A new UK study has raised concerns that women may be receiving poorer treatment for back and neck pain because clinical guidelines and diagnostic frameworks are often designed around a “male by default” model. Researchers warn that the oversight could be contributing to persistent health inequalities across musculoskeletal care, including within the NHS.
The findings come from researchers at the University of Central Lancashire, who analysed clinical guidance used in the management of chronic spinal pain. Their review concluded that many guidelines fail to consider biological differences between men and women, such as hormonal changes, pregnancy and variations in skeletal structure. Experts say this lack of sex-specific guidance may lead to less accurate diagnoses, less effective treatment strategies and longer cycles of untreated or poorly managed pain for female patients.
“Male by default” clinical guidelines
The research, published in the journal Physical Therapy Reviews, examined UK clinical guidance used to treat chronic neck and lower back pain. The authors found that guidelines frequently refer only to generic “patients” or “individuals”, without acknowledging biological differences that may influence how spinal pain develops or is experienced.
According to Lauren Haworth, research associate at the University of Central Lancashire and lead author of the study, the omission of sex-specific considerations risks disadvantaging women within healthcare systems. She noted that anatomical and physiological factors can significantly influence spinal pain. For example, breast size and weight can place strain on the neck and upper spine, while pregnancy introduces major biomechanical changes that affect spinal alignment and posture.
Co-author Dr Anastasia Topalidou, an associate professor specialising in perinatal biomechanics and health technologies, explained that pregnancy places significant stress on the spine as the body adapts to support a growing foetus. Even after childbirth, the pelvis and spine may take months to return to their previous alignment. However, such factors are rarely incorporated into treatment pathways or diagnostic frameworks used by clinicians.
Impact on patient care and NHS services
Back pain is one of the most common health conditions worldwide and a major burden for healthcare systems. Globally, more than 600 million people experience lower back pain, making it a leading cause of disability.
Within the UK, musculoskeletal disorders, including back and neck pain, account for millions of GP consultations every year and represent a significant financial cost to the NHS. Chronic pain conditions also contribute heavily to sickness absence and long-term disability claims. If women are assessed or treated less precisely due to gender-neutral guidelines, the consequences can include repeated GP visits, delayed recovery and unnecessary referrals to specialist services.
Matthew Parker, associate professor of neuroscience and translational psychiatry at the University of Surrey, warned that failing to consider biological differences between men and women could result in poorer outcomes for some patients. Women may not always be misdiagnosed, he said, but the absence of tailored assessment can lead to “less precise” treatment and longer periods of persistent pain.
Wider concerns about gender bias in medicine
The findings align with a growing body of research highlighting gender bias in medical diagnosis and treatment. Historically, medical research has often relied heavily on male participants, meaning clinical knowledge and treatment standards may not fully reflect female biology. Studies have shown that women’s pain is sometimes underestimated by clinicians, with symptoms more likely to be attributed to psychological factors rather than physical conditions. Women are also more likely to experience delayed diagnoses for certain conditions compared with men. Healthcare experts say addressing these biases is essential to delivering equitable care.
Implications for NHS policy and digital healthcare
The new study arrives at a time when the UK government is attempting to address gender inequalities in healthcare through its Women’s Health Strategy for England. Researchers argue that musculoskeletal care should be included in this agenda to ensure guidelines reflect sex-specific medical evidence.
For the NHS, the findings also highlight the potential role of health technology and data analytics in improving personalised care. Digital clinical decision-support systems could help clinician. integrate sex-specific risk factors into diagnosis and treatment planning. Artificial intelligence tools trained on diverse patient datasets may also help identify patterns in musculoskeletal pain that differ between men and women, enabling more precise treatment pathways.
Calls for reform of clinical guidelines
The authors of the Lancashire study have called for greater transparency in how clinical guidelines are developed and updated. They recommend that sex-specific biological factors be explicitly considered when designing treatment pathways for spinal pain. The National Institute for Health and Care Excellence (NICE) has acknowledged the research and said it will consider the findings when reviewing future guidance. The organisation emphasised that clinicians are already encouraged to tailor treatment to individual patients, but recognised that new evidence could help refine recommendations.
Towards more personalised musculoskeletal care
As the NHS continues its digital transformation, experts believe more personalised and data-driven healthcare could help address longstanding inequalities in treatment. For millions of people experiencing chronic back and neck pain, integrating biological, social and lifestyle factors into care pathways may improve outcomes and reduce the burden on primary care services. For now, the new research serves as a reminder that effective healthcare requires not only advanced technology and new treatments, but also clinical frameworks that reflect the full diversity of patient experiences.
