapist at the hospital, says the problem of back pain has risen in the past year among younger people from 12% to 15%; the middle-age office and non-office workers from 17% to20%, and older persons from 40% to 45%. In gender terms, the ratio of the number of women with back pain complaints to that of the men is 3:1. This is attributed mainly to poor ergonomics (the way people execute their daily activities in regards to their bodies) like bad sitting and standing posture, daily routine like washing especially among housewives, degenerative changes in the spine due to aging, and infections like tuberculosis of the spine among other causes.

However, this can be avoided by practicing good habits like exercising and following the therapy recommended by the medical practitioners, assures Akori.

Lower back pain

According to Robert Sempuma, a physiotherapist from Ggwaatiro hospital in Bweyogerere, Wakiso district, lower back pain is a condition involving the bones, nerves, and muscles of the lower area of the back, as a result of muscle strain due to sudden injury and poor body mechanics while lifting heavy objects or diseases like cancer. And it can vary from dull to sharp pain depending on the cause.

He adds that this pain can last for days or even years and it can be categorized as referred pain (pain resulting from infection) and non-referred back pain (resulting from an injury or fracture).

“Lower back pain can also be associated with unexplained weight loss, pain in the legs, loss of sensation in the lower limbs, failure to control urine and stool, loss of muscle stretch in the lower limbs, among other signs,” explains Sempuma.

Signs and symptoms

Not every pain around the back necessarily means that one has back issues, sometime it can be because of the menstrual cycle or fatigue and these normally heal even without visiting a medical practitioner,

Back pain refers to sharp pain after movement, persistent pain while bending, and pain while twisting the back, explains Robert Sempuma, a physiotherapist from Ggwaatiro hospital in Bweyogerere.

Causes of back pain

Over seating

According to Isaac Kakooza, a physiotherapist at Nakasero Hospital, sitting in one position for more than two hours can lead to mechanical back pain (pain resulting from poor sitting posture).

According to online sources, lower back pain is defined as pain in the part of the spine that curves inward at the base.

A common reason your back may hurt is from bad posture while seated. Sitting in a slouched or hunched over position can put a strain on the discs — the fluid-filled cushions that protect the vertebrae from rubbing together. This may be worsened by an underlying medical condition.

“It is always good for one to sit with a straight back, but not for more than two hours,” he advises.

With more people working and studying from home, due to Covid 19, Sempuma advises people to practice good sitting posture like sitting with a straight back, to prevent back pain that may result from oversitting. He adds that one should not sit for more than one and a half hours.

Sempuma also adds that one should avoid sleeping on poor quality mattresses, for example, soft ones because these can make the body weak and in the long run it can lead to back pain. “A firm mattress is the best to sleep on because this does not make a dent that can result in back pain when one sleeps on it,” reveals Sempuma.

He added that one should avoid sleeping on a mattress for a long period of time. “Always discard or burn old mattresses to avoid overuse that can result in back pain,” advises Sempuma.

Muscle or ligament strain

Sempuma says repeated heavy lifting or a sudden awkward movement such as bouncing can strain back muscles and spinal ligaments. He adds that sitting with a bent back on office chairs, or constant strain when doing laundry can cause painful muscle spasms leading to back pain.

Sempuma also adds that it is scientifically advised that one should always squat with support from the knees while lifting up something heavy. 

Arthritis

Arthritis is inflammation of the joints caused by falling leading to joint stiffness and swelling. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis. “This can be worsened by sciatica caused by compression of the sciatic nerve,” adds Sempuma.

Skeletal irregularities

A condition in which the spine curves to the side (scoliosis) also can lead to back pain but generally not until after 45 years and above. Sempuma attributes this more to lifestyle which some people adopt for example this so-called ‘bouncing with a bent back’ for swag causing scoliosis (bending of the back on one side). “This can lead to permanent skeletal irregularities if not stopped earlier,” warns Sempuma.  He adds that it can be weak bones due to calcium deficiency and wear and tear of muscles. 

Infections

According to Kakooza, infectious diseases like tuberculosis of the spine can lead to pathological back pain which can be accompanied by osteomyelitis (an infection in a bone spread through the bloodstream or from the nearby tissue), lumbar spondylosis (spine problems resulting from disc) and abscess (collection of purse within the body tissue).

