The authors of the study do not conclude that diabetes directly causes back pain. However, the overall body of evidence increasingly suggests that diabetes should be considered a relevant risk factor and comorbidity in back pain.
For chiropractic practice, this means the question may no longer be whether diabetes affects patients with back pain—but rather how this knowledge should be integrated into clinical decision-making.
The message is clear: when patients with diabetes present in the clinic with back or neck pain, more than biomechanics alone may be at play.
Clinical implications for chiropractors
The findings highlight the importance of viewing back pain within a broader health context. Patients with recurrent or persistent back and neck pain may have underlying metabolic risk factors that influence prognosis, treatment response, and the risk of recurrence.
The study particularly points to three clinically relevant areas:
- Screening and risk awareness
Clinicians should be attentive to comorbidities and identify patients in whom metabolic conditions may influence the pain presentation. - Focus on physical activity
Physical inactivity is highlighted as a modifiable shared risk factor. Exercise and movement can therefore play a dual role—supporting both metabolic control and pain management. - Interdisciplinary collaboration
The researchers argue that patients with diabetes-related back problems may particularly benefit from coordinated care involving general practitioners, chiropractors, physiotherapists, and other healthcare professionals.
Larger data foundation provides stronger evidence
The research group included 15 new studies and compiled data from nearly one million participants across 13 countries. Compared with previous research, this provides a significantly stronger basis for understanding the relationship between metabolic disease and musculoskeletal health.
The analysis showed that people with diabetes had:
- 44% higher odds of reporting low back pain
- 11% higher odds of reporting neck pain
- 42% higher odds of reporting back pain overall
At the same time, longitudinal data showed that people with diabetes had an increased risk of later developing both neck and back pain.
Why might diabetes affect the spine?
The researchers describe several biological mechanisms that may help explain the relationship:
- Chronic hyperglycaemia may promote inflammation and degeneration of intervertebral discs
- Micro- and macrovascular changes may reduce tissue healing and affect muscles, ligaments, and connective tissue
- Neuropathy and muscle atrophy may alter load patterns and biomechanics
- Physical inactivity likely acts as a shared risk factor for both diabetes and back pain
It is therefore unlikely that a single mechanism is responsible—rather, the relationship likely reflects a complex interplay between metabolic, inflammatory, and biomechanical factors.
Dale, H., Pozzobon, D., Fernandez, M. et al. Is there an association between diabetes and neck and back pain? An updated systematic review with meta-analyses. Chiropr Man Therap 2026.
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