Review written by Dr Sandy Hilton info


The body of literature regarding musculoskeletal rehabilitation focuses on the search for effective and efficient treatments of pathoanatomical changes. The authors of this viewpoint write in support of the critical importance of the words used to describe both musculoskeletal conditions and the nature of pain itself. They stress the need to consider psychological factors in the prediction of outcomes of pain and disability, and encourage clinicians to take seriously the ability to influence the expectations of recovery based on language and word choice. They present an argument that clinicians should deliberately use their words to support a positive view of recovery and specifically avoid pathoanatomical language such as "degenerative discs" and catastrophic images. The authors state that ignoring the psychological impact of the words used to describe musculoskeletal conditions risks negative therapeutic outcomes.


This is an opinion paper with supporting references from the literature; there is no data collection and no systematic or comprehensive literature review on the subject. Clinical and expert opinion serves an important purpose in the literature and may direct future research.

They present a case example of Ben, a 15-yearl old track athlete who has a conceptual model that back pain will lead to loss of function and persistent pain. "Ben says that he feels broken and cannot switch off the thought that he is going to need spinal surgery." The authors describe phrases that can reconceptualize pain and function for Ben. They emphasize the need to choose words that give an image of resilience and recovery versus frailty and chronic pain. An example of "therapeutic emplotment" is used to describe how a therapist can set the scene for a patient to expect success through a focus on what the patient can do vs what they are not able to do.

Key points of the article are for clinicians to take a panoramic view of how the biomedical or musculoskeletal problems relate to the life of the patient. They recommend keeping the individual in the center of care by considering a couple of key questions - "What does it all mean to them?" and "How can I help them find a positive outlook in this situation?".


Not applicable to this type of study.

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