The Impact of Physical Activity on the Prevention of Spine Musculoskeletal Disorders in Lactating Women in Cameroon

Abstract

Introduction

Spine musculoskeletal disorders (SMSDs) may interfere with breastfeeding and negatively impact maternal and infant health. Physical activity (PA) is known to reduce the risk of musculoskeletal issues.

Objective

This study aimed to assess the impact of PA levels on the occurrence of SMSDs in Lactating Women in Cameroon.

Methods

This cross-sectional study conducted from September to December 2024 included 399 nursing women in the Foumbot Health District, Cameroon using a consecutive non-probability convenience sampling. PA was assessed using the International Physical Activity Questionnaire–Short Form (IPAQ-SF), and SMSDs were evaluated using an adapted version of the Nordic Musculoskeletal Questionnaire (NMQ). Data were analyzed using SPSS version 23.0, and multivariate logistic regression was used to identify associations. The level of significance was set at p < 0.05.

Results

The mean (SD) age of participants was 24.3 (5.1) years, and that of their infants was 11.1 (8.5) weeks. The Madonna position was the most common breastfeeding position, used by 388 (97.2%) nursing women. Among participants, 236 (59.1%) reported SMSDs, with the most affected region being the upper back 98 (41.5%). PA levels were high in 149 (37.3%) participants, moderate in 208 (52.1%), and low in 42 (10.5%). No significant association was found between PA and SMSDs. However, working in the informal sector significantly increased the risk of SMSDs (aOR = 2.21, CI: 1.33–3.67, p = 0.002).

Conclusion

SMSDs are highly prevalent in nursing women. Interventions should address occupational risk factors to reduce their impact in similar settings.

Keywords

Postpartum spine musculoskeletal disorders physical activity nursing women Cameroon

Introduction

The World Health Organization (WHO) recommends exclusive breastfeeding as the optimal form of nutrition for the first six months of newborn's life (WHO Recommendations on Maternal Health, n.d.). During this period, nursing women undergo significant physical and psychological adjustments to ensure their infant's well-being. These essential adjustments can inadvertently expose breastfeeding women to postural imbalances and physical strain, particularly during breastfeeding and infant care routines (Dandekar & Khatavkar, 2022; Klinpikul et al., 2010; Nduagubam et al., 2021; Rani et al., 2019). Beyond the physical demands, this postpartum period is marked by hormonal changes, emotional fluctuations, and the establishment of new caregiving responsibilities, all of which can affect the woman's overall health (Dingana et al., 2022; Govender et al., 2020; Kuppusamy et al., n.d.; Liao et al., 2023; Meyling et al., 2023; Singh et al., 2021).

Among the various health concerns faced by nursing women, spinal musculoskeletal disorders (SMSDs) have been widely neglected in the literature in favor of metabolic and psychological conditions (Womsi et al., 2025). In low- and middle-income countries (LMICs) like Cameroon, where health systems face resource limitations, SMSDs present a significant but underappreciated burden. SMSDs refer to conditions affecting the spinal muscles, bones, joints, and connective tissues, often resulting in pain, limited mobility, and reduced functionality (Ojukwu et al., 2022). Breastfeeding women are particularly prone to SMSDs due to the repetitive and physically demanding nature of breastfeeding and infant handling. Poor posture during breastfeeding, as well as inadequate support while lifting or carrying infants, can contribute to chronic back, shoulder, and neck pain (Womsi et al., 2025).

Review of Literature

Multiple international studies highlight the prevalence of SMSDs among nursing mothers. A study in Asia found that prolonged breastfeeding with improper posture contributed to symptoms such as shoulder, neck, and upper back pain (Aburub et al., 2022). Similarly, a study in Islamabad revealed that 74% of nursing mothers experienced musculoskeletal pain in various parts of the body (Ratajczak & Górnowicz, 2024). A recent study conducted in Saudi Arabia reported a 58% prevalence of musculoskeletal pain among lactating women (Almutairi et al., 2024). Infant carrying methods also play a role; a study in Nigeria reported 82.8% of nursing women experienced lower back pain linked to infant carrying practices (Ojukwu et al., 2022). A common factor across these studies is the lack of ergonomic education and support interventions, which exacerbates the problem, as many nursing mothers are uninformed about optimal breastfeeding and infant care techniques.

