| What We Treat
Diabetes Mellitus
Exercise is a treatment for type 2 diabetes, not just general advice. It also has specific musculoskeletal consequences worth knowing about.
Overview
What It Is
Diabetes affects far more than blood glucose. It produces a recognised set of musculoskeletal problems — frozen shoulder, trigger finger, Dupuytren’s, restricted hand movement — at considerably higher rates than in the general population, and causes peripheral neuropathy that changes balance and foot risk. Exercise improves glycaemic control directly and is properly regarded as treatment.
Frozen Shoulder and Hands
Frozen shoulder, trigger finger and Dupuytren’s all occur substantially more often, and tend to be more stubborn.
Symptoms
How It Tends to Feel
These are the features that point towards this diagnosis rather than another:
Frozen Shoulder
Occurs several times more commonly in diabetes, and often bilaterally.
Trigger Finger and Dupuytren’s
Both substantially more common.
Limited Joint Mobility
Stiff, waxy hand skin with difficulty flattening the palms together.
Peripheral Neuropathy
Numbness in the feet, changing balance and foot injury risk.
Slower Tissue Healing
Tendon and wound healing take longer, which changes rehabilitation timescales.
Reduced Exercise Tolerance
Often multifactorial, and worth investigating rather than accepting.
Causes & Risk Factors
What Drives It
The usual contributors, in rough order of how often they turn out to matter:
Glycaemic Control
Higher long-term glucose is associated with more musculoskeletal complications.
Duration of Diabetes
Complication rates rise with years since diagnosis.
Tissue Glycation
Sugar molecules cross-linking collagen, which stiffens connective tissue.
Reduced Activity
Both a cause and consequence, and the most modifiable factor.
How We Can Help You
Treatment & Management
Treatment is built around what the assessment finds, but generally follows this shape:
When to Seek Help
Red Flags — Don’t Ignore These
Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:
⚠ Seek Medical Advice If You Notice
- Any foot ulcer, wound or unexplained redness — seek same-day review
- Symptoms of very high or very low blood glucose during or after exercise
- New chest pain or breathlessness on exertion
- Rapidly progressive numbness or weakness
If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.
Common Questions
Frequently Asked Questions
Why does diabetes affect my shoulder?
Excess glucose cross-links collagen, stiffening connective tissue. Frozen shoulder is several times more common in diabetes, often affects both sides, and tends to be more stubborn.
How much exercise do I need?
Both aerobic and resistance work, most days. Resistance training in particular has a strong effect on glycaemic control and is frequently left out.
Is it safe to exercise with neuropathy?
Yes, with supportive footwear and daily foot checks. The falls risk from doing nothing is greater than the risks of sensible activity.
Not Sure If This Is What You Have?
An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.