Language, both verbal and non-verbal, has enormous power which can have positive or negative effects on us and those we communicate with. When writing the last blog post, I looked at some of the more official definitions that associations and governing bodies have used for their professional roles (such as physiotherapy, osteopathy, chiropractic etc). I came across one definition that explained their goal as: “…detecting and treating damaged parts of the body such as muscles, ligaments, nerves, and joints.” When I saw the word ‘damaged’ being used by the actual association of Osteopathy, it made me sad and a little frustrated. It’s hopefully not an insight into the perspective of most osteopaths. Those I have met have been positive people who want to help others, but when we use the word ‘damaged’ when speaking to a client as a broad term to somehow describe an area of pain or symptom that they would like to improve, it sets a really negative tone to start with. Plus – who’s to say the area is ‘damaged’?? If I had a clicky knee and I wanted to improve it, I wouldn’t assume my knee was damaged. If I had a headache, I wouldn’t assume my brain or those muscles in my neck were damaged. What I would hope is that a healthcare or medical professional would be able to give me some advice and/or treatment that would improve the symptoms or issue I was dealing with.
The use of language in healthcare
There’s been a great deal of development over the past 10 years or so, as we’ve become increasingly more aware that words and communication (in all its forms) are important. Using words that hold negative meanings is generally not useful. I have heard hundreds of times from people I have worked with to try and help (whether in the NHS or privately) use words such as:
They said the joint was ‘damaged’
I was told the pain is caused because its ‘bone on bone’
The consultant said it’s never going to get better
I was told to stop doing exercises and limit physical activity
They said I need to rest until the pain stops
Apparently it’s wear and tear
It’s to be expected with age
It’s probably just arthritis and I just have to get on with it
Learn to live with it
If something hurts, don’t do it
We can pick some of that apart….
If you break a bone and have it set in plaster cast or supported so you can’t move it for a while. When the cast comes off – how sore is that?! It’s stiff, muscles are tight and have become weak. To get it moving, there’s gentle stretches and strengthening exercises that will be vital in getting you going again but they will be sore. So what’s the difference between good pain and bad pain? It differs and is very subjective, one person’s ‘ouch’ is another person’s ‘agony.’ Pain is a maaaaaaaaassive topic, too big to unpick here, but generally if it isn’t sharp/stabbing pain and if it’s not referring (such as radiating down the leg or arms), but feels a little achy with a feeling of putting in effort that is bearable, it is more likely to be something you can gently push up to and a little into without forcing it.
Body parts aren’t ‘good’ or ‘bad’
Talking about the area of your body that is affected, rather than ‘damaged’ or ‘bad’ reminds us that the area could be temporarily affected, that it is able to be improved and not at fault. Body parts are not ‘good’ or ‘bad.’ Generally, ‘good,’ is desirable, approved of, beneficial, and morally right…whereas the word ‘bad’ is often defined as the opposite or the absence of good. It can often refer to neglect or of poor morality, ignorance, or abuse. Hopefully no body part is those things, but instead needs some attention and work on it to get it either back to your ‘normal’ or to a place where it feels like you can be as independent as possible and have the best quality of life as you can!
While there’s been an increasing awareness of the language that healthcare and medical professionals use when speaking with the people they’re caring for, that doesn’t mean it’s stopped. You may recognise the wording directly or know of someone else who’s been told something similar to:
‘Looking at x rays, the spine (or another joint) is crumbling’
‘The joint is ‘bone on bone’ and ‘wearing away’
‘You’ll just have to learn to live with the pain’
…and one of the worst pieces of advice given by some who should know better: ‘You’ll need to do less of what hurts, reduce your activity and rest more.’ Cue a huge groan and a forehead slap….NOOOOOOOOOOOOOOOO!
Even in hospices where someone may live their last few weeks or days, patients have access to physiotherapists. Movement is so important! Broken bone? If it’s set and in a form of restraint (such as a boot or cast), moving other bones and joints is important to maintain strength and flexibility, ready for when the cast is off and you can start rehabbing the affected area. Having a broken wrist means that having a stronger upper arm that isn’t stiff will help you complete exercises.
What if when we see a healthcare or medication professional after having been given a diagnosis, they could then use positive language on how to either improve things or manage symptoms as well as possible.
None of this should surprise us – say negative things repeatedly to an adult or child and they may not only start to believe it, but decide there’s no hope in changing, that they’re a ‘bad’ person, that it’s somehow their ‘fault.’ Telling outright untruths isn’t needed, but saying things in a positive light and from the point of view of what can be done, is surely far better than being told that little can be done, being in pain is to be expected and with no light shone on ideas for the future in how to make a tough diagnosis or situation better.
The power of language in healthcare
A range of studies were analysed in which the effects of positive expectations were measured. This 2018 review found seven trials in which patients reported improved pain, less anxiety and more satisfaction after an empathic (understanding) consultation. An amazing eighteen trials reported improved psychological outcomes (mostly in reported pain), and also reported improved physical outcomes (including level of function and even length of stay in hospital!). Who would have thought – a positive, understanding consultation leads to not only changes in someone’s perspective, but physical improvements too!! This review shows that conveying empathy and talking about positive expectations of the treatment plan (whether it’s a course of treatment or a one off) while we’re talking to healthcare professionals, will consistently reduce pain and anxiety, a minimum improvement of 10-20% in many cases.
Conclusion – the words and language we use make a huge difference to our wellbeing
We can easily internalise messages from social media and from those around us, but most of all from people we feel are more qualified or in a position of greater knowledge or power in a particular situation than we are, and that can often include healthcare providers. When we hear messages that we perceive negatively, whether it was intended or not, it can lead to feelings of shame, guilt and resentment. If we are frustrated or even ashamed of a condition, we will find it much harder to engage and manage that condition proactively.
It could help to step back and see yourself and think about what words you use about yourself and your capabilities. Is your internal dialogue using words phrased in a way that could help you or slow you down? What could you change them to? Could trying a new exercise program be a ‘new challenge’ instead of ‘yet another thing you have to do.’
If you have persistent pain, it can be valuable to test yourself and see if you may be holding yourself back without knowing it. Or talking to those closest to you that you trust, and asking them if they have noticed any frequent negative words or phrases you use about yourself or your injury/condition/symptom (delete as appropriate). A more balanced and positive way to approach your current situation, may be just a few helpful phrases away.