Women Receive Inferior Care for Back and Neck Pain Due to Gender-Blind Guidelines
Women in the United Kingdom are receiving substandard treatment for back and neck pain because current clinical guidelines do not factor in sex-specific biological differences, according to a new study from the University of Lancashire. The research highlights that NHS protocols for non-surgical management of chronic musculoskeletal pain operate on a "male by default" basis, overlooking critical considerations such as women's smaller skeleton size, hormonal fluctuations, and experiences of pregnancy or menopause.
Widespread Impact of Musculoskeletal Disorders
Lower back pain affects over 600 million people globally, as reported by the World Health Organization. In the UK, back pain costs the NHS billions of pounds annually and accounts for millions of GP appointments each year. Musculoskeletal disorders remain one of the leading causes of work absence across the nation, underscoring the urgent need for effective and equitable treatment strategies.
Systematic Review Excludes Female-Specific Factors
A major review published in the Physical Therapy Reviews journal examined clinical guidance in the UK and found that by consistently using gender-neutral terms like "people," "individuals," or "patients," the guidelines ignore the role of women's distinct biological characteristics in musculoskeletal pain. The study also notes that guidelines fail to address the different biological needs of intersex patients, further compounding healthcare disparities.
Lauren Haworth, research associate at the University of Lancashire and lead author of the study, emphasized that considering sex-specific biology is essential for delivering personalized and equitable healthcare. "We know that large breasts can be heavy, and without adequate support this additional weight, combined with gravity, can cause strain on a woman's body, which may contribute towards neck and back pain," she explained.
Haworth added that because existing guidance does not acknowledge these sex-based differences, "women may still be disadvantaged simply because their biological needs differ from those of men."
Pregnancy and Postpartum Effects on Pain
Having children significantly impacts experiences of pain, according to the research. Dr. Anastasia Topalidou, co-author of the study and associate professor in perinatal biomechanics and health technologies, stated: "Pregnancy places major biomechanical demands on the spine as the body adapts to the growing foetus."
She further noted that even after birth, the spine and pelvis can take months to return toward their pre-pregnancy alignment, a factor often overlooked in clinical assessments and treatment plans.
Calls for Policy Reform and Improved Care
The study advocates for the government's women's health strategy to ensure that sex-specific biological factors are transparently considered in the development of clinical guidelines. Matthew Parker, associate professor of neuroscience and translational psychiatry at the University of Surrey, warned of a "real risk" that these female-specific factors are not consistently addressed in routine care.
"That does not mean women are always being misdiagnosed, but it does mean some women may be assessed less precisely, treated less effectively, and end up in longer cycles of persistent pain and repeat appointments," Parker cautioned.
Response from Health Authorities
A spokesperson for the National Institute of Health and Care Excellence (NICE) responded to the findings, stating: "Our guidelines encourage doctors to tailor care to each person's individual needs, and we welcome research that helps us improve the guidance we provide. We will consider these findings carefully as part of our ongoing commitment to ensuring our guidance is useful, useable, and works for everyone."
The research underscores a critical gap in UK healthcare, urging a shift towards more inclusive and biologically informed clinical practices to better serve women and other underrepresented groups in pain management.