Recognizing these challenges, the WHO advocates for physical activity (PA) during the postpartum period due to its numerous health benefits, including enhanced musculoskeletal strength, improved mental well-being, and social integration (Bull et al., 2020). Studies from various global contexts support the effectiveness of PA in improving the overall health of postpartum women (Baattaiah et al., 2022; Demissie et al., 2011; DiPietro et al., 2019). However, in Cameroon, the PA among nursing women has not been explored, and its impact on SMSDs is yet to be investigated, despite the increasing incidence of SMSDs among nursing women. Given the proven role of PA in promoting health during the postpartum period, this study seeks to fill a critical gap by investigating the impact of PA on the occurrence of SMSDs disorders in nursing mothers in the Noun Health District, Cameroon.

Methods

Study Design and Setting

A cross-sectional analytical study was conducted from June 1, 2024, to February 28, 2025 in the Foumbot Health District, located in the Noun Division of the Western Region of Cameroon. This area is a harbor for individuals of wide origins from neighboring southwest, northwest, adamawa and littoral regions. This provides the researchers a good cross section of Cameroonian nursing women thus providing us with an even wider cross section of individuals. This setting was selected due to its high attendance by nursing women from across the Noun Division. The study population included all nursing women from various health areas within the Noun Division who visited the Foumbot District Hospital and provided informed consent. Exclusion criteria included incomplete questionnaires, withdrawal of consent during data collection, and a history of pre-existing SMSDs.

Data Collection

A consecutive non-probability convenience sampling technique was employed in this study, ensuring that each nursing mother had an equal chance of being selected. The minimum required sample size was determined using Cochran's formula for prevalence studies: n = Z²⋅p⋅(1−p)/d², where Z is the standard normal deviate at a 95% confidence level (1.96), p is the estimated prevalence (0.5), and d is the margin of error (0.05). Based on these parameters, the calculated sample size was 384 nursing mothers. Data were collected from September 15^th to December 31^st 2024, through face-to-face interviews conducted by trained physiotherapists from the research team. The interviews were based on a structured questionnaire comprising three sections (Sections 1, 2, and 3). Section (1) gathered information on participants’ sociodemographic and maternal characteristics, including: age, occupation, marital status, educational level, age of the breastfed infant, number of children, breastfeeding positions, and number of infants breastfed. The section (2) was investigating the level of PA practice of the nursing mothers by the International Physical Activity Questionnaire - Short Form (IPAQ-SF). The IPAQ-SF is a widely used and reliable tool for assessing physical activity levels. It categorizes activity into walking, moderate, and vigorous intensity, with results expressed in metabolic equivalent task (MET)-minutes per week. The interpretation of the IPAQ-SF involves classifying participants into activity levels as low, moderate, or high based on their total MET-minutes. A score of less than 600 MET-minutes/week typically indicates insufficient activity, while scores of 600 MET-minutes/week or more suggest adherence to health-enhancing physical activity guidelines. This tool provides valuable insights into PA patterns and is particularly useful in large-scale epidemiological studies (Lee et al., 2011). The IPAQ-SF is publicly available and used under the Commons Attribution Licence (CC BY 4.0). Section (3) focused on the incidence of SMSDs and the affected anatomical regions (neck, upper back, and lower back), using a questionnaire we adapted from the Nordic Musculoskeletal Questionnaire (NMQ), a reliable and widely used tool for investigating musculoskeletal disorders (Descatha et al., 2007).

Statistical Analysis

Data were analyzed using IBM SPSS (Statistics for the Social Sciences) software, version 23.0. Descriptive statistics were used to summarize and quantitatively describe the results, while unadjusted odds ratios (OR) were calculated and multivariate logistic regression performed in order to determine associations by calculating adjusted odd ratios (aOR). The significance level was set at p < 0.05 and the confidence interval (CI) was set at 95%. Then the level of PA practice has been dichotomized into Inactive/Low Activity for “Low” activity level or those with insufficient activity (less than 600 MET-minutes/week) and Active: combining “Moderate” and “High” activity levels (greater than or equal to 600 MET-minutes/week).

