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Pulling exercises for back pain harmful, medics rule

Two studies in Kenya have placed the prevalence of lower back pain in the working class at 64%

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by The Star

Health08 December 2023 - 11:37
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In Summary


•The guidelines also outline 14 interventions that are not recommended for most people in most contexts.

•The condition is common in urban as well as rural areas.

Years later, this physicological distress may manifest as physical symptoms, called somatic symptoms.

A Nairobi-based hospital is running a “special end-year offer” for people with chronic back pain promising stretching exercises that will free you for life.

Another clinic, located in the Kilimani area, has an offer for braces that keep the spinal disks back in place.

But in new regulations published on Thursday, medics say such interventions end up doing more harm than good.

Low back pain (LBP) describes the pain that occurs in the lower part of the spine, just before the buttock.

It is the most common condition affecting the muscles and skeleton and is the leading cause of disability worldwide, according to the World Health Organization.

The organisation says this condition is growing rapidly in Africa and Asia, where populations are getting larger and people are living longer.

"To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” Dr Bruce Aylward, WHO assistant director-general for UHC, said in a statement.

“Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care."

WHO now recommends non-surgical interventions to help people experiencing chronic primary lower back pain.

These interventions include some physical therapies, such as spinal manipulative therapy and massage; psychological therapies, such as cognitive behavioural therapy; and medicines, such as non-steroidal anti-inflammatory medicines.

The guidelines also outline 14 interventions that are not recommended for most people in most contexts.

“These interventions should not be routinely offered, as WHO evaluation of the available evidence indicates that potential harms likely outweigh the benefits,” the organisation said.

It advised against interventions such as lumbar braces, belts and supports that are routinely offered in Kenyan clinics.

Other harmful interventions are some physical therapies, such as pulling on part of the body and some medicines, such as opioid painkillers, which can be associated with overdose and dependence.

For people who experience persisting pain, their ability to participate in family, social, and work activities is often reduced, which can negatively affect their mental health and bring substantial costs to families, communities, and health systems.

“Addressing chronic low back pain requires an integrated, person-centred approach. This means considering each person’s unique situation and the factors that might influence their pain experience,” Dr Anshu Banerjee, WHO director for maternal, newborn, child, adolescent health and ageing said.

 “We are using this guideline as a tool to support a holistic approach to chronic low back pain care and to improve the quality, safety and availability of care.”

The condition is common in urban as well as rural areas.

In 2020, four researchers from the University of Nairobi carried out a survey that estimated a 12-month prevalence of lower back pain (LBP) at 64 per cent among university teaching staff.

“Physical inactivity, sitting on chairs without lumbar supports and workplace stress have been identified as modifiable risk factors for LBP among teaching staff,” they said.

 Their study, “Prevalence and risk factors for low back pain among university teaching staff in Nairobi, Kenya: a cross-sectional study," was published last year.

In 2019, Moi University researcher Hussein Elias and two colleagues also conducted a study to determine the prevalence of LBP among primary school teachers in western Kenya.

“The 12-month self-reported prevalence of LBP among primary teachers was 64.98 per cent, with close to 70 per cent of them reporting minimal disability,” they said.

The study, “Low back pain among primary school teachers in Rural Kenya: Prevalence and contributing factors,” was published in the African Journal of Primary Health Care Family Medicine.

Most teachers with the condition were female. “Preventive measures should be in place to prevent and reduce the progression of LBP disability,” they said.

The two other researchers, Raymond Downing and Ann Mwangi, also work at the College of Health Sciences at Moi University.

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