Patient Education Part 1: Words that Harm

When we think of communication the primary tool that comes to mind is speech.  Within the clinic setting we have an extremely important role in communicating with our patients an understanding of their condition.  Arguably the most important role we play is as health educators.  Research is showing again and again that one of the keys to better outcomes with patients is education in order to empower patients to take control of their own health.

The words we use to communicate to our patients an understanding of their condition can empower them to better health but also can have a nociceptive effect and induce fear and adaptation.

We now know that many conditions cannot be adequately explained by a tissue based diagnosis.  Our years of training and consequent primary skills are tissue based – palpation, assessment of movement and function in order to identify areas of dysfunction, or imbalance.  We tend to focus on telling our patient’s what is wrong with them rather than what works well.  If we tell patient’s they have a disc bulge or degeneration this can often lead to fear avoidance behaviours – fear of movement, reduction in activities.  This is an inappropriate response and can lead to further compensations and ongoing pain.

There has been much harmful information spread about over the years.  You may well have seen some of the shocking videos that provides a demonstration of discs being comparable to jam doughnuts.  Yes, you’ve guessed it – they increase the loading on the discs and the ‘disc’ doughnut bursts with the jam spewing everywhere.  If you thought that had happened inside your back it is pretty alarming and the first reaction you will have will be to take extra care to make sure that no more of your discs rupture their jam out and you would be very worried how that jam is going to get back into your disc! Watch at about 3:30

Words we often use

An excellent piece of research listed some of the phrases that we often use in our clinics that may be misunderstood or miscommunicated to patients.

Look carefully at the list of phrases – I’m sure every reader will identify at least one they are guilty of regularly saying to patient’s.  Patients may often misunderstand the words that we use.  Degeneration to somebody with musculoskeletal knowledge has a very different meaning to many of our patients.

 Other things we may erroneously communicate to our patients are:

  • Structure explains pain
  • Poor posture explains pain
  • A weak core causes pain
  • Over-pronation causes pain
  • Let the pain guide you
  • OA is wear and tear

See this article for a lot more miscommunications and references.

Osteopath, Eyal Lederman has been working for years to overcome many of the myths been relied upon.  He has written several indepth papers – The Myth of Core stability and The Fall of the Postural-Structural-Biomechanical model – excellent reading but be prepared to have your beliefs challenged!

Patients need to be educated about their pain in a way that empowers them to understand their condition and how they can act to help themselves.  If you have explained something to your patient, check their understanding by asking them to describe back to you what they have understood.  It is the story they are going to tell their friends and family and it will form the basis of how they view their ongoing health and well-being.

If all this is coming as a surprise to you and you are feeling challenged about how you practice osteopathy I would urge you to start reading and connecting with other physiotherapists and osteopaths via social media.  I especially recommend Peter O’Sullivan, Mary O’Keeffe and Penny Sawell at as a good start but find and connect with academics and you will find they point you to fantastic resources.

Having perhaps undermined some of your communication strategies in this blog, next week we will take a positive approach andl look at words that help and how we can be effective communicators in clinic for empowering our patients.

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