Years ago, the queues in Nairobi’s spine, physiotherapy and orthopaedic hospitals only had old people. Back pain was a disease of the elderly and the business of the back was not as lucrative.
Now there are hundreds of physiotherapists in Nairobi alone and the people waiting to see these doctors are as young as 12 years. A majority are in their 30s and 40s.
Back pain has become a disease of this era. And as the number of patients rises, so is the setup of studios and parlours that offer exercises, acupuncture, chiropractic, massage therapy and yoga as a relief.
The number of physiotherapy graduates has also doubled, to match the growing demand for the services. About 2,022 physiotherapists graduated two years ago, compared to 1,047 five years ago, the latest Economic Survey shows.
Back pain is treated best by exercise, massage therapy or yoga and over-the-counter pain relievers. FILE PHOTO | SHUTTERSTOCK
Peter Gitonga, a physiotherapist consultant with Nairobi Spine and Orthopaedic Centre says nowadays, the majority of patients he attends to have back pains.
He gets patients who are of tender age between 12 and 18 years coming in with back pains as well. They have not established why children are developing back pains, but research points to heavy school bags, improper sitting posture in school, and sedentary lifestyles where they move from sitting at a desk in class to sitting on the couch for hours, playing video games or watching TV.
Ken Otieno, another physiotherapist at Upper Hill Medical Centre, Nairobi has been in the physiotherapy field for 12 years. Before joining the university he volunteered at a disability centre and that is where his love for physiotherapy was sparked.
Nairobi Spine and Orthopaedic Centre physiotherapist Peter Gikunda during the photo session at the Fortis Centre on February 23, 2023. PHOTO | DIANA NGILA | NMG
Over the years, Mr Otieno has also noted a shift in the back pain conditions.
“Before back pains were a preserve for the elderly. However, right now back pains have become a lifestyle disease that affects even young persons. While ageing people still get back pains, the emerging trend is that people who work sitting or standing for long hours without much exercise seem to have more back pains than the elderly. An analysis right now shows that most people who come in struggling with back pains as a result of work-related issues are more than the elderly,” he tells the BDLife.
While both men and women are equally vulnerable to developing back pains, Mr Otieno says they see more women than men.
“If we see 10 patients, six will be women,” he says.
Women have more predisposing factors to back pains due to pregnancy and daily household duties such as bending, cleaning and lifting. Those with heavier bosoms and a wider waistline that weighs down on the back nerves also experience back pain.
Causes of back pain include:
a) Discogenic causes: These are back pains that are caused by the deformities of the atomic back structures. This occurs when one has a cancerous tumour, kidney problems, fibroids or swelling within the spine.
b) Degenerative cause: This is where one develops back pain as a result of old age. One can develop osteoarthritis (the most common form of arthritis) of the spine ending up with a fractured spine.
c) Mechanical causes: This is caused by one’s lifestyle. It can be a result of prolonged sitting, standing, lifting, and bending. Mr Githonga says that the primary cause of back pain in Kenya is due to patient lifestyles.
Back pain is treated best by exercise, massage therapy or yoga and over-the-counter pain relievers. FILE PHOTO | SHUTTERSTOCK
d) Posture-related causes- This is related to spine mechanics. “Where the spine is not in its normal functioning state or posture it interferes with the weight distribution. Whenever the weight is not well distributed at the spine you end up with stiff muscles,” Mr Otieno says.
Weight can also affect spine posture. With excess weight, the back muscles can be overworked and strained.
e) Traumatic injury: Back pain caused by an accident or a fall fall in this category. Mr Otieno advises that if you develop back pains as a result of an injury it is important that you see a doctor immediately.
He, however, cautions that there are some back pains that may develop as a result of fatigue which can be relieved by taking painkillers or resting.
f) Muscle abnormalities such as muscle spasms can also cause back pain. Muscle spasms are cases where there is the over contraction of the back muscles.
g) Pregnancy: Pregnant women are susceptible to back pains due to a change of spine position. Mr Otieno says in their case, pains can be prevented during the first trimester of the pregnancy.
“Expectant mothers should do recommended stretches to ease the tension and build up the pelvic floor muscles. Women who are active in the first trimester of the pregnancy get less pain in the second and third trimesters,” he says. Women also experience pain after giving birth because the back muscles are stretched and become weak.
So, how do you treat back pain?
Many people with chronic back pain tend to shut down, avoiding their usual activities, afraid of making things worse. Acute back pain is defined as present for four weeks or less that does not radiate down the leg.
Back pain is treated best by exercise, massage therapy or yoga and over-the-counter pain relievers. Most doctors look at therapies that are non-drug and non-surgical first.
a) Medical treatment- This one involves the use of medicines. “There are times when a patient comes in with acute pain such that we are forced to give them anti-inflammatory medication and muscle relaxants, to ease the pain before we do the manipulation of the back,” Mr Otieno says.
However, most times pain management will only work on the muscles leaving the muscular cause of the problem. “For instance, if a person has a slip disc, medication will reduce pain in the muscles but the disc which is holding pressure at the nerve will remain intact requiring manipulation,” he adds.
b)Conservative management: This involves the manipulation of the back. This includes using methods such as heat treatment, massage and exercises. Mr Gitonga says the recommended exercises depend on the cause of the back pain and the age of the patient.
Exercises and physical activities are two different things. Exercises are programmed and timed and the change is calculated. Back extensions, trunk rotation and straight leg lifting are some of the back exercises that Mr Otieno recommends.
“Bridging exercises and stretches can also strengthen your abdominal and back muscles,” adds Mr Gitonga adds.
C) Surgical intervention: This is the last option that a doctor will recommend after the first two options fail. “If you have a fracture of the back you may have to go the surgical way,” Mr Otieno says, adding that even after the surgical procedure one will still need to undergo conservative management.
A physiotherapy session can range from Sh2,000 to Sh5,000 or as high as Sh250,000 to Sh1 million for surgery. So how do you prevent back pains?
“Prevention of back pains requires the observation of the ergonomics of the back to prevent the factors that cause back pains. If you don’t have a tumour on the back then you can avoid the mechanical causes of back problems” Mr Otieno says.
Back pain is treated best by exercise, massage therapy or yoga and over-the-counter pain relievers. FILE PHOTO | SHUTTERSTOCK
To avoid developing back pains, the two physiotherapists, recommend the following:
1. Avoid long hours of sitting and when you sit, ensure that you sit on the right chair. “If you are sitting, sit in a way that your back is supported at an angle of 90ᵒ. Your knee and hip should also be at 90ᵒ. Also, ensure that the chair accommodates more than two-thirds of your thigh length,” Mr Githonga says.
2. Avoid lifting far away from the object that you are carrying. “If you are lifting an object that is far away, you might break your spine,” Mr Otieno says.
The item that you are lifting must always be close to you. While lifting let the knees and hips be bent, pick up the item then rise with it. Do not bend your back.
3. Sleep on a firm mattress. “If your mattress is too soft, your back will be in an irregular alignment causing pressure on your spine,” Mr Otieno says.
4. Regular exercises reduce the tension in your muscles, reducing your chances of getting an injury. “If you are flexible and fit, your chances of injury go down,” Mr Gitonga advises that your weight should be within your body mass index to protect yourself from developing back pains.
5. When using your phone ensure that it is at the level of your shoulder such that you will not be straining your back or bending your neck. “When working with your computer, make sure that it is at the level of your chest such that it is not above your shoulder and not below your tummy,” Mr Gitonga says.
6. Avoid accidents or falls that can cause trauma to your body.
7. For pregnant women, use a pregnancy belt to support the weight of the baby and avoid straining your back.
