Telehealth Solutions for Low Back Pain Care in Sub-Saharan Africa
By Dr. Antti Rintanen, MD – The Internet Doctor. Medically reviewed by: Rukhsar Jabbar M.Sc. Physiotherapy
A middle-aged black man sitting on a sofa, holding his lower back in discomfort while looking at a smartphone. The setting appears to be a home living room with warm lighting and modern decor. Image credit: AI generated using ChatGPT
Low back pain is one of the most prevalent and disabling health conditions worldwide. It affects over 600 million people globally at any given time, according to the Global Burden of Disease study. Yet, while the condition is nearly universal, its impact is not evenly distributed.
In low- and middle-income countries—particularly across parts of Africa—access to effective diagnosis, treatment, and rehabilitation is often scarce. Long travel distances, limited healthcare infrastructure, high costs, and a shortage of qualified professionals all delay care and compound suffering.
Virtual care technologies—telemedicine consultations, digital self-care education, and remote physiotherapy—are now reshaping how care can be delivered in resource-limited settings. These tools, once considered supplementary, are becoming critical components in making musculoskeletal care more equitable and scalable. As digital access expands and mobile phone penetration deepens across the continent, the opportunity to rethink pain management is growing.
This blog aims to show how telehealth solutions—through real-life examples and emerging evidence—can help to expand access to back pain care in underserved and marginalised communities.
With just a smartphone and a stable internet connection in regions where health infrastructure is limited, back pain care can begin — with no in-person clinic attendance required. This digital approach offers a promising, cost-effective alternative that deserves strong policy support.
The Burden of Low Back Pain in Underserved Areas
In many African countries, work patterns and limited occupational safety regulations increase the risk of spinal injury. Manual labor, agricultural work, and long hours spent sitting in non-appropriate positions contribute significantly to chronic low back pain. Unfortunately, these same environments often lack access to physical therapy, diagnostic imaging (X - rays and CT scans, etc.), and evidence-based pain management services.
Even though low back pain is rarely life-threatening, its effects are far-reaching. A study among hospital workers in Nigeria found that 38% had experienced low back pain in the past year, and 20% reported it at the time of the survey. Severity was linked to factors such as long hours of sitting and senior staff roles. These findings highlight how back pain quietly impacts productivity and well-being—even within the health workforce. [1]
When left untreated, low back pain can evolve into a chronic condition that drains family resources and undermines public health goals. In areas where healthcare is largely out-of-pocket, delayed intervention often leads to more severe outcomes and unnecessary suffering.
A black couple sitting at a wooden table, holding a tablet and speaking with a smiling female doctor on a video call. Two cups of coffee and a small glass vase with decorative beads are also on the table. Image credit: AI generated using ChatGPT.
In resource-limited settings, patients with low back pain often face significant obstacles in accessing timely care—from long travel distances to a shortage of musculoskeletal specialists. Telemedicine presents a practical and increasingly evidence-based solution to bridge these gaps. For many musculoskeletal conditions, including non-specific low back pain, remote consultations can be as clinically effective as in-person assessments, particularly when guided by trained professionals using structured rules. [2]
This model of care has growing support in sub-Saharan Africa. A 2023 study from Ethiopia found that a majority of patients with chronic conditions were both willing to use telemedicine and perceived it positively as a way to receive care. [3] Although the study did not focus specifically on musculoskeletal pain, it highlights the growing readiness among patients to engage with digital health tools—even in settings where digital infrastructure remains limited.
With as little as a smartphone and a stable connection, remote providers can take detailed histories, rule out red flags, provide reassurance, and initiate conservative treatment plans. Follow-up sessions can help monitor progress, reinforce adherence to home-based therapies, and adjust care as needed—all while minimizing the financial and logistical burden on the patient.