Gym

Sempuma says most gym instructors are not well trained and as a result, they assign their trainees exercises that are not suitable for them, thus leading to back pain.

Pregnancy

Stella Nakawunde, a midwife at Bukerere health centre II in Mukono district, attributes back pain during pregnancy to pressure exerted between the lining of the pelvic muscles caused by the growth of the zygote, leading to expansion of the uterus in the abdomen.

Menstrual periods

Nakawunde explains that during menstrual periods lower back pain is caused by contractions in the uterus, which radiate through the web of nerves within the pelvic region. "This pain is from the uterus contracting to shed the lining which has built up since the last cycle,” she added.

Ruptured disks

A ruptured disk refers to a problem with one of the rubbery cushions (disks) that sit between the individual bones (vertebrae) that stack to make the spine. “Each vertebrate in the spine is cushioned by disks, so when the disk ruptures, there will be more pressure in the nerves hence leading to back pain,” explains Sempuma.

Sempuma says if back pain is not treated in time it can eventually lead to loss of sensation (paralyzing) in the body parts like the feet or even permanent lameness.

How to avoid back pain

Sempuma emphasizes exercises like stretching and jogging daily to stretch the muscles and relieve the pain. Avoid sleeping on a soft mattress because it will cause your back or hips to sag, and your spine to fall out of alignment which can lead to major pain. Always sleep on a moderately firm mattress to avoid putting too much pressure on your joints, especially if you sleep on your side or your back.

Avoid bending while lifting up things. Always squat and get support from the knees using your elbows.

Who is prone to back pain?

“Everyone is prone to back pain because most of the work that we do involves the back. The medical practitioners, those who work in offices and sit for long, the traffic officers who stand for long, the builders, housewives, and farmers,” discloses Akori.

Akori adds that even children, particularly day scholars, are prone to back pain because of the heavy bags they carry.

However, people aged 35 years and above are at a higher risk of getting back pain because of degenerative changes around the spine as explains Isaac Kakooza, a physiotherapist at Nakasero hospital. 

People ages 35 to 60 are more likely to have disc (tissues which act like shock absorbers between the spine bones) related disorders, while people over the age of 60 years are more likely to have pain related to osteoarthritis because of joint inflammation, adds Kakooza. 

Treatment and management options

Sempuma, says that healing of the back depends on the history of the patient and the findings. The best way to rule out the cause of back pain is by undergoing a Magnetic Resonance Imaging (MRI) test ranging from between sh550,000 and sh750,000. Sometimes a CT scan and x-ray can be recommended for those who cannot afford the MRI. After the cause is discovered, then the doctor can recommend appropriate treatment/medication.

Physiotherapy

Joseph Katumba, a general medical doctor at Ggwaatiro Hospital in Bweyogerere says there is no specific treatment for back pain. He adds that it is after tracing the cause that the right treatment can be recommended.  “If, for instance, the patient has spinal issues, we recommend that an x-ray is carried out then we assign a physiotherapist (a health care professional who assists people to restore, maintain and maximize their strength and movement of the body for a proper functioning),” explains Katumba.

Drugs

Katumba also says that specific drugs like tuberculosis drugs are administered to patients with tuberculosis of the spine to help the back heal after completing treatment.   

Massage therapy

Massage aims at relaxing, reviving, and healing the body, Katumba says, through manipulation of the soft tissues and muscles, massage therapy works to promote healing and enhance a person's overall well-being.

However, he emphasized that this must be carried out by experts and depending on the history given by the patient.

Exercises stretching under the supervision of a physiotherapist can help strengthen the spine and reduce stiffness of the back, adds Akori. 

Akori stresses that patients should not be discharged before they have learned how to do the exercises on their own. 

Backrest (a modified sponge specifically made for supporting the back while sitting), can also be used to manage back pain. This helps to keep the back straight while sitting since it is wrapped around a chair. It costs about sh150, 000 at hospitals like Mulago, explains Akori.

Backcare through health education is also a remedy for managing back pain, says Akori.