Whole body

What It Is

Diffuse idiopathic skeletal hyperostosis is a condition in which ligaments (the tough bands that hold bones together) and tendons become calcified and hard, and can slowly turn into bone where they attach to bone. It usually affects the spine (Arthritis UK, 2026; Healthdirect Australia, 2026). DISH might not cause any symptoms and doesn't always require treatment; it is sometimes only noticed by chance on an x-ray taken for another reason (Arthritis UK, 2026). When symptoms do occur, some of the most common are pain and stiffness, especially in the upper back. It can also affect the neck and lower back (Healthdirect Australia, 2026; Arthritis UK, 2026). Certain people may experience the condition in their shoulders, elbows, knees and heels (Healthdirect Australia, 2026). The condition can slowly progress, and in some people it causes more serious complications (see Tips below).

Diffuse Idiopathic Skeletal Hyperostosis (DISH) Anatomy

The spine is made up of bones stacked one on top of the other, known as the vertebrae. Five sections make up the spine. At the top, the cervical spine connects to the skull. The thoracic spine is attached to the ribs. It is the ribs that form the chest. Below the thoracic spine is the lumbar spine, which attaches to the sacrum, part of the pelvis. The last part of the spine is the coccyx (tailbone).

Ligaments help to stabilise the spine. The ligament that runs along the front of the spine is the anterior longitudinal ligament. Another ligament runs along the back of the vertebrae, called the posterior longitudinal ligament. In DISH, it is mainly the anterior longitudinal ligament, at the front and sides of the spine, that turns into bone (Weng et al., 2025).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Manage Diffuse Idiopathic Skeletal Hyperostosis

The stiffness associated with DISH can often be helped with physiotherapy and exercise (Arthritis UK, 2026; Healthdirect Australia, 2026). I can help with hands-on work for stiff, tight muscles, gentle mobilisation and a home programme of mobility and postural exercises. See the My Approach tab for how I work.

1. Pain Relief

At the moment there are no treatments known to stop the ligaments calcifying, so treatment aims to ease symptoms (Arthritis UK, 2026). If DISH is causing pain, Arthritis UK (2026) says your doctor may suggest painkillers, and Healthdirect Australia (2026) lists anti-inflammatory medicines (NSAIDs) among the treatments a doctor may recommend. Seek advice from your doctor or pharmacist about which is suitable for you.

(This medicine information comes from Arthritis UK and Healthdirect Australia, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

2. Physical Therapy

The stiffness associated with DISH can often be helped with physiotherapy (Arthritis UK, 2026; Healthdirect Australia, 2026). Exercises can help to increase the range of movement in the joints, and a physiotherapist can advise you on the best exercises for you (Arthritis UK, 2026).

3. Exercise

Exercise is very important to maintain mobility in the spine (Healthdirect Australia, 2026). General exercise and specific exercises are both useful. General exercise could include swimming, walking, jogging or riding a bike. Specific exercises include postural exercises and spinal mobility exercises.

4. Looking After Your Blood Sugar

If you have diabetes, keeping your blood sugar levels well managed is part of treating DISH (Healthdirect Australia, 2026).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Surgery: rarely needed. An operation to remove bony growths may help if they are pressing on nerves or making it hard to swallow (Arthritis UK, 2026; Healthdirect Australia, 2026).

How I can help (see the My Approach tab)

Hands-on work for stiff, tight muscles in your back, neck and shoulders
Gentle mobilisation for the parts of your spine that can still move
Mobility, postural and breathing exercises to do at home

Tips

DISH is more common in men than in women (Arthritis UK, 2026; Healthdirect Australia, 2026).
DISH is rare before the age of 40 and becomes more common with age, especially over 50 (Arthritis UK, 2026; Healthdirect Australia, 2026).
People who have diabetes or pre-diabetes are more likely to develop DISH (Healthdirect Australia, 2026).
Obesity and high insulin levels in the blood (hyperinsulinaemia) are also linked with DISH (Healthdirect Australia, 2026; Weng et al., 2025).
There is limited evidence that isotretinoin, a medicine related to vitamin A that is used for acne, may be linked to DISH-like symptoms. If you take medicine for acne, ask your doctor whether it may be causing your symptoms (Healthdirect Australia, 2026).
Regularly moving or lifting heavy objects may increase your risk (Healthdirect Australia, 2026).
Possible complications include difficulty swallowing or a change in your voice from bony growths in the neck, sleep apnoea (pauses in breathing during sleep), and a higher chance of breaking a bone in the spine (Healthdirect Australia, 2026).