Patient education remains one of the most effective yet underutilized interventions for managing low back pain. Despite strong clinical evidence supporting movement, reassurance, and self-management as first-line strategies, many individuals—especially in low-resource settings—continue to associate back pain with bed rest or surgery. [4] In areas where formal physiotherapy is unavailable, accessible and culturally appropriate educational content can empower patients to take control of their recovery.
Digital health tools offer scalable solutions. A randomized controlled study - a form of scientific experiment that removes bias and controls for accuracy and validity of a study - by Shebib et al. demonstrated statistically significant improvements in pain and disability through a 12-week digital care program that included educational content and remote coaching. [5] The intervention was effective without requiring in-person visits, making it a promising model for underserved regions.
In Kenya, mobile platforms like M-TIBA have been leveraged to deliver health education alongside their core function of managing healthcare payments. During the COVID-19 pandemic, the platform distributed public health messages via SMS in local languages—highlighting its potential for broader digital health education, including musculoskeletal self-care. [6] Although dedicated trials for back pain are pending, the infrastructure exists and could be adapted for conditions like low back pain through simple, evidence-informed messaging.
Taken together, these examples illustrate that even in low-resource environments, mobile-first education initiatives can bridge gaps in care—especially when aligned with cultural norms and delivered through familiar communication tools.
Physiotherapy remains a cornerstone of low back pain treatment. Yet in Kenya, access is critically limited—with only 2,170 physiotherapists serving a population of over 55 million as of 2023, amounting to just 4 physiotherapists per 100,000 people. [7] This shortfall underscores the potential of virtual physiotherapy solutions to bridge access gaps, especially outside urban centres.
Remote physiotherapy—delivered through video calls, mobile apps, or printed materials—enables patients to follow guided exercises from their own homes. A study concluded that virtual exercise treatment was as effective in cost and outcomes as in-person physiotherapy for managing non-specific and chronic low back pain. [8] It didn’t require any specialised equipment for exercise-based treatment and is suitable for people living in small living environments.
The success of such programmes depends on cultural sensitivity, accessibility, and follow-up. Exercises must reflect the daily movements and physical loads of patients—lifting water buckets, digging, or pushing carts—rather than generic gym routines. Patient motivation can be supported through weekly video check-ins, community health worker involvement, or simple reminders sent by SMS.
Despite the promise of virtual care, implementation challenges remain in sub-Saharan Africa. Some of these include:
Low Digital Literacy: Digital literacy is uneven, particularly among older adults or those with limited formal education.
Design issues: Interfaces must be intuitive, and content must be designed in clear, local-language formats. Involving family members or carers during remote sessions can support adoption.
Internet Connectivity Issues: Internet connectivity is another major concern. While mobile penetration in Africa is among the highest in the world, access to high-speed internet remains uneven. Yet not all digital health solutions require broadband. Simple technologies like SMS, USSD codes, and voice calls over 2G networks can still deliver meaningful care. These modalities also offer more equitable access to patients with basic mobile phones.
Data Security and Privacy Issues: Data security and patient privacy must be considered from the outset. Consent processes, encrypted platforms, and clear regulatory guidelines will be essential to protect personal health information, especially in remote settings where oversight may be limited. Ministries of Health across Africa are beginning to publish telehealth regulations—an important step toward standardisation and safety.
Stakeholders Engagement: Crucially, digital tools must integrate with—not replace—existing healthcare systems. Collaboration with local clinics, NGOs, and government programs helps ensure continuity and local ownership. Without these partnerships, even the most promising virtual care model may fail to take root.
A black male doctor in a white coat sitting at a desk, smiling as he writes on a notepad during a virtual consultation on his laptop. The background features a modern, neutral-toned office setting with shelves and a small potted plant. Image credit: Canva Pro
Two real-world examples illustrate how virtual care can transform back pain management in resource-constrained settings.
In a qualitative study published in Musculoskeletal Science and Practice, participants in the TEXT4myBACK intervention (treatment) received four SMS messages per week over 12 weeks, focused on physical activity, pain management, and motivational support. Delivered entirely through basic mobile phones without requiring internet access, the messages were found to be useful and well-accepted. Participants described feeling more confident staying active, better understanding their condition, and being supported in self-management. [9] This shows that how low-cost, mobile-first approaches can meaningfully enhance care in underserved communities.
