COLLEGE OF NURSING AND MIDWIFERY NALERIGU

TOPIC: EFFECTS OF PHYSIOTHERAPY MANAGEMENT ON LOWER BACK PAIN

AMONG HEALTH TUTORS IN GHANA, A CASE STUDY OF THE COLLEGE OF

NURSING AND ALLIED HEALTH SCIENCES, NALERIGU.

BY:

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 CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Low back pain is a disorder that has obtained global attention as it affects many people. Low

back pain (LBP) occurs around the dorsal region between or below the costal margin and above

the inferior gluteal folds. Mostly, it is associated with pain that sometimes radiates to the lower

extremities (Almeida & Kraychete 2017) and may result from an injury, disease, or stress on

various structures of the body (Rizk, Nader, Karam, & Ayoub, 2012). The lumbar spine

comprises five rigid bones attached to joints capsules, ligaments, tendons, and muscles. The

robust nature of the spine protects the spinal cord and spinal nerve root. Moreover, the spine's

extreme flexibility allows for movement in many directions or areas (Allegri et al., 2016). Most

of the pains or symptoms experienced by people with LBP arise from the spine, the disc is in-

between the vertebrae, ligaments surrounding the spine as well as the disc, spinal cord, nerve

root, muscle, and structures of the pelvis and abdomen (Nasution, Lubis, Amelia, & Hocin,

2018).

In as much as low back pain represents an alarming phenomenon, the exact etiology of some

cases of LBP is usually obscure. However, it is primarily understood to be multifactorial. LBP is

either known as specific or non-specific low back pain. Nonspecific LBP is defined as pain with

an unidentified origin or pathology, accounting for 90% of all presenting cases (Chou et al.,

2018). On the other hand, a specific LBP is defined as one that is related to a specific causal

agent with a physiological mechanism (Almeida & Kraychete 2017; Gupta & Sharma, 2018).

Depending on its symptoms, low back pain may be classified as acute, sub-acute, or chronic. The

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pain is described as acute when it remains incessant for less than four weeks, sub-acute when it

continues for more than twelve weeks, and chronic when it is present with the sufferer for more

than three months (Malik & Nelson, 2018). Again, the sensation of pain can differ significantly;

for instance, the pain may be aching, burning, stabbing, tingling, sharp, dull, and well-defined or

elusive. The intensity may also range from mild to severe back pain (Rizk et al., 2012).

Furthermore, individual/biological, psychosocial, and occupational factors are among the

numerous factors contributing to LBP (Williams et al., 2015). Among the factors, occupational

factors are said to be a significant contributing factor to low back pain. They account for 37% of

all LBP described universally (Gupta & Sharma, 2018).

Low back pain has been a significant setback over the decades and remains one of the severe and

topmost occurring musculoskeletal disorders confronting both the young and old. It represents

the single leading cause of disability across the world (Hartvigsen et al., 2018). Additionally, the

global burden of disease study reports that in 2010, 2015, and 2016, LBP became the 4th leading

cause of disability-adjusted life years (DALYs) as compared with other diseases among the

world's population. It remains the sixth-highest disease burden (Hurwitz, Randhawa, Yu, Côté, &

Haldeman, 2018). This evidence suggests that LBP plagues over half a billion individuals

universally. A United States study (Alanzi et al., 2017) posited that about 60%-80% of the

masses suffered from LBP at certain times in their lives. It represents the most common cause of

limited activity among the populace. They further found out that it was the leading cause of

work-related disability and occurred in people less than 45 years old. A similar study in the

United Kingdom concluded that LBP afflicted the working-age group with the highest disability

and the number of individuals suffering from LBP increased from 36.4%-44% in the past decade.

In Africa, studies (Awosan, Yikawe, Oche, & Oboirien, 2017) on LBP's epidemiology revealed a

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lifetime prevalence rate of 28%-74%. Tanner (2017) argued that this was one of the most typical

reasons why 30%-40% of patients in Sub-Saharan Africa seek assistance from a rheumatologist.

Low back pain is considered a phenomenon that transpires only among persons in high-income

countries. However, several research studies in recent years have demonstrated that LBP

incidence is almost the same as that in lower and middle-income countries (Igwesi-Chidobe,

Kitchen, Sorinola, & Godfrey, 2017). They attributed this to the focus of health services on other

areas combined with inadequate resources and other provisions to deal with the burden of LBP.

For instance, Bello, Quartey, and Lartey (2015), in a systemic review of LBP incidence in

Nigeria, discovered a prevalence rate of 32.5%-73.5%, and all were related to the occupations of

the individuals. Moreover, although such data is not readily available for reference in Ghana, a

study undertaken among commercial and professional taxi drivers disclosed a prevalence rate of

34.3% and 58.8%, respectively (Wanamo, Abaya, & Aschalew, 2017).