Treatment

My Approach

DISH is managed by your doctor, and there is no treatment yet that stops the ligaments turning to bone. Where I can help is with the pain and stiffness that come with it: easing tight muscles, keeping what can still move moving, and building a routine you can keep up at home.

I start by assessing how your neck, back, shoulders and hips move, your posture and breathing, and your strength. I'll also ask about any swallowing, voice or nerve symptoms. Please bring any X-ray or scan reports and notes from your doctor to your first visit. They help me plan safe treatment for you.

Hands-On Treatment

Massage, myofascial and trigger point work for tight muscles along your back, neck, shoulders and hips
Warm applications on stiff areas to help them relax
Gentle, low-velocity mobilisation of the parts of your spine and ribs that can still move, never forcing areas where the bone has bridged, and never quick thrusts
Gentle stretching for the chest and hip muscles that pull you into a stooped posture

Exercise and Self-Care

A home programme of spinal mobility and postural exercises
Deep breathing to keep your ribs moving
Light strengthening for your back, hips and shoulders, without heavy lifting
Regular activity you enjoy, such as walking, swimming or cycling

Because a spine affected by DISH can break more easily, I avoid strong pressure or force over the spine. If you've had surgery, I need your surgeon's okay before hands-on treatment. If you notice difficulty swallowing, a hoarse voice, or pins and needles, numbness or weakness in your arms or legs, tell your doctor promptly (see When to See Your Doctor).

What to Expect

Typical Course

Typical course: Most people start with weekly visits, or twice a week for the first two to three weeks if pain is high, then space them out as they manage more on their own, with a reassessment at about 4 to 6 weeks. DISH is long-term, so expect pain and stiffness to ease gradually over the first few weeks, with occasional visits after that fitting around your doctor's plan.

What I Focus On

Pain & Stiffness Relief

Gentle Spinal Mobility

Posture & Breathing

Home Exercise

Working With Your Doctor

Please read

When to See a Doctor First

When to See Your Doctor

See your family doctor or nurse practitioner if you have symptoms of DISH or are worried you might have it, or if your symptoms get worse (Healthdirect Australia, 2026). Tell your doctor promptly if you have difficulty swallowing, a hoarse voice, or pins and needles, numbness or weakness in your arms or legs. These can happen if the bony growths press on the food pipe or on nerves (Healthdirect Australia, 2026; Arthritis UK, 2026).

Sources

References

Arthritis UK (2026) Diffuse idiopathic skeletal hyperostosis (DISH). Available at: https://www.arthritis-uk.org/information-and-support/understanding-arthritis/conditions/diffuse-idiopathic-skeletal-hyperostosis-DISH/ (Accessed: 7 October 2026).
Healthdirect Australia (2026) Diffuse idiopathic skeletal hyperostosis (DISH). Available at: https://www.healthdirect.gov.au/diffuse-idiopathic-skeletal-hyperostosis-dish (Accessed: 7 October 2026).
Weng, R. et al. (2025) 'Global prevalence estimates of diffuse idiopathic skeletal hyperostosis: a systematic review and meta-analysis', Frontiers in Endocrinology, 16, 1517168. doi: 10.3389/fendo.2025.1517168

Massage therapy · Kitchener–WaterlooDiffuse Idiopathic Skeletal Hyperostosis (DISH)

What It Is

Diffuse Idiopathic Skeletal Hyperostosis (DISH) Anatomy

Self-Care & Treatment

How to Manage Diffuse Idiopathic Skeletal Hyperostosis

1. Pain Relief

2. Physical Therapy

3. Exercise

4. Looking After Your Blood Sugar

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Self-Care

Typical Course

When to See a Doctor First

When to See Your Doctor

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooDiffuse Idiopathic Skeletal Hyperostosis (DISH)

What It Is

Diffuse Idiopathic Skeletal Hyperostosis (DISH) Anatomy

Self-Care & Treatment

How to Manage Diffuse Idiopathic Skeletal Hyperostosis

1. Pain Relief

2. Physical Therapy

3. Exercise

4. Looking After Your Blood Sugar

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Self-Care

Typical Course

When to See a Doctor First

When to See Your Doctor

References

Related Conditions

Amyotrophic Lateral Sclerosis

Anterior Wedge Fracture to the Vertebra

Bone Tumor

Chronic Fatigue Syndrome

Book a session