Neck and Back Pain When You Have Diabetes

You have a neck that does not turn as far as it used to and aches now and then, and a low back that grumbles most of the time since you strained it.

Two things are worth saying at the start.

First, this is not simply your age. Back and neck pain do get more common as people get older, but most people in their sixties and seventies are not in daily pain. If age alone caused it, everyone would have it. Something else is going on, and the something else is usually far more changeable than the calendar.

Second, and this is the part most people are never told: your diabetes is relevant here, and not in the way you might expect. Diabetes affects a great deal more than blood sugar. It changes the tissues that make up your joints, and that has a direct bearing on a neck that has stopped turning. Section 6 explains it, and there is a hopeful finding at the end of it.

This guide is not saying your pain is in your head. Your pain is completely real.

The short version

• Pain is an alarm. It protects you. It does not measure damage.
• It is not just your age. Plenty of people your age have necks and backs that give them no trouble.
• Diabetes stiffens connective tissue. That is part of why your neck has lost range. See section 6.
• And that stiffening is not fixed. As diabetes control has improved over the decades, rates of it have fallen sharply.
• Nearly every pain free person your age has wear on a scan. That is normal ageing, not damage.
• Movement does three jobs for you at once: your back, your neck, and your blood sugar. See section 9.
• Range you do not use, you lose. That applies to your neck more than anywhere.

1. Pain is an alarm, not a damage meter

Your body has danger sensors. They fire when tissue is stretched, squashed or irritated. They send warning signals to your spinal cord, and then to your brain. None of that is pain yet. It is just information.

Then your brain weighs it against everything else it knows: what you were doing, what happened last time, what you think it means, how stressed you are, whether you slept. Then it decides how much pain you need to feel in order to stay safe.

Pain is the answer to that question. Your brain produces it.

That is why damage and pain match up so badly. A paper cut is agony with almost no damage. Soldiers get badly hurt and feel very little until they are safe. People who have lost a leg can still feel pain in it.

So how much you hurt does not tell you how much damage there is. It tells you how protective your body is being right now.

2. The pain gate

In 1965, two researchers called Ronald Melzack and Patrick Wall came up with an idea that changed pain medicine.

Picture a gate in your spinal cord. Warning signals have to pass through it to reach your brain. Open, and more gets through. Closed, and less does. Nothing in your neck or back has to change for the pain to change. Only the gate setting.

What closes the gate

• Touch, rubbing, heat and hands-on treatment. Touch signals travel on bigger, faster nerves than danger signals, and they crowd them out.
• Moving and exercise, which release your body's own painkillers.
• Feeling safe and calm.
• A decent night's sleep.
• Company. Being lonely genuinely makes pain worse, and it matters more in later life than most people admit.
• Understanding what is going on. Reading this counts.

What opens the gate

• Stress and worry, especially about your independence.
• Broken sleep.
• Low mood, and feeling written off because of your age.
• Checking how far your neck turns, several times a day.
• Being told frightening things about your spine. Arthritis, degeneration and wear and tear are the three phrases that do the most damage, and they get used carelessly.

Your brain does not just receive signals at that gate. It sends signals down and changes the settings. That is why an identical week is fine one month and wearing the next.

3. When the alarm gets too sensitive

When a pain system has been busy for months or years, it does not wear out. It gets better at its job. The sensors fire more easily, and the brain concludes danger more quickly.

Think of a car alarm. When fitted, it went off if someone forced the door. Years later it goes off when a cat walks past. The alarm is not broken. It is set too sensitive for the actual threat.

Because your body learned it, your body can unlearn it. There is no age limit on that. Studies of pain education and gradual activity show benefit in people in their seventies and eighties.

4. What scans show at your age

Researchers scanned people who had no pain at all and counted what showed up.

In the low back, in people with no pain:

• At 60, about 9 in 10 had disc degeneration. At 80, nearly everyone.
• At 60, about 7 in 10 had a disc bulge.

In the neck, in people with no neck symptoms at all:

• A study of 1,211 people found nearly 9 in 10 had disc bulging somewhere.
• Narrowed discs, bone spurs and worn facet joints were similarly common.

