Language has been examined a lot lately in the pain world including how explaining pain translate to patient outcomes. Patients want to know the cause of their pain which often provokes medical providers to use words and phrases that catastrophize, dramatize, over-simplify, and predict long-term outcomes. These four categories of words and phrases should be avoided to promote a more positive patient mindset and overall outcomes.
The first category of words are those that have a catastrophic connotation some of which include chronic, degenerative, and unstable. They all sound as if the pain will never end, will only get worse, and is unavoidable. In reality these diagnoses are very treatable with strengthening and manual interventions.
Next, patients also tend to dramatize their pain by clinging to relatively minor pathologies as the cause of their pain and disability. One we tend to hear the most is the dreaded OSTEOarthritis (osteo is capitalized because it tends to be annunciated clearly and with emphasis when patients are relaying their medical history). The medical world and our culture in general tends to credit OSTEOarthritis with some intangible power to cripple, debilitate, and paralyze seemingly strong, able-bodied people.
Thirdly, many words fall into a category of over-simplification that often leads to misunderstanding. One of these is “slipped disc.” Patients hear this phrase from a medical professional, friend or colleague and think the disc has slipped away into some abyss and is never going back to wherever it belongs (but where that is they don’t even know). Other oversimplified explanations of pain often focus on a “tear.” This could pertain to a miniscule tear in a rotator cuff muscle or the annulus surrounding a vertebral disc but wherever it happens to be the tear is THE cause of their pain and because you can’t un-tear something their pain will always be there (please note my sarcasm). In reality many people with a tear (wherever it is) can have great strength as well as treatable pain related to but not directly due to the “tear.” Over-simplifying explanations with words like this causes patients to become very fearful and often experience greater pain.
The last bad category of phrases is any phrase that tries to predict long term outcomes. For instance “you’ll never run again” or “forget about playing sports.” How many ESPN E:60 segments have you seen where someone with seemingly insurmountable physical disabilities returns to sport? Yet, medical professionals are telling patients with OSTEOarthritis or a tear that they should give up all recreation and physical activity.
All of these statements and phrases translate into clients using what we call pathology first language. For example, “I have a slipped disc so I hurt” or “I have a tear so I can’t do that.” The client’s function and pain no longer hinge upon their strength or ability but on their understanding of their pathology. More than anything, these words and phrases create in our patients an underlying mindset of fear. With fear comes movement and activity avoidance which often leads to depression and increased pain. This pattern will continue and pain will increase with each cycle.
The first step in stopping this cycle of pain is eliminating these four categories of words and phrases from our explanations of pain and pathology. Yes, the patient may have a tear or OSTEOarthritis but these things shouldn’t be emphasized. Instead discuss the course of treatment and interventions that will decrease their pain and increase function.
Dr. Kristen A Lattimore, PT, DPT, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. She has also had experience as an athlete and coach of the speed and jumping side of Track and Field. She is passionate about integrating her knowledge and experience with fast and powerful exercise into the practice of physical therapy. She also enjoys working with patients whose concerns and complaints have been overlooked and perpetually deferred to the next medial professional.
Kristen continues to challenge herself with varied exercise including interval running, weight lifting, yoga, and Pilates. She is passionate about making her patients their best selves and adding power and intensity back into physical therapy. She can be reached at firstname.lastname@example.org.