Women’s Back & Neck Pain: UK Guidelines ‘Male by Default’ | NHS & Sex Differences
Chronic back and neck pain, a condition affecting millions globally, may be experienced and treated differently by women due to a systemic oversight in clinical guidelines, according to new research from the University of Lancashire. The study, published in the Physical Therapy Reviews journal, highlights how a “male by default” approach to care fails to account for sex-specific biological factors that can contribute to musculoskeletal pain in women.
Lower back pain alone impacts over 600 million people worldwide, according to the World Health Organization and represents a significant burden on healthcare systems like the NHS, costing billions annually and driving millions of GP appointments. The University of Lancashire research suggests that current guidance, by consistently using gender-neutral language like “people” or “patients,” overlooks crucial differences in skeletal size, hormonal influences, and the impact of experiences like pregnancy and menopause.
Biological Factors and Pain Experience
The study’s lead author, Lauren Haworth, a research associate at the University of Lancashire, emphasized the importance of personalized, equitable healthcare that considers sex-specific biology. “We recognize 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,” Haworth explained. However, she added that the lack of acknowledgement of these differences in existing guidelines means women “may still be disadvantaged simply because their biological needs differ from those of men.”
The impact of pregnancy was also highlighted by Dr. Anastasia Topalidou, a co-author of the study and associate professor in perinatal biomechanics and health technologies. She explained that pregnancy places “major biomechanical demands on the spine as the body adapts to the growing foetus.” Even after childbirth, she noted, the spine and pelvis can require months to return towards their pre-pregnancy alignment. Research published in PLOS ONE supports this, detailing the significant biomechanical changes during pregnancy and postpartum.
Guidance and the ‘Male by Default’ Approach
The research team found that clinical guidance in the UK consistently fails to address these sex-specific considerations. By not explicitly acknowledging the role of biological factors unique to women, the guidelines may lead to less precise assessments, less effective treatments, and prolonged cycles of pain and repeat appointments. 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 considered in routine care.
This isn’t simply a matter of misdiagnosis, Parker clarified, but rather a potential for less accurate assessment and treatment, leading to extended periods of persistent pain and increased demands on healthcare services. The study’s findings align with growing calls for a more nuanced approach to healthcare that recognizes the biological differences between sexes and their impact on health outcomes.
Implications for the NHS and Women’s Health Strategy
The study authors are urging the government’s women’s health strategy to prioritize the transparent consideration of sex-specific biological factors in the development of clinical guidelines. This call for change comes as the NHS faces increasing pressure to address health inequalities and improve care for all patients.
The National Institute for Health and Care Excellence (NICE), the body responsible for developing evidence-based guidelines for the NHS, acknowledged the research and stated that it would “consider these findings carefully as part of our ongoing commitment to ensuring our guidance is useful, useable, and works for everyone.” NICE guidelines already encourage doctors to tailor care to individual needs, but the study suggests that a more systematic and explicit consideration of sex-specific factors is needed.
Beyond Biology: Intersex Considerations
The University of Lancashire research also extends its critique to the exclusion of intersex patients from clinical guidance. The study points out that guidelines also ignore the different biological characteristics of intersex individuals, further highlighting the demand for inclusive and personalized healthcare approaches. This underscores the importance of moving beyond a binary understanding of sex and recognizing the diversity of biological experiences.
What’s Next: Refining Clinical Practice
The findings from this study are likely to prompt a review of existing clinical guidelines for the management of chronic neck and back pain within the NHS. This review will likely involve consultation with experts in musculoskeletal health, women’s health, and pain management, as well as patient representatives. The goal will be to identify specific areas where guidelines can be revised to better address the needs of women and intersex individuals.
Further research is also needed to better understand the complex interplay between biological factors, pain perception, and treatment outcomes in women. This research could involve large-scale observational studies, clinical trials, and the development of new diagnostic tools and therapies tailored to the specific needs of female patients. The Institute for Applied Health and Wellbeing (LIFE) at the University of Lancashire is actively involved in such research, supporting globally relevant health and wellbeing studies. Learn more about their work here.
the aim is to create a healthcare system that provides equitable and effective care for all, recognizing that a one-size-fits-all approach is no longer sufficient. Addressing the “male by default” bias in clinical guidelines is a crucial step towards achieving this goal.
For more information on back pain and available resources, consult the World Health Organization’s fact sheet on low back pain. Individuals experiencing chronic pain should consult with a qualified healthcare professional for personalized advice and treatment options.