Cervical spondylosis, which you may have heard, simply means age related change in the neck. If wear caused pain, every person your age would be in pain. They are not. A scan describes your age, not your problem.

If you have had a scan and been given frightening words, bring the report in. We will go through what it actually says.

5. Why two areas at once

Two sore areas almost never means two separate injuries. That would be quite a coincidence.

What it usually means is that the whole system has become more protective, and that both ends of your spine share the same drivers: the same sleep, the same stress, the same daily load, the same overall strength and fitness.

In your case there is a third shared driver, and that is section 6.

One set of causes showing up in two places. Which is good news, because one plan covers both.

6. The diabetes connection

This is the section most people have never had explained, and it is the one that makes sense of your neck.

Diabetes does not only affect blood sugar. It changes the tissues that hold you together.

Here is the mechanism, in plain terms. Collagen is the protein that makes up your tendons, ligaments and the capsules around your joints. It is what gives them their strength and their give.

When there is more sugar circulating than there should be, some of it attaches itself to collagen. That process creates what researchers call advanced glycation end products. These form extra cross-links between the collagen fibres, and they also slow down the rate at which your body replaces old collagen with new.

The result is connective tissue that is stiffer, less elastic, and slower to renew itself.

That shows up in predictable places. Limited joint mobility in diabetes is well described, and while it is best known in the hands, it can involve the wrists, elbows, shoulders, knees, and the neck and spine.

• It also explains why several other things are commoner with diabetes:
• Frozen shoulder. When researchers pooled the studies, they found it in about 13 in 100 people with diabetes, against roughly 2 to 5 in 100 in the general population. That is somewhere between three and a half and five times more likely, depending on which pooled analysis you read.
• Calcific tendonitis, a gritty deposit in a shoulder tendon, around three times more common.
• Carpal tunnel syndrome, affecting up to 1 in 5 people with diabetes.
• Trigger finger and Dupuytren's contracture.

None of this means your neck is damaged. It means the tissue around your joints has become stiffer than it would otherwise be, and stiffness is not the same thing as injury.

And now the part that matters most.

This is not fixed. As diabetes control improved across whole populations over the decades, rates of this joint stiffness fell substantially. In one American group it dropped from around 30 in 100 to 7 in 100. In a British group, from around 43 in 100 to 23 in 100.

The tissue responds to the conditions it lives in. Better control, over time, means less of this.

7. Your neck

Your neck does not turn as far as it used to, and it aches on and off. Two things are contributing, and neither is damage.

Ordinary age related change. Universal, and present in the necks of people who feel perfectly fine. See section 4.

The connective tissue stiffening described in section 6. The capsules around the small joints in your neck are made of exactly the tissue that is affected.

What follows from that is simple and it is the most important sentence in this section: range you do not use, you lose.

A stiffer neck turns less. Turning less makes it stiffer. Each month of not going to the end of the range makes the end of the range a little further away. That loop is where most of the lost movement actually comes from, and it is the part you can reverse.

• Two things worth protecting deliberately:
• Turning your head far enough to check a blind spot. This is a skill worth keeping. If it is limited, it is worth working on rather than accepting, and if it cannot be fully restored, mirrors and technique can be adapted.
• Looking up. Needed more often than people expect. Top shelves, hanging washing, stairs, watching for a bus.

Gentle movement through the full range you have, several times a day, does more for a stiff neck than anything else available. Not forcing. Visiting the end of the range regularly so that it stays where it is and slowly comes back.

8. Your low back

You strained it, and it has grumbled since. That is an extremely common story and it does not mean the strain never healed.

A strain heals in weeks. What tends to persist afterwards is not the injury but everything that followed it: a system that stayed on alert, muscles that kept guarding, a period of doing less, and the loss of strength and tolerance that comes with that.

So the ache you have now is usually not the original injury still being injured. It is a back that has become more sensitive and less conditioned than it was.

That distinction matters, because the two need opposite things. An injury needs protecting. A sensitive, under-conditioned back needs using.

9. Why movement matters more for you than for most people

Everything above gives you the usual reasons to move: it closes the gate, it keeps range, it rebuilds tolerance, it settles a sensitive system.

