Choose Wisely: The Importance of WHAT you say and HOW you say it

PT Blog   •   September, 2018

“Words are free. It’s how you use them that may cost you.”             Unknown

The old rule of “it’s not what you say, it’s how you say it” may prove true in many situations in life: consoling a grieved loved one, encouraging a family member, having a “discussion” with your spouse; however, as it goes with most things in life, rules are meant to be broken.

A recent article published in the July 2018 edition of the Journal of Orthopedic and Sports Physical Therapy titled, “Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation” sought to “gain an improved understanding of the frequently hidden influence that language can have on musculoskeletal rehabilitation” and emphasize “the powerful consequences of the words that we use in clinical practice and discuss the practical considerations for adapting the current language.”The article highlights the fact that many clinicians are unaware that their word choice has a dramatic influence on the way patients perceive and experience pain and that interventions employed to decrease pain and promote healing may, in fact, be doing the exact opposite.

Physical therapy professional education and training is deeply rooted in the biomedical model with a concentration on pathoanatomical language. One study by Briggs et all cited “biomedical issues account for 99% of all health care training.”Conversely, mounting evidence exists that psychosocial factors, not pathoanatomical factors, are more effective predictors of pain and disability.3 With this knowledge, word choice is of paramount importance when dealing with patients. Words have the capability to either heal and restore or create detrimental and lasting harm. They can build or they can destroy; reduce anxiety and perceived threat or place undue burden on the system. The article in JOSPT offers a table of “Typical Words to Avoid and Alternatives for Patients” in the hopes of creating an environment where patients view their conditions in a more optimistic lens and enhance recovery expectations. In her book, Rainy Brain, Sunny Brain: The New Science of Optimism and Pessimism, author Elaine Fox states,

“if we change the way we view things, the things we view can change.”4

Avoiding words that increase threatening input such as, “degenerative changes, damage, chronic” and replace them with alternatives – “normal age changes, reparable harm, it may persist, but you can overcome” – fosters an environment that focuses on the patient’s expectant recovery, guiding their perception away from hopelessness and despair and towards anticipated healing.

Chronic musculoskeletal pain continues to rear its ugly head and fill physical therapy clinics across this country affecting approximately 126.1 million adults yearly.5 A comprehensive approach to treatment must be utilized taking into account the biomedical issues alongside psychological influences surrounding how patients perceive their injuries, their pain, and their view of their world and circumstances. The words that are spoken (or not spoken) greatly impact recovery for all patients, and it’s the hope of this post that this knowledge will spark a paradigm shift in our treatment of certain musculoskeletal disorders; however, knowledge is only half the battle. As the German playwright Johann Wolfgang von Goethe stated, “Knowing is not enough; we must apply. Willing is not enough; we must do.”

Contributing Author Credit: W. Evan Stringfellow, PT, DPT, CSCS, Cert. DN

Edited by: Ashley Theobald, DPT

Photo by rawpixel on Unsplash


  1. Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018;48(7):519-522.
  2. Briggs EV, Carr EC, Whittaker MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011;15:789-795.
  3. Chester R, Jerosch-Herold C, Lewis J, Shepstone L. Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. Br J Sports Med. 2018;52:269-275.
  4. Fox E. Rainy Brain, Sunny Brain. New York, NY: Perseus/Basic Books; 2012.
  5. Louw A, Nijs J, Puentedura EJ (2017): A clinical perspective on a pain neuroscience education approach to manual therapy. Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2017.1323699

About the Author:

Ashley Theobald, D.P.T. – Ashley was born and raised in a small town in Alabama. She attended the University of South Alabama and was an advanced undergraduate student completing her Bachelor of Science degree in pre-professional health sciences in 2012. She then graduated with her doctorate in physical therapy in 2014. During her first year of PT school she met and married her husband, Ben. They moved to Nashville, TN where she worked for 3 years in an outpatient clinic full time and at Vanderbilt Stallworth Rehabilitation Hospital PRN. She is now working for ATI Physical Therapy full-time in Greenville, SC. She has been an avid health and fitness fan playing softball growing up, tennis in high school, and completing 2 half-marathons in college. She enjoys traveling overseas and has completed 2 short-term medical mission trips for physical therapy in the Dominican Republic (2013) and Haiti (2015), with intentions of returning yearly.
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