Low back pain negatively impacts the lives of persons afflicted by it (Chou et al., 2018), and

prominent among the reasons why patients seek treatment is pain, the University of Ghana

http://ugspace.ug.edu.gh 4 which may be precipitated by physical activities such as bending,

lifting, and prolonged sitting, among others (Arya, 2014; Kruger, Billson, Wood, & du Toit,

2015). The International Association for the Study of Pain (IASP) defined pain as "an unpleasant

sensory or emotional experience associated with actual or potential tissue damage or described in

terms of such damage" (IASP, 1979, p. 249). Low back pain represents a cause of pain and

disability and inflicts significant consequences on the quality of life of the sufferers (Harris,

Gurden, Martindale, & Jeffries, 2017). Likewise, LBP negatively influences the individual's

physical, social, and psychological aspects, thereby increasing costs for industries, government,

and society in general (Bento et al., 2019). For instance, in the United Kingdom, LBP costs about

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14 billion pounds yearly and was responsible for 7 million visits to the physician annually

(Rimpilainen, 2016). Furthermore, LBP consumes ten billion pounds (£10) of health services

offered in the United Kingdom, making it the third most expensive specialty following mental

health and cardiac conditions (Potier, Tims, Kilbride, & Rantell, 2015). Low back pain may

result in severe financial loss, loss of labor force, and several other physical and psychological

difficulties due to its chronic nature (Tosunoz & Oztunc, 2017). The unsuccessful and extended

period of treatment, and direct and indirect costs culminate into critical social problems that

consequently lead to disability and enormous economic burden across the world (Kameda &

Tanimae, 2019). Moreover, the pain and disability accompanying LBP affect the individual's

sense of purpose and meaning in life, making them rely on spirituality to adapt to their pain and

injury (Siddall, McIndoe, Austin, & Wrigley, 2017). Therefore, the management of low back

pain has focused on a multidisciplinary approach that includes all aspects of the person rather

than just physical treatment in reducing pain and disability (Kamper et al., 2015).

1.2 Problem Statement

Low back pain carries a considerable healthcare cost. Despite increased spending on healthcare

services, patient outcomes have not improved as global disability related to low back pain

continues to rise (Ferreira et al., 2018; Traeger, Buchbinder, Harris, & Maher, 2017).

Additionally, the quality of life of individuals and their ability to be productive during work

activity is compromised as a result of LBP (Fan & Straube, 2016). Again, the disability that

follows LBP makes individuals absent themselves from work and further causes them to retire

from work in their productive years (Sá, Dias, Souza, Lessa, & Baptista, 2015).

Moreover, the incidence and impact of low back pain continue to rise despite biomedical

treatment and patients continue to experience pain, disability, and dissatisfaction, suggesting the

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need for a different management approach. (O'Sullivan, 2012; Snelgrove & Liossi, 2013; Walker

et al., 2006).

Estimates show that LBP afflicts 11.9% of people worldwide at a given time and affects both the

young and old between 20-50 years with an incidence of 19.6% (Doualla et al., 2019). In Ghana,

a women's health study showed that chronic LBP was persistent in 1328 women screened,

accounting for 19.4%. Another survey of 100 male farmers in a rural community in the Brong

Ahafo region acknowledged that low back pain was prevalent (76%) among the farmers

(Oppong‐Yeboah, 2014).

This study is therefore aimed at identifying the effects of physiotherapy management on Lower

Back Pain among Health Tutors in Ghana, a case study of the College of Nursing and Allied

Health Sciences, Nalerigu.

1.3 Objective of the Study

1.3.1 Main Objective

The main objective of the study was to identify the effects of physiotherapy management on

Lower Back Pain among Health Tutors in Ghana, a case study of the College of Nursing and

Allied Health Sciences, Nalerigu.

1.3.2 Specific Objectives

1. To explore health tutors’ knowledge of massage therapy about Lower Back Pain.

2. To investigate the effects of stretching exercises on the Lower Back.

3. To ascertain the effects of Posture on the Lower Back.

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1.4 Research Questions

Based on the objectives of the study, the following research questions were posed;

1. What is the health tutors’ knowledge of massage therapy about Lower Back Pain?

2. What are the effects of stretching exercises on the Lower Back?

3. What are the effects of Posture on the Lower Back?

1.5 Significance of the Study

Low back pain is mostly acknowledged as a significant health problem worldwide and thus obtaining an

understanding of the experiences of living with pain among Health Tutors suffering from LBP, will be

beneficial in many ways. The study will assist in alerting health tutors in intensifying their

education on proper body mechanics when sitting, standing, and sleeping to prevent Lower Back

Pain.

Also, it will inform program developers such as the Ministry of Health / Ghana Health Service

on the goals/objectives, activities, and expected results from any program intervention that is

targeted at improving the knowledge level and perception of Lower Back Pain among Health

Tutors’.