Ethics Considerations

The study received ethical clearance from the Ethics and Human Health Research Committee from Western Region of Cameroon (Ref: 885/28/08/2024/CE/CRERSH-OU/VP). Written informed consent was obtained from all participants after a detailed explanation of the study's objectives and procedures. For participants who were minors, informed consent was obtained from a parent or legal guardian. Interviews were conducted in private settings and data were anonymized, coded and handled confidentially.

Reporting Guidelines

This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting cross-sectional studies. A completed STROBE checklist has been submitted as a supplementary file.

Results

Sociodemographic Characteristics of Participants

A total of 425 nursing women were assessed for eligibility, of whom 26 were excluded: some refused to participate due to their husbands’ objections, while others did not perceive any direct benefit from the study. Consequently, 399 participants were included in the final analysis. The participants had a mean (SD) age of 24.30 (5.1) years, while their infants had a mean (SD) age of 11.12 (8.53) weeks. Women were breastfeeding an average (SD) 1.04 (0.20) infants. Among the 399 participant, 209 were less than 25 years of age (52.4%). The most common occupation among participants was housewife, with 81 women being housewives (20.3%). According to marital status, 235 participants were married (58.9%). Regarding the level of education, 270 participants attained a secondary level of education (67.67%). The most frequently used breastfeeding position was the Madonna (cradle hold) position, reported by 388 participants (97.2%) (see Table 1).

Table 1.

Sociodemographic Characteristics and Breastfeeding Positions of Participants.

Variables	Frequency (n = 399)	Percentage
Age groups
<25 years	209	52.4%
≥25 Years	190	47.6%
Professions
Care assistant	3	0.8%
Hairdresser	36	9.0%
Shopkeeper	72	18.8%
Dress Maker	63	15.8%
Farmer	4	1.0%
Pupil	64	16.0%
Teacher	15	3.8%
Student	45	11.3%
Nurse	7	1.8%
Housewife	81	20.3%
Pharmacist	2	0.5%
Others	7	1.7%
Marital status
Single	164	41.1%
Married	235	58.9%
Level of Education
No schooling	10	2.5%
Primary	53	13.3%
Secondary	270	67.7%
Higher	66	16.5%
Breastfeeding Positions
Madonna Position	388	97.2%
Australian position	2	0.5%
Straddling position	1	0.3%
Lying position	8	2%

Prevalence of Spine Musculoskeletal Disorders Among Nursing Women

In that population, 236 participants out of 399 (59.1%) reported having SMSDs. Among the 236 participants reporting SMSDs, the most affected region was the upper back, reported by 98 participants (41.5%). Following the upper back, the neck was reported by 83 participants (35.2%) and the least affected region was the lower back, with 55 affected participants (23.3%).

Levels of Physical Activity Practice Among Nursing Women

After assessing the level of PA among nursing women in the Noun health district, the researchers found that 149 out of 399 participants had a high level of PA practice (37.3%). Additionally, 208 participants had a moderate level of PA (52.1%) and finally, 42 women had a low level of PA (10.5%). As a result, 10.5% of participants were physically inactive, compared with 89.5% who were physically active.

Factors Associated to the Occurrence of Spine Musculoskeletal Disorders in Nursing Women

As described in Table 2, after performing bivariate analysis, no significant association was found between PA and the occurrence of SMSDs in nursing women (OR: 1.61; CI: 0.81–3.21; P = 0.17). However, being single (OR: 0.504; CI: 0.33–0.76; P = 0.001), working in the informal sector (OR: 2.63; CI: 1.72–4.02; P < 0.001) and being under 25 years old (OR: 0.518; CI: 0.34–0.78; P = 0.002) were associated with the occurrence of SMSDs in nursing mothers. After multivariate logistic regression was performed (see Table 3) working in the informal sector was the only remaining significant associated factor and increased more than doubled the risk of SMSDs (aOR:2.21; CI: 1.33–3.67; P = 0.002).