In Nigeria, researchers tested a WhatsApp-delivered physiotherapy protocol using the McKenzie method (a treatment technique used by physiotherapists). Patients filmed themselves performing stretches, received personalised feedback from remote physiotherapists, and tracked their progress via weekly updates. Not only did the programme achieve similar outcomes to in-clinic rehabilitation, it also reduced transportation costs and time off work. [8] This example shows how common messaging platforms can become powerful health delivery tools when structured intentionally.
The rise of virtual care is not just a story of technology—it is a shift toward more inclusive, patient-centred healthcare. For millions of people living with low back pain in underserved regions, digital tools offer a practical path to evidence-based care. From virtual diagnosis to remote education and exercise therapy, the possibilities are expanding.
The success of these interventions depends on cultural relevance, local integration, and continuous evaluation. When designed with empathy and practicality, virtual care models can bridge some of the biggest gaps in health access.
Rather than replacing traditional services, virtual care should be seen as a force multiplier—extending the reach of clinicians, empowering patients, and ultimately reducing the burden of chronic pain on communities. With the right partnerships, regulation, and innovation, low back pain care can be delivered anywhere—no waiting rooms required.
1. Omokhodion FO, Sanya AO. Risk factors for low back pain among office workers in Ibadan, South West Nigeria. Occup Med (Lond). 2003;53(4):287–289. Available from here.
2. Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract. 2020;48:102193. doi: 10.1016/j.msksp.2020.102193. Available from here.
3. Belachew EA, Getachew D, Netere AK, Gizachew E, Sendekie AK. Perception, willingness, and practices of telemedicine in patients with chronic diseases: implication of digital health in patients’ perspective at a tertiary care hospital in Ethiopia. Front Public Health. 2023;11:1234436. Available from here.
4. Nicholas M, Molloy A, Tonkin L, Beeston L. Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain. [Internet]. ABC Books; Sydney, NSW 2001. [Cited June 20 2025]. Available from here.
5. Shebib R, Bailey JF, Smittenaar P, Perez DA, Mecklenburg G, Hunter S. Randomized controlled trial of a 12-week digital care program in improving low back pain. NPJ Digit Med. 2019 Jan 7;2:1. doi: 10.1038/s41746-018-0076-7. Available from here.
6. Huisman L, van Duijn SMC, Silva N, et al. A digital mobile health platform increasing efficiency and transparency towards universal health coverage in low- and middle-income countries. Digit Health. 2022;8. Available from here.
7. World Physiotherapy. Kenya: Country profile – Annual Membership Census 2023. [Internet]. Published January 2024. Accessed June 20, 2025. Availble from here..
8. Fatoye F, Gebrye T, Fatoye C, Mbada CE, Olaoye MI, Odole AC, Dada O. The clinical and cost-effectiveness of telerehabilitation for people with nonspecific chronic low back pain: randomized controlled trial. JMIR Mhealth Uhealth. 2023;11:e41262. doi: 10.2196/15375. Available from here.
9. Fritsch CG, Abdel-Shaheed C, Mohamed R, Ferreira PH, McLachlan AJ, Ferreira ML. A qualitative assessment of a text message intervention for people with low back pain. Musculoskelet Sci Pract. 2023;64:102739. doi: 10.1016/j.msksp.2023.102739 . Available from here.
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Dr. Antii Rintanen
Dr. Antti Rintanen is a medical doctor with a background in global health and digital care innovation. As the founder of The Internet Doctor, he advocates for accessible, evidence-based healthcare solutions for underserved communities worldwide.
Related:
Low back pain: Causes, Symptoms, Diagnosis, Treatment and Prevention
How to Deal With Joint Pains - Tips for Africans
Published: July 1, 2024
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