African Farmers & Low Back Pain: The Untold Insights

There’s a long held myth that our levels of low back pain are directly attributable to western culture and sitting at a desk for eight hours a day. Suggesting manual workers, farmers for example, are better off. Even medics, tend to assume that staying active in this way – bending, lifting, carrying - is better for muscular skeletal or low back health. But is it? I’m not so sure.

In this video I’m taking a look at some of the studies done of people in Africa and Asia, who carry huge loads on their back or perform work bending over from the hip in the paddy fields for hours a day. And the impact this has on their spinal health and the incidence of low back pain. After all, they don’t have ergonomic advice given to them, they just stand or lift how they’ve been taught by the generations before them.

So are they really better off, simply because they’re moving all day and not sedentary?

Published research into manual labour in lower socio-economic countries

The first study¹ I’ll discuss, looked at the impact of heavy load carrying on muscular skeletal pain and disability among women in the Shinyanga Region, Tanzania. This wasn’t a controlled study, it just looked at information that has been collected. But findings indicate a substantial burden of musculoskeletal damage and disability in this population of women who carry heavy loads daily. It was found that the extent of discomfort and disability increased with the increasing exposure to various load carrying measures, especially for low back pain.

The second study² is another meta analysis of 64 studies with 68,684 participants across 23 countries. Researchers found statistically significant associations between musculoskeletal disorders, particularly activities including heavy lifting and repetitive movement. So again suggesting that regular heavy lifting can be a problem.

Do you know what I find interesting here?

A lot of people say that when it comes to lower back pain we need to continue lifting, we need to continue doing the movements to strengthen the back. But what's being found here is that the people that do a lot of them are getting the same problems.

We’re going from one end of the spectrum to the other, in our culture we might sit down all day and then do a load of heavy lifting in the gym, while these people are lifting, probably moderate loads, every day and they are getting essentially the same problem.

African farmers and low back pain:  global prevalence

Muscular skeletal disorders are not just common here, they’re common in agricultural workers in low to middle income countries. In fact, global prevalence of low back pain in farmers, particularly in Africa, is greater than previously reported. So these people aren't necessarily better off, they do experience back pain  - probably a very similar problem, but possibly for different reasons. And what this proves is that lifting isn't necessarily the saviour for lower back pain.  It can actually be as much of a problem as it is a cure.

We do need to lift, and we should lift, but we have to understand how and when to do it.

There’s one final study to mention: Prevalence and associated risk factors of low back pain among users of a primary health care clinic serving semi-urban and rural settlements in KwaZulu-Natal, South Africa³. This was smaller – only 14 participants. Again, in this setting, the prevalence of low back pain is seen to be high. And specialised treatments for low back pain are not available in the Primary Health Care Facilities. So while it is perceived by therapists in the west that these people are fine and this is the type of lifestyle that we should be pursuing, unfortunately this is incorrect.

People in lower socioeconomic countries that are active all day aren't necessarily in a better position to people that sit all day.

The importance of preventative care for a healthy spine

What we actually need to do is need to find an optimal range in the middle, neither too active nor too sedentary.  If we do become more active we need to be able to recover properly. If we overcook our spine with too much movement or too much static posture, then we're going to get a problem. We need to find a balance. Not only using exercise but also using everyday activities to desensitize the pain. If the problem is created by lifting, we need to modify the lift – perhaps the position, perhaps the load – there are a million things to consider.

But really, the point here is that we shouldn’t think that people in lower socioeconomic environments – such as farmers and manual workers – particularly those in Africa or Asia - are better off because of their active lifestyle. In reality, they tend to have the same issues with their lower back, albeit they potentially occur for different reasons. And we shouldn’t overlook the importance of proper techniques and preventative care for a healthy spine.

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References

1. Kadota JL, McCoy SI, Bates MN, Mnyippembe A, Njau PF, Prata N, Harris-Adamson C. The Impact of Heavy Load Carrying on Musculoskeletal Pain and Disability Among Women in Shinyanga Region, Tanzania. Ann Glob Health. 2020 Feb 21; 86(1):17. doi: 10.5334/aogh.2470. PMID: 32110509; PMCID: PMC7034319.
2. Shivakumar M, Welsh V, Bajpai R, Helliwell T, Mallen C, Robinson M, Shepherd T. Musculoskeletal disorders and pain in agricultural workers in Low- and Middle-Income Countries: a systematic review and meta-analysis. Rheumatol Int. 2024 Feb; 44(2):235-247. doi: 10.1007/s00296-023-05500-5. Epub 2023 Nov 24. PMID: 37999798; PMCID: PMC10796632.
3. Khumalo K, Haffejee F. Prevalence and associated risk factors of low back pain among users of a primary health care clinic serving semi-urban and rural settlements in KwaZulu-Natal, South Africa. Afr Health Sci. 2022 Jun; 22(2):592-601. doi: 10.4314/ahs.v22i2.68. PMID: 36407349; PMCID: PMC9652636.