Table 2.

Factors Associated to the Occurrence of Spine Musculoskeletal Disorders in Nursing Women After Bivariate Logistic Regression.

Variables	Effective (%)	OR (Unadjusted Odds Ratios)	CI 95%	p-value
Age groups
<25 years	209 (52.4)	0.518	[0.34–0.78]	0 . 002
≥25 years	190 (47.6)	1.93	[1.28–2.90]
Profession
Informal sector	139 (34.8)	2.63	[1.72–4.02]	0 . 000
Formal sector	260 (65.2)	0.380	[0.25–0.58]
Marital status
Single	164 (41.1)	0.504	[0.33–0.76]	0 . 001
Married	235 (58.9)	1.98	[1.32–2.98]
Level of Education
Low	63 (15.7)	1.46	[0.83–2.58]	0.188
High	336 (84.3)	0.683	[0.39–1.20]
Breastfeeding Position
Madonna	388 (97.2)	7.16	[0.91–56.5]	0.062
Others	11 (2.8)	0.140	[0.02–1.10]
Physical activity Practice
Inactive	42 (10.5)	1.61	[0.81–3.21]	0.171
Active	357 (89.5)	0.619	[0.31–1.23]

Table 3.

Factors Associated to Spine Musculoskeletal Disorders in Nursing Women After Multivariate Logistic Regression.

Variables	Effectif (%)	aOR (adjusted odds ratios)	CI 95%	P value
Age groups
<25 years	209 (52.4)	0.742	[0.44–1.25]	0.268
≥25 years	190 (47.6)	1.34	[0.79–2.29]
Profession
Informal sector	139 (34.8)	2.21	[1.33–3.67]	0 . 002
Formal sector	260 (65.2)	0.451	[0.27–0.75]
Marital status
Single	164 (41.1)	0.919	[0.51–1.63]	0.773
Married	235 (58.9)	1.08	[0.61–1.94]

Discussion

This study aimed to evaluate the prevalence of SMSDs among nursing women in Noun Division, Cameroon and the impact of PA practice in preventing these conditions. In this population, 236 mothers out of 399 (59.1%) reported having SMSDs. with the most affected region being the upper back (98 cases; 41.5%) followed by the neck (83 cases; 35.2%). This high prevalence could be explained by the biomechanical constraints imposed by breastfeeding and infant care (Ojukwu et al., 2022). The persistence of pregnancy-related hormonal influences on ligaments and connective tissues may result in joint hypermobility and increased risk of injuries in postpartum women (Kesikburun et al., 2018). In addition, the fact that the neck and upper back were the regions most affected could be explained by the breastfeeding position, which predisposes women to overuse the musculoskeletal structures of the neck and upper back. Indeed, in this study, 97.2% of women were breastfeeding in the Madonna position (see Table 1 above). The Madonna position is a position that involves biomechanical constraints on the neck, upper back, and shoulders in a sustained kyphotic position. Such kyphotic postures are usually leading to physiological changes that alter the center of gravity. This resulting in tension in the neck and upper back muscles combined with overstretching of the abdominal and paraspinal muscles (Kamal et al., 2020; Ojukwu et al., 2022). This prevalence found in Noun division, Cameroon is similar to the result reported by Womsi et al. in Dschang district in Cameroon (Womsi et al., 2025). However, in that study the most affected region was lower back unlike the present study where the most affected spinal region was the upper back. Lifestyle habits and biomechanical stress may differ in the two populations, hence the difference in disease location. However, since SMSDs are a condition that degrades the health of nursing mothers, campaigns to raise awareness and educate women should be considered to reduce the incidence of SMSDs.