But for you there is a second payoff, and it has nothing to do with your back at all.

Regular activity lowers blood sugar, and the effect is not small.

A large analysis pooling the trials found that regular physical activity reduced HbA1c by:

• Around 0.7 to 1.0 percentage points in people whose control was well above target.
• Around 0.5 to 0.6 in people moderately above target.
• Around 0.4 to 0.5 in people whose control was already reasonable.

To put that in perspective, that is the sort of change people expect from adding a medication. And the types that came out best were walking, strength work, and programmes combining the two. The same analysis concluded that how much you do matters more than precisely what you do.

Add that to section 6. Better glucose control over time is linked to less of the connective tissue stiffening that is currently limiting your neck.

So the same half hour is doing three separate jobs: settling your back, keeping your neck's range, and working on your diabetes. Very few things in medicine pay out three ways.

10. What to actually do

Daily, and this is the one that matters most for your neck:

• Take your neck through its full comfortable range, several times a day. Turn each way, look up and down, tilt ear to shoulder. Slowly, without forcing. A minute at a time, five or six times a day, beats one long session.

Most days:

• Walk. Build towards around 30 minutes on most days. Start from whatever you manage now and add a little each week. Walking appears in the evidence for back pain, for neck and general mobility, and for blood sugar.

Twice a week:

• Strength work. The NHS advice for adults over 65 is strength, balance and flexibility work on at least two days a week. Real resistance, meaning the last few repetitions are genuinely hard. Weights, bands, or bodyweight movements.
• Standing up from a chair without using your hands is an excellent place to start and needs no equipment. It trains exactly what you need for getting off a toilet, out of a car, and up from the floor.
• Include your neck and shoulders, not just your legs and back.

Some soreness while you build is expected and is not damage. A good rule: discomfort that rises while you move and settles back to your normal within about a day is fine. Still raised the next day means you did a bit too much, not that you did harm.

And a practical note that applies to you specifically: keep an eye on your blood sugar when you increase activity, particularly if you take medication that can lower it. Worth a word with your diabetes nurse before you step things up.

11. Pacing and flare-ups

A good day comes, you seize it and do everything, then you pay for three days. Over months the trend quietly goes down.

• Work out what you could manage on almost any day, including a bad one.
• Do that amount consistently, good days and bad.
• Once it feels easy, add about a tenth more each week.
• Break bigger jobs into chunks, with breaks built in before you need them.

Flare-ups are normal and do not mean new damage. Keep moving gently, drop back to your baseline for a few days, use whatever settles it, and remind yourself that this has settled before.

Keep the neck movements going even during a flare. That is the one thing not to drop, because range is easier to keep than to win back.

12. A word about painkillers

I am not your prescriber, and this is not prescribing advice. But two things are worth knowing.

Anti-inflammatory tablets such as ibuprofen and naproxen carry higher risks after sixty, including stomach bleeding and raised blood pressure. They interact with several medicines commonly taken later in life.

They also affect the kidneys, and that deserves particular attention with diabetes, because diabetes itself is one of the commonest causes of kidney problems. If you are taking anti-inflammatory tablets regularly, please raise it with your GP or diabetes team and ask whether it is suitable for you.

Anti-inflammatory gels rubbed into the skin carry considerably less risk than tablets.

A free medicines review with your pharmacist is a genuinely useful half hour.

13. What treatment does, and what it does not

Hands-on treatment works through the mechanisms above. It closes the gate, calms sensitivity, relaxes muscles that have tightened to protect you, and gives you a spell where moving feels easier. For a stiff neck it can also make the range work in section 10 considerably more comfortable, which is its main value to you. What it does not do is reverse wear, undo the tissue changes in section 6, or put anything back in place. Nothing is out. The clicks and pops you sometimes hear are gas moving inside a joint, the same as cracking a knuckle.

Think of a session as a window: a stretch of time where you can move more freely, which you use to do the work in section 10. The movement is what changes things in the long run.

I will adapt what I do to you. Technique, positioning and force all change depending on bone strength, medicines, and other health conditions, and I will always ask. Please tell me about your diabetes control, any circulation or sensation problems in your feet, and anything you have been told about your kidneys or your eyes, because all of those change what is appropriate.

