Written By: Olawoye Oluwakemi, physical therapist and Health reporter who is passionate about health promotion and advocacy in Africa.
Walking into a logistics company in the suburbs of Lagos, a two-storey building with ten offices and five major departments, employees are seen sitting at colorful workstations looking keenly at their laptops focused on the task at hand. The customer service officer is sitting in a slouched position at his desk while his colleague next door is looking at her obviously inappropriately placed office computer and a few others in more potentially harmful workstation positions. Hours pass by and no one is seen standing up from their desk. This continues for an hour or two before the account officer at the far end of the first office is seen standing up to grab a quick lunch.
This describes a typical work day in the life of a Nigerian white-collar worker; an average of 1-2 hours commute in the morning to get to work, a quick breakfast in the office kitchen, 2-3 hours of sitting at the desk, half-hour to an hour of lunch, another 2-3 hours of sitting at the desk and back to 1-3 hours commute in the evening back home. This shows that a significant number of white-collar workers live a sedentary lifestyle.
In a research on evaluation of ergonomic deficiencies in Nigerian computer stations, Momodu and Edosomwan found out that chair height, chair arm or back, and desk height in Nigerian workstations had a high error of 76%, 66% and 46% respectively. This is a major indication that there are poor furnitures in these workstations and majority of employers in this part of the world do not bother about appropriate work facilities for workers. This is not surprising as an average business in Africa is struggling to make enough profit to meet up with business running costs and work station furniture is usually not a primary or even secondary focus.
This increased number of ergonomic deficiencies in workstations coupled with high prevalence of sedentary lifestyle among white-collar workers are contributory factors to growing cases of musculoskeletal disorders including lumbar spondylosis. Lumbar spondylosis refers to an osteoarthritic disease of the lower back bones that make up the lumbar spine. It typically occurs in later life due to degeneration or aging of the bones and joints but can manifest earlier in the younger age groups if there is persistent abnormal positioning that counterbalances the normal structure of the lumbar spine as occurs in wrong sitting positions, especially in people with sedentary lifestyle.
The importance of lumbar spondylosis in white-collar workers cannot be overemphasized. The direct cost of health care expenses and the indirect cost resulting from loss of wages and productivity are enormous. Low back pain is among the most common causes of disability in those younger than 45 years and a leading cause of frequent visits to a physician. To cut the cost of treatment and reduce the burden of disability and loss of productivity from lumbar spondylosis, urgent preventive strategies need to be adopted.
According to recent statistics from African Development Bank, about 23% of the total population who are middle class with a daily spend of $2-$20 constitute the majority of the independent population whom the larger percentage of dependent population rely on. Most of these middle-class workers have white-collar jobs. It is therefore imperative that any work-limiting factor such as occurs with low back pain from lumbar spondylosis be reduced to the barest minimum.
Low back pain or waist pain is a frequent complaint by individuals affected by lumbar spondylosis. The pain increases with movement and may be associated with stiffness. It may radiate to the buttocks, the thighs and the legs. It may be very disabling in extremes of cases when spinal nerves or the spinal cord become compressed from the spondylotic process leading to weak legs. In sedentary obese individuals, there can be lumbar disk disease leading to disk herniation or ruptured disc with excruciating pain.
The diagnosis of spondylosis is made using imaging studies such as plain film X-rays of the lower back, CT scans, or MRI. Findings include decrease in the disc space and bony spur formation at the upper or lower portions of the vertebrae. MRI is better at visualizing spinal cord compression or compression of other neural structures. It is important to state that symptoms may not correlate well with imaging studies in lumbar spondylosis as an individual may have prominent symptoms in the absence of significant imaging abnormalities.
Treatment of lumbar spondylosis can be non-pharmacological, pharmacological or surgical. Non-pharmacological measures include physical therapy, use of lumbar supports and weight loss. Medications constitute the pharmacological means of treatment and this is aimed at relieving pain and stabilizing neural functions altered from compression on the nerves. Decompressive surgeries are aimed at relieving pressure on neural structures in individuals with compressive symptoms especially pain radiating below the waist, weak legs, bladder or bowel dysfunction.
Just last month, I got into a conversation with my friend, a human resource manager at Milan Bank who unhappily complained about an employee who had to take an unplanned leave and how this had negatively affected work output in the organization. She narrated the story of the longtime employee who reportedly presented to the hospital after months of managing on and off episodes of chronic back pain which was beginning to affect her work output. Following her consultation at the hospital, she was placed on medications, referred for daily physical therapy, educated on lifestyle changes to make to prevent recurring episodes and advised to take few days off work to fully recuperate. Following her narration, I mentioned the possibility that this might have been a result of inappropriate work furnitures at their organization. She then recalled similar complaints by other employees and even mentioned another longtime employee who recently had a decompression surgery.
A number of preventive measures has been identified to reduce early onset of degenerative changes in the lumbar spine. Adopting the use of appropriate workstation furniture, proper posture while sitting and standing, exercising regularly, learning correct lifting technique, maintaining a healthy body weight and generally adopting a healthy lifestyle are vital preventive measures. Materials such as the lumbar roll, pedometer watch, sports pulse watch and the innovative posture training wearable called ‘upright’ have jointly assisted to create interesting ways of maintaining a good physical posture and minimize sedentary lifestyle amongst the general population.
In conclusion, considering the social and economic implications of lumbar spondylosis, this area should continue to be a critical research and public health focus.