Dr Ajibola Oladiran is a lecturer and consultant orthopaedic and trauma surgeon with subspecialty in hip surgery and sports medicine at the College of Medicine and the University College Hospital (UCH), Ibadan. In this interview by SADE OGUNTOLA, he speaks on spondylosis, a silent problem on the prowl that affects the productive age and why it is important for one to take care one’s back and joints as one ages.
What is spondylosis and how common is it?
Spondylosis is essentially a degeneration that occurs in the spine, usually with aging. In some people, it starts early either due to familial predisposition, a previous injury or poor posture. The commonest reason why people present to the orthopedic outpatient clinic is low back pain. Majority of those cases are either due to spondylosis or a prolapsed intervertebral disc.
In many orthopedic outpatient clinics, of every 10 patients, three to five have low back pain and two to three of these are due to spondylosis. So, it is really common.
The commonest cause of low back pain is a poor posture; the posture in which people sit to work, do heavy lifting or do household chores. For instance, farmers who spend a lot of time working on the farm while bent over tend to develop severe degenerative spondylosis very early in life and conversely diggers, because their back is flexing and extending continuously have well-developed back muscles that tend to be protective to an extent against spondylosis.
Most times, when people talk about spondylosis, they make reference to their neck and not the back. So, back pain, neck pain and spondylosis, what is the link?
Spondylosis can occur anywhere in the spine, but the neck and the lower back are the two regions mostly affected. For both the neck and lower back, posture is a major risk factor. Some people have a genetic predisposition to developing spondylosis. A condition called ankylosing spondylitis can also predispose people to early degeneration in practically all the joints of the body.
While spondylosis is rare in children, it occurs in both men and women for reasons that are slightly different. Some occupations that put people at risk are gender-biased. Men tend to be more prone to a disc prolapse, especially those whose job involves heavy lifting. Outside of that, this degenerative change occurs more or less to the same degree in both genders. Either cervical or lumbar spondylosis, the risk factors are more or less the same.
Now, a lot more people are coming down with cervical spondylosis because we spend a lot of time bent over mobile devices. When the head leans forward, the muscles of the neck are straining to hold up the weight of the head. It is like holding a four-litre jerry can with your arm stretched out. It is a lot of weight. That is how the neck feels when one is bent over a phone. The younger generation is now spending more and more time over their phone. We envisage that we are going to start seeing more and more cases.
How does posture contribute to spondylosis?
When sitting, you should sit squarely on the buttocks, with the back straight. When you slouch either by moving your buttocks forward or by leaning back or to one side, the spine is not erect. Once that happens, the distribution of weight through the spine is distorted and it puts pressure on the spine. For people who do a lot of driving, the position of the seat is very important. If the seat is upright, the bad road is not so much of a risk because the spine is designed to be upright while we are running, jumping and all of that. The spine can actually handle more than twice the body weight in an upright position. But when the posture is poor and the seat is leaning backwards, if the vehicle runs into a pothole, its impact is like taking a punch in the back. So, a lot of people who do prolonged driving often have back pain because of the poor posture.
Does weight or poor lifestyle contribute to the occurrence of the condition?
Weight is a major factor; the heavier an individual is, the more the pressure on the spine. The size of a large abdomen either because of obesity or pregnancy pulls on the lower back, causing pain. It also puts a lot of pressure on the upper back and shoulders and as such, they tend to have a bit more upper and mid-back pain. So, they would need to pay a bit more attention to their posture.
Diet has no direct relationship with spondylosis except that a poor diet that leads to pot belly will put more pressure on the spine and subsequently pain. Except for smoking, which causes early degeneration over the entire body, there is no direct relationship between what kind of food you eat and the development of spondylosis.
Structured exercise is protective against spondylosis. While it is advisable that people exercise, if it is more than brisk walking or jogging, say weight lifting, sit ups or push-ups, you should have someone who is knowledgeable to advise on proper form and posture so you don’t injure yourself.
Could bad footwear have an impact on the development of this degenerative condition?
Footwear is particularly important. Any kind of heeled shoes alters the mechanisms of the foot. The distribution of weight and the forces through the foot, ankle, knee, hip and back is completely altered. So, that puts a lot of pressure on many joints in the body. So, the only good shoes, as far as I am concerned, are the well-padded, comfortable rubber-soled shoes. If you take care of your feet, your feet will take care of your entire body. I always advise that individuals invest in very good shoes.
What are the signs and symptoms?
Pain is the first reason why most people come to complain in the hospital. Usually, it is pain in either the back or the neck. For spondylosis, the pain is usually gradual at the onset but progressively worsens. It is often described as a pain that is aggravated by prolonged sitting or bending over.
In its severe form, there may be pressure on the nerves that supply the limbs. As such, there will be a complaint of pain in the legs or pain going down the back of the leg or the arms. The pain is felt in the part of the body where the nerve supplies. Sometimes they experience tingling sensation or numbness (paraesthesia) in the fingers or feet. Meanwhile, there is absolutely nothing wrong with the hands or feet. The pain, numbness and tingling that are being described are coming from the back or the neck and are being felt in the hands or legs. It takes proper evaluation to be able to identify what exactly the problem is.
