In the physical therapy world, we do a lot of listening (or we should … if you don’t, then you should start – there will be a post in the future about listening), but we also do plenty of talking – mostly educating our clients. However, not all words are created equal. We, as professionals, have to be very careful with our word selection because that can directly influence our outcomes with the client.
Words and language are a form of external, auditory stimulus. All stimuli (external, physical, etc…) are processed in the brain and then a response is sent out. If the stimulus is a touch of another person’s hand, the output response is that it is human touch. If the stimulus is a paper cut, the output response is pain. The same works for auditory stimuli – the brain has to decide how to respond to certain words and phrases. The output is usually emotion – how we feel towards hearing these words; do we feel happy/sad/neutral?
Think about this scenario: if you were a client (no healthcare background, unfamiliar with medical conditions or rehab guidelines in general like much of the populations we serve) and you found out you had a rotator cuff tear. You get an MRI and the MD tells you that you tore your RTC, you may need surgery, you may not be able to lift your arm without pain, they may ask “how much pain are you in?” etc… The same can be said of chronic pain clients. When these words are processed by the client, the brain’s output of emotion is negative and can heighten the pt’s perception of pain. There is an article published by Thomsen, R. et al in 2011 “Impact of emotion on consciousness” where they found that “participants were more confident and accurate when consciously seeing happy versus sad/neutral faces and words” with “evidence of interaction between emotion and conscious experience”.
If the client is predisposed towards having negative emotions with regards to their injury, we have to do better as PTs to change their overall outlook. We interact with the client on a more consistent and frequent basis than the MD does, so what we say matters more – if we are consistently conscious of our language use around the client, it can re-shape how they perceive pain. However, if we are consistently asking the client “how bad is your pain today?” or “do you have pain with overhead lifting?” or “don’t run/don’t lift heavy objects” – we are feeding into the client’s negative emotions towards their injury. Instead, ask these questions with different phrasing such as: “how’re you feeling today?”, “Are you able to perform any overhead lifting?”, “Modifying your run schedule or working on pacing during your run can decrease your discomfort”.
By turning some of these questions into “open-ended” ones, the client is forced to become more aware and mindful of their current status – over time, the client may start responding in a more positive manner. They may say “I still get a little pinching with overhead lifting” to which you can respond “that’s a positive improvement, when you started overhead lifting was a very difficult movement for you!” Positive language can help your client become more mindful of their current status. Luiggi-Hernandez et al published a paper in 2017 on mindfulness for chronic low back pain where they found that mindfulness helped participants decrease negative emotions towards chronic low back pain, decrease fear of pain, reduced significance of pain etc…
During a client’s first evaluation (especially chronic pain clients), I set the expectations very clearly – I know that pain will persist for a while, however, I don’t want the client to search for improvements on a day-to-day basis. Even if they still have the same level of “pain” or “discomfort” what I want them to look for, weekly/bi weekly, is if they can perform more functional tasks – tasks that they weren’t able to do prior to starting PT. This, in itself, is improvement. This sets the tone for all of my future sessions because the client won’t focus on the pain – they know it’ll still be there. Once they begin to follow through with my plan of care, they will – all of a sudden, usually – realize they have less pain with movements and it becomes an “A-HA!” moment for them.
Now, I don’t want people to read this post and think they can talk someone out of pain. The idea is to be aware of our choice of words and use guided mindfulness to decrease the client’s sensitivity and allow you, the PT, to treat their impairments and dysfunction. You still have to address their deficits and strengthen weak areas, cue proper movement patterns etc… but having the right word choice can open up new opportunities for gains.