Words Hurt - Are you being Labeled?

We’ve all heard the saying “Sticks and stone may break my bones but words will never hurt me”. This statement, when it comes to pain couldn’t be more false. Words hurt. Labels hurt. Fear hurts.

The current times and medical world has us chasing diagnoses when we hurt - what is wrong? Is something broken? Torn? Is something bad going on? These thoughts and the chase itself can lead us to unnecessary imaging, unhelpful diagnoses, and labels that make us fear movement and fear worsening our conditions.

Labels may be from images that were taken “I have bad arthritis”, “I have a disc herniation”, “I have bone on bone”, “there’s a partial thickness tear in my rotator cuff”. Labels may be subjective from healthcare providers “this is the worst case I’ve ever seen”, “your hips are so out of alignment”.

As a patient - do you really want to hear that your scan is “the worst ever seen”? No, right? But yet many people carry this as a badge and it is then how they identify themselves when talking about their current condition. This mindset then inhibits progress and may instill fear of movement/exercise.

Let’s start with imaging. Imaging can be extremely instrumental at times to rule out sinister pathologies or quickly identify tissue damage that needs attention (broken bone, dislocated joint, torn muscles) - however when pain has been persistent for long periods of time (e.g. low back pain, shoulder pain, neck pain) - images may be more harmful than helpful.

In people WITHOUT pain, imaging will show a disc bulge in 50-60% of the population aged 40-50 (84% by age 80) and disc degeneration in 68-80% in people aged 40-50 (96% by age 80). This begs the question as to if these “findings” are ACTUALLY NORMAL, not abnormal. To change this in the medical world, clinicians need to keep thinking, keep reading, and accept this knowledge that is not new news. So imagine that you are someone with low back pain (or maybe you actually are) and you are labeled with a disc herniation - when actually 50% of people around you have THE SAME diagnosis and do not have pain - is this the actual problem? Maybe, but clinically it has to make sense and treatment will likely be the same regardless of "the finding". This situation is not unique to the low back - knee osteoarthritis, hip arthritis, shoulder/rotator cuff tears - all have similar findings where asymptomatic people show significant findings on an image.

With imaging - once you’ve seen your picture you cannot unsee it. The call to action in the medical field is to reduce imaging, but this will take a long time to change. On a recent call with a phenomenal group of professionals, one of the current mentees gave a great analogy - the Xray/MRI is a picture - but when we work with you we are taking the video to help understand your body. Things cannot be explained in one still shot.

Other labels are include “your hips are out of alignment” (PTs, chiropractors, massage therapists, I totally used to say this as it was what I was taught), “your rib is out of place”, “it’s wear and tear of your joint”. There is no evidence to support such statements and they only make us feel like we need someone to fix us or worse yet that we are constantly hurting ourselves.

Let’s stop and think how words can actually hurt. This is the slope I see…When you hurt, you get scared. When you are labeled you become even more fearful to do something wrong. When you fear yourself or your movements, you stop moving, stop exercising, stop using that body part. When you stop using a body part you may overuse another part. When you stop exercising you gain weight. When you gain weight your self confidence reduces and your overall health suffers.

Words hurt. Labels hurt. Choose them wisely, understand what is normal and not. Build people up and make them feel resilient and not fragile. Make them believe they can build themselves back and do not need to be "fixed".