You said posture is a factor for spondylosis, how about pillow use since it can affect the posture while sleeping?
Essentially, the size of the pillow determines the posture in which you sleep. If the pillow is too big or too small or the posture in which the person sleeps is awkward, then the position of the neck will put pressure on the joints in the neck and once that is happening, then the joints begin to degenerate faster and this eventually results in spondylosis.
Some sleep with many pillows; including one behind their knee. Can this habit increase the possibility of spondylosis?
The most important is the pillow behind the neck. If you sleep flat on your back, you need a small pillow supporting the back of the neck such that your neck is not bent forwards. If you watch Chinese and Japanese films, the size of the pillow they use is like a roll that they put just behind their neck. That actually is the ideal posture but most people cannot sleep the way they sleep. They sleep flat on their back. Not many people can sleep on their back. So, different people need to make different adjustments. Essentially, the important thing is that the neck and spine should be in a straight position when you sleep.
So, putting a pillow behind the knees if you are sleeping on your back flexes the hip a little and allows the back to relax but that only helps if the mattress is good and firm. Once the mattress begins to sag in the middle, then there is a problem.
Is spondylosis the same as neck or back pain or arthritis of the neck or spine?
Spondylosis is a cause of neck or back pain, but not the only one. Howbeit, other things can cause neck pain. Neck pain can arise from tension headaches. When they are tensed, the muscles around the neck and upper back are bunched up and this can result in pain. That may not be because of spondylosis. Some people have had injuries or other conditions such as inflammation in the throat that causes pain in the neck. Lower back pain also, maybe from other relatively common causes. Menstrual pain sometimes goes down to the back. Sometimes ulcer pain radiates to the back. Sometimes cancers spread to the back and cause low back pain. So, spondylosis causes back pain but there are several other causes of back pain.
Now, spondylosis is a degeneration of the joint between the bodies of the bones of the spine, what we call the vertebrae. So, you may refer to it as arthritis of the joints at the intervertebral disc. So, it is a type of arthritis, to put it simply.
How best can one cope with the pain and other symptoms of spondylosis?
Typically, when someone presents with pain, the first thing is to relieve the pain. Medications are given to relieve the pain. Sometimes when the pain is severe, a neck collar or a lumbar corset may help to rest the neck or the lower back. But I always advise that it should be used for as short a period as possible. Then they are advised to pay attention to their posture. Many times, it is about self-re-education, so that you consciously have to change the posture in which you sit, bend to pick something from the ground or lift something from the floor. It is essentially re-educating your body to move differently. It takes a lot of conscious effort but that is one of the most important things. Then after the pain subsides, back muscle strengthening exercises are advised. But for people who already are having pain radiating down the legs, numbness, tingling, paraesthesia, they will need specific attention to those symptoms. Depending on the severity, sometimes surgery is necessary but less than five percent of people will need to have surgery.
Can spondylosis be cured?
Degenerative changes cannot be reversed, so essentially it cannot be cured. Once it starts, treatment is aimed at limiting the progression and relieving the symptom. It is going to be treatment for life. But for people who are able to re-educate themselves, work on their posture and do back strengthening exercises, many times, the pain reduces to a point that it is negligible. About 80 per cent of people will cope with the problem with lifestyle modification.
In the public, people say that jedijedi, pile or hemorrhoid causes back pain? Can you relate this to spondylosis?
The level of awareness of Nigerians about the condition is disastrous; so many people come into my clinic complaining about jedijedi, a term many refer to as pile. When they are asked what is meant by jedijedi, they refer to back pain. Then I say, ‘Rather tell me that you have back pain’. They claim that jedijedi causes all sort of things from infertility to irregular menses, black menses, erectile dysfunction and impotence. It takes people’s attention away from the fact that the biggest thing you can do to protect their back is to maintain a good posture.
It is also a misconception that consumption of sugar in excess causes back pain. What would cause back pain could be poor posture or if the person has been taking a lot of sugar over time and tummy has grown big and the weight of the tummy is now pulling on the lower back, essentially pot belly.
How can individuals maintain a good posture and prevent a slip disc?
A lot of the executive, fancy chairs that are able to recline look good but they don’t help the back. The posture individuals maintain when they sit is important. The good chair should ensure that the back is kept straight, the incline is small and then there is a curve in the lower part of the chair that fits into the lower back and supports the lower back.
To pick or lift something from the floor, it is better to squat rather than bend over. The spine can handle more than twice the body weight when upright, but it is not designed to lift weights while bent over. For weightlifters, they take extra precautions with their form and their posture to be able to lift that way. Bending over to pick or lift is one of the commonest things people do every day.
So, women need to reduce having to bend to sweep and should get long-handled brooms so that they can sweep while standing upright; cooking and other household chores like washing should also be carried out either by standing or sitting down to protect the back. We need to re-educate the public on proper posture.