One of the more difficult aspects in medical care is explaining to patients what their problem is in terms that they can understand. For example, ‘the extrusion of the nucleus pulposus through the annulus causing nerve root impingement at the level of L4’ probably means sweet FA to the person on the street, but tell them they have a ‘slipped disc’ and they will have an immediate idea of whats going on.
And this is where the trouble begins, because you can’t slip a disc. My god, if you could the pain would be excruciating and the damage likely irreparable. Apart from the most severe disc injuries, most could be likened to a bulge in the sidewall of a car tyre.
However, this person now has a ‘slipped disc’, and guess what? They want me “to put in back in” - because of course, something has slipped out which means it can be pushed back in right? No, nope, not gonna happen. I would like to think we are well past the idea of thinking we are pushing discs back in with physiotherapy treatment.
It’s also interesting how the language that medical professionals use affects the patient’s experience of pain. Now everybody’s experience of pain will differ, but I’ll bet that the person who’s been told they have ‘crumbling discs’ by a practitioner will be more distressed than the person who’s been told that the discs in their spine are in ‘a normal state of ageing’. Which sounds better? Because when people tell me they have crumbling discs I conjure up a image like this -
So if that’s what I imagine, what is the poor patient thinking is going on?! If you were told you had crumbling discs you’d be forever in fear of making it worse which in turn would affect how you functioned which in turn would likely worsen your experience of pain. It’s a vicious circle, and one that is difficult to break.
So as well as the above let’s look at some other common descriptives that patients will be told is wrong and what is likely to be actually going on.
Crumbling discs - The most common form is degenerative disc disease (again language here could be better - ‘degenerative’ and ‘disease’ both have negative connotations) which is a natural ageing of the discs where they dehydrate, lose height and can develop small tears in the outer rim. What’s important here is that it is often natural, and the key is effective management with physiotherapy, exercise, strength and conditioning, medication etc.
Crumbling spine - (I’m starting to hate that word!) This can be related to the above, or it can involve osteoporosis, a condition which leads to bones weakening and causing compression fractures in the spine. But again, there is no ‘crumbling’ of structures, just that they lose the ability to withstand the demands of everyday life which may lead to more serious complications.
Trapped nerve - One of the most common descriptives we come across. Unless its related to trauma/accident, you can’t trap a nerve. The nerve may lose some of its mobility (yes nerves move - we’d literally be stuck if they didn’t) but often conditions like sciatica are the result of the nerve being irritated or undergoing compression.
Being out of alignment - I’ve lost count of the amount of times people have told me other practitioners have said they are ‘out of alignment.’ Sometimes, in severe lower back pain, the patient can experience a ‘shift’ of the torso to either side which appears to be a protective normal muscular response. Often, however, this diagnosis of malalignment is normally in the absence of pain or any other symptom, so I’ve got to be honest, I’ve no idea what the other practitioner is on about. Then of course, the patient is ‘put back in alignment’; nope , still no idea. If you were truly out of alignment you may look like this
In which case kudos to whoever can put that 'back in alignment'. No amount of physio/osteopathy/chiropractic will sort that.
5. Twisted pelvis - An all too familiar diagnosis which again doesn’t really stand up to scrutiny. There are normal variations throughout the population; your pelvis may be naturally elevated on either side, there may be a slight rotation of either side within normal ranges, but twisted? I’m not sure that’s the best way to describe it.
So you can see in the above, the words used all have negative meanings - crumbling, slipped, trapped, malalignment, twisted. Words which are likely to have negative impact on the patients experience of pain. There are no neutral words being used - normal, age-related, natural, response, protective, compensating etc. There is a fine line between using layman’s language to connect with a patient and explain their problem in terms they can understand, and striking an element of 'fear' into them with inappropriate descriptives.
I guess what I’m saying is that if you are told you have problems like those listed above don’t fret about the language used. Ask your practitioner what’s really going on. Understand the mechanisms behind your pain. Understand why you are experiencing the symptoms you have. Understand what you can do yourself to help quicken your recovery or to manage the problem. A good practitioner will actually enjoy their patients taking an interest in their symptoms and injuries, because it’s likely to lead to a better outcome, which is all we are after.
Until next time...
*This blog is the solely the opinion of the author, and is not a substitute for medical advice. If you have any concerns, seek medical attention from a suitably qualified person