On measuring progress. Pain scores bounce around. Better questions: how far can I turn my head to reverse the car? Can I get out of a low chair without pushing off? How far can I walk? Am I sleeping through? Function usually improves before pain does.

14. When to get urgent help

Almost all neck and back pain is not an emergency. A few things are, and a few of them deserve particular attention with diabetes.

Call 999

• Any sign of stroke. Face drooping on one side, weakness in one arm, slurred or muddled speech. Think FAST.
• Sudden severe neck pain or headache unlike anything you have had before, especially with double vision, slurred speech, trouble swallowing, veering when you walk, or sudden severe dizziness.
• Numbness or altered feeling between your legs, around your back passage or genitals, including toilet paper feeling different when you wipe. Any new loss of bladder or bowel control. New or worsening weakness in both legs.
• Severe pain straight after a bad fall or accident.

Contact your GP or NHS 111 today

• Any red, hot, swollen joint, with or without a fever. Infections are more common and can move faster with diabetes, so this needs same day attention rather than watching.
• New numbness, tingling, burning or pins and needles in your feet, or any sore, blister or ulcer on your foot that you had not noticed. This needs checking promptly. Diabetes can affect the nerves and circulation in the feet, and foot problems are far easier to deal with early.
• Signs of pressure on the spinal cord in your neck. Dropping things, getting clumsy with your hands, trouble with buttons or coins, changed handwriting, unsteadiness on your feet, heavy legs. These start subtly and are easy to put down to age. Please do not wait on them.
• New headache with scalp or temple tenderness, jaw ache when chewing, or any change in vision.
• Pain with fever, shivering, or feeling generally unwell.
• Pain with unexplained weight loss, night sweats, or a past history of cancer.
• Sudden severe back pain after a minor fall, a cough or a sneeze, or with no cause at all, particularly with osteoporosis or long term steroid use.

Worth mentioning at a normal appointment

• Any fall, even one that did not hurt you.
• A shoulder that is becoming stiff in all directions, including when someone else moves your arm. Given section 6, this is worth flagging early rather than late.
• Any change in sensation in your hands or feet.
• Aching and stiffness in both shoulders and hips, worst first thing and lasting more than an hour.

Everything else, including a bad flare-up, can wait for a normal appointment.

15. If you want to read or watch more

Start here

• Tame the Beast. A five minute animation by Professor Lorimer Moseley. The best possible starting point. tamethebeast.org
• Flippin' Pain. A UK campaign about long lasting pain. flippinpain.co.uk
• NHS activity guidelines for older adults. nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults

On diabetes

• Diabetes UK. Reliable, practical, and has a good section on activity and on looking after your feet. diabetes.org.uk
• NHS advice on type 2 diabetes. nhs.uk/conditions/type-2-diabetes

Practical help

• The Pain Toolkit, by Pete Moore. Good on pacing and building activity back. paintoolkit.org
• Recovery Strategies, by Greg Lehman. A free illustrated workbook. greglehman.ca/recovery-strategies-pain-guidebook
• Age UK, on staying steady, and strength and balance exercises. ageuk.org.uk

The research behind this guide

• Melzack R, Wall PD. Pain mechanisms: a new theory. Science, 1965. The original pain gate paper.
• Brinjikji W et al. Imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 2015. The low back scan figures in section 4.
• Nakashima H et al. Abnormal findings on MRI of the cervical spine in 1211 asymptomatic subjects. Spine, 2015. The neck scan figures in section 4.
• Hordon L. Limited joint mobility and other musculoskeletal problems in diabetes. Journal of Diabetes Nursing, 2016. The basis of section 6.
• Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles, Ligaments and Tendons Journal, 2016. The frozen shoulder figures in section 6.
• Optimal dose and type of physical activity to improve glycemic control in people diagnosed with type 2 diabetes: a systematic review and meta-analysis. Diabetes Care, 2024. The HbA1c figures in section 9.

Bring any of this to your next appointment. Especially the parts that did not sit right, or that felt uncomfortably familiar.

This guide is general information. It does not replace the advice I give you in clinic.