In this study, very few women were physically inactive (10.5%). The majority of participants were engaged in regular PA. PA is important for postpartum women for its multiple beneficial effects (Baattaiah et al., 2022; Bauman et al., 2009; Lee et al., 2012; Pratt et al., 2014). Our findings differ from those of Alsobayel et al. (Alsobayel et al., 2020) in Saudi Arabia, where 62.0% of postpartum women were reported to be physically inactive. This elevated prevalence of inactivity may be explained by differences in socio-economic and environmental conditions. In more developed settings such as Saudi Arabia, greater access to transportation services and ergonomic support facilities may reduce the need for physically demanding daily activities. In contrast, in the present study, predominantly rural context, women are often obliged to engage in physically strenuous tasks, which may account for the lower prevalence of inactivity observed. The fact that the majority of nursing mothers in Noun were physically active is a lifestyle habit to be encouraged. Not only should this PA be encouraged, but it should also be monitored by health professionals to avoid the harmful effects of improper PA practice. Strategies for monitoring these women need to be put in place to ensure that not only does PA comply with WHO guidelines, but that biomechanical stresses do not lead to injury.

No association was found between PA practice and the occurrence of SMSDs among nursing women in the Noun Health District, Cameroon. These results contradict some studies that have reported a protective effect of PA against musculoskeletal disorders in nursing women (Ruchat et al., 2025; Sánchez-Polán et al., 2023; Shaik et al., n.d.). Beyond its impact on musculoskeletal disorders, physical activity has been shown to promote mental health by alleviating symptoms of stress, depression, and anxiety. Additionally, regular physical activity supports cardiovascular and metabolic health, which may have downstream benefits for overall maternal well-being. These broader effects underscore the importance of encouraging physical activity interventions as part of comprehensive health promotion strategies for lactating women (Bull et al., 2020). However, SMSDs are multifactorial and result from a number of interrelated factors beyond PA levels (Demissie et al., 2011; Meyling et al., 2023). Incorrect breastfeeding postures contribute significantly to SMSDs (Ojukwu et al., 2022). In addition, the cumulative physical demands of infant care and household responsibilities can exacerbate musculoskeletal strain, potentially reducing the perceived preventive benefits of PA. Furthermore, a lack of ergonomic education on optimal breastfeeding techniques has been associated with higher incidences of musculoskeletal pain among breastfeeding women (Shaik et al., n.d.). The lack of connection between PA and SMSDs observed in this study warrants more detailed investigation. Possible explanations include misclassification of PA intensity due to self-reporting bias in the IPAQ-SF, cultural influences on how activity is reported, or the likelihood that ergonomic stressors outweigh the protective benefits of PA in this population. Together, these factors could overshadow the preventive effects of PA on SMSDs. The researchers findings suggest that SMSDs prevention strategies should take into account the socio-economic and cultural factors specific to this population. Future studies should further explore the relationships between PA and SMSDs in nursing women across different contexts to better understand the underlying mechanisms.

Working in the informal sector was identified as a significant risk factor for SMSDs among nursing women in the Noun Health District (aOR = 2.21; CI: 1.33–3.67, P = 0.002). In the Cameroonian context, women in the informal sector often engage in physically demanding tasks such as carrying heavy water containers, transporting goods at markets, prolonged standing during vending or trading, and repetitive household or agricultural activities without ergonomic support. Poor working conditions, lack of equipment, and extended working hours further exacerbate musculoskeletal strain. These occupational demands, combined with the physical load of infant care, increase vulnerability to SMSDs. These findings highlight the urgent need for policies aimed at improving working conditions, promoting ergonomic practices, and providing support for nursing women in informal employment in Cameroon and similar socio-economic settings.

Study Limitations

This study has several limitations. First, its cross-sectional design prevents causal inferences, so the associations observed between risk factors and SMSDs cannot be interpreted as evidence of causation. Second, survey-based data collection relied on participants’ self-reported information, which may be influenced by recall bias or social desirability. To minimize these biases, the researchers employed a standardized questionnaire, trained interviewers, and restricted the recall period for PA to the past seven days. Additionally, the use of validated tools and face-to-face interviews helped ensure more accurate data on PA practices and the occurrence of SMSDs. Finally, certain potential confounders, including body mass index, duration and frequency of breastfeeding, prior ergonomic education, and household workload, were not measured or controlled for, which may have affected the observed associations. Despite these limitations, the study provides valuable insights into SMSDs among nursing women in Noun, Cameroon, and can inform future longitudinal studies and targeted interventions.

Implications for Practice

The findings of this study underscore the importance of integrating ergonomic education into postnatal nursing care to prevent spinal musculoskeletal disorders (SMSDs) among breastfeeding women. Nurses and midwives should provide systematic guidance on appropriate breastfeeding postures; particularly recommending alternatives to the Madonna position, to reduce musculoskeletal strain in the neck and upper back regions. Given that most nursing women in this study were physically active, promoting safe and structured physical activity adapted to postpartum physiology is essential. Health professionals should monitor the type and intensity of physical activity to ensure alignment with World Health Organization recommendations and to minimize the risk of injury.

The absence of a significant association between physical activity and SMSDs highlights the need for a multifactorial prevention approach that goes beyond exercise promotion. Ergonomic counseling, workload management, and physical conditioning strategies should be implemented together to address the combined effects of infant care, household duties, and occupational demands. Furthermore, as working in the informal sector was identified as a major risk factor, policymakers and community health professionals should develop context-specific interventions to improve working conditions for nursing mothers. These may include ergonomic support, access to appropriate equipment, and educational programs on safe lifting and carrying techniques.

Overall, musculoskeletal health promotion should be incorporated into maternal and child health programs, with a focus on early screening, education, and culturally appropriate interventions. Such strategies could contribute to reducing the burden of SMSDs and improving the overall well-being and quality of life of nursing women in Cameroon and similar low-resource settings.

Conclusions

This study highlights a high prevalence of SMSDs among nursing mothers, highlighting the urgent need for targeted interventions to reduce this significant health burden. Although PA alone may have a limited effect on preventing SMSDs, our findings emphasize the critical role of occupational and ergonomic factors, particularly among women engaged in the informal sector. A comprehensive strategy that integrates, ergonomic training, and workplace modifications is therefore essential to protect the health and well-being of nursing mothers in Cameroon. Furthermore, these strategies could inform health policy and occupational health guidelines in similar socio-economic and cultural contexts, serving as a scalable model for sustainable health improvements in vulnerable populations.

Supplemental Material

sj-docx-1-son-10.1177_23779608251397447 - Supplemental material for The Impact of Physical Activity on the Prevention of Spine Musculoskeletal Disorders in Lactating Women in Cameroon

Supplemental material, sj-docx-1-son-10.1177_23779608251397447 for The Impact of Physical Activity on the Prevention of Spine Musculoskeletal Disorders in Lactating Women in Cameroon by Maurice Douryang, Hyacinte Trésor Ghassi, Leonard Tanko Tankeng, Christelle Lameli, Mamadou-Alexandre Dramé, Doria Loïc Metchehe Djommo and Florian Forelli in SAGE Open Nursing

Footnotes

Abbreviations

The following abbreviations are used in this manuscript:

Acknowledgments

The researchers express their gratitude to all participants who contributed to this study.

ORCID iDs

Maurice Douryang

Hyacinte Trésor Ghassi

Leonard Tanko Tankeng

Florian Forelli

Ethical Considerations

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics and Human Health Research Committee from Western Region of Cameroon (Ref: 885/28/08/2024/CE/CRERSH-OU/VP).

Consent to Participate

Informed consent was obtained from all subjects involved in the study. For minors participants, the Informed consent was obtained from their parents or guardians.

Authors contributions

MD and HTG : study design, study preparation and supervision, data collection, data analysis, writting the original draft, revising and editing ; LTT: study design, writting and editing ; CL : study design, data collection, editing ; MAD : data analysis, editing ; DLMD : data analysis, editing ; FF : editing and proofreading.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data that support the findings of this study are not publicly available due to privacy or ethical restrictions but are available from the corresponding author on reasonable request and pending editorial clearance.

Supplemental Material

Supplemental material for this article is available online.

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