Time to Stop Helping People Feel...Worse
Updated: Nov 14, 2022
Let's start with a simple little game of choice that I like to call "this or that." There is one rule and that rule is simple. I want you to tap on one phrase from each of the pairs below that you best identify with.
Ready? Go!
Pairing 1
- Herniated disc
- Protrusion of the L4/5 intervertebral disc
Pairing 2
- Instability
- Hypermobility of the right glenohumeral joint
Pairing 3
- Weak glutes
- Reduced motor fiber recruitment of sup./inf. gluteal nerves
It is likely that your answers are a reflection of your profession, knowledge base, and overall healthcare experience.
For instance, a medical/healthcare professional may recognize the importance of describing the severity of a disc related injury in terms of using the word " disc protrusion" which is less severe than "disc sequestration."
In comparison, without this knowledge or background, someone may have selected "herniated disc" because it is more commonly heard and familiarly tossed around in the community.
Ok, so what's the point?
The language used by medical and healthcare professionals, in my opinion, is meant to be unifying. It includes latin root based anatomical words with directionality. It contains suffixes that indicate disease state or process. It has letter and number pairings that indicate locations, stages of injury, stages of disease, and meaurements. Inherently, it is complex, but it is a language that conveys intentional meaning that can be understood across medial and healthcare professions. What does this all mean? Better care for you as the consumer of medical and healthcare services.
The glaring problem with this type of specific medical language, however, is that it can create feelings of confusion and unease for those that do not have this knowledge or background during or after an appointment with one of these medical or healthcare professionals.
Everyone has experienced this feeling of confusion and unease at some point in time in a variety of settings.
For example, I am not the best with technology, wiring, or electrical components. I appreciate all the help I can get in this area. However, often times the experience I have when talking to someone about an issue I am having looks and feels a little something like this...
"Your X23 cable inlet does not transmit the 15cd3 file with the correct frequency of 50 hz so you will want to split the HD with the MI and loop your transmitter around the 52ac converter to fix the problem." - purposeful and helpful technology professional
"[crickets, verbal head nodding, and hoping to look convicing]...got it." - me
This example is obviously and purposefully ridiculous, but in reality, it is not too disimilar from some of the patient stories I hear that go usually something like this after an overly complex or overly simplified appointment...
"My doctor told me something about my hip joint...maybe something about some inflammation around some tendon? I'm not quite sure, but they made it seem like the only answer to my pain is to go to some pain professional and to try physical therapy." - a patient seeking solutions and clarity
Or, even worse...
"I saw a physical therapist previously and they mentioned something about how my left kneecap position is effecting my right shoulder position and therefore contributing to my complicated headache problem through some twisted tissue that is all knotted up and stuck." - a patient seeking solutions and clarity
In my opinion, professionals across many fields, should all try their best to help others better undertand the message they are attempting to convey without overly simplifying or overly complexifying the information. Finding the sweet spot is crucial and can be different for everyone.
Personally, I make it a goal for all of my patients to be able to describe to their family, friends, coworkers, or other providers what it is that we are working on during their time at Reach Physical Therapy and how/why we are addressing the problem. In fact, some of you reading this may remember me asking you to recite back to me the details or your first appointment and throughout your care as if you were speaking to your friend. This helps me, as a healthcare provider, make sure that my message was conveyed and that the information learned was salient enough to be verbalized back to me in the patient's own language without losing the correct interpretation of the message.
It's time to stop "helping" our patients feel...worse
Here are some of the top phrases that I hear from my patients that warrant further discussion - yes, I am looking at you healthcare and medical providers. Let's open this up for discussion so we can start making influential changes in our communities.
Dead Butt Syndrome
Patients often report that at some point along their healthcare journey they were told that they have something called "Dead Butt Syndrome."
Let's all take just one moment and just interpret the catchy language used for this "syndrome," which cannot actually be found in literature outside of blog articles written by people like myself.
Dead = not alive
If left up to interpretation, one could assume that their butt is "dead" and doesn't actually work. This is actually what is intepreted a majority of the time by patients in the clinic that come to see me from other providers. How do we expect people to feel regarding their ability to improve when they are told your butt doesn't work? In fact, it is "dead."
A truly "dead butt syndrome" might be more truly applied to people with spinal cord injuries or neurologic diseases in which the nerve to muscle connection no longer functions as it once did or even does not function at all.
Instead, I suggest that we start calling "dead butt syndrome" what it is actually meant to imply.
"Weak butt muscle that is difficult to utilize - specifically when in a standing position."
Simple. Meaningful. Repeatable. No room for intepretation that leaves the patient feeling helpless because their butt is nearing the state of death. Changing this language instills optimism that something can be changed and how that might be done.
Comparing a lumbar spine disc to a jelly filled donut
This is probably the most commonly discussed language out their when it comes to lumbar spine disc injuries. The good news is that patients are hearing less of this language, and this is a really good thing.
The analogy of a jelly filled donut resembling a lumbar spine disc (or any other interveterbral disc) does make sense when looking at a picture and comparing the two.
The problem with this is that jelly donuts are inherently not made of anatomical tissue.
Let's all take a brief moment to imagine stepping on a jelly filled donut. Imagine the feeling of the donut easily compressing, giving way, and eventually seeing the red jelly splattered everywhere.
Now, replace that donut and imagine stepping on a lumbar spine disc...Houston, we have a problem. This imagery that is used commonly as an analogy promotes the disc as being weak, squishy, easily damaged.
Anatomically speaking, the disc, unlike a jelly donut, has incredibly dense, overlapping, and criss-crossing layers of strong, fibrous tissue called the annulus fibrosus. This tissue is resistant to stretching forces. The annulus fibrosus surrounds a remarkably resilient structure that is firmly gelatinous in
nature and responsible for resisting compression/squeezing forces. This is called the nucleus pulposus. On either end (top and bottom) of the disc are dense, cartilaginous plates that create even more stability to the disc and allow for migration of fluid between the bone and disc for
nourishment. Furthermore, the disc is surrounded by wide, tough ligaments that provide added structure and support to the spine and discs. The disc is further protected by compact, strong bone and finally supported by layer-upon-layer of resilient muscles that can also reduce loads imparted on the disc.
https://www.statpearls.com/ArticleLibrary/viewarticle/24456
Now, let's return to our imaginary world, and again, imagine stepping on a lumbar spine disc... Houston, we have liftoff. This imagery promotes the disc for what it actually is...strong, stable, and supportive.
I am not denying the fact that discs become injured, but I am arguing that we can help people better understand how inherently strong a disc can be by changing the language we use to describe disc injuries and anatomy of the body.
The jelly donut example also doesn't allow for correct interpretations of disc injury severity/stages or even disc healing properties.
For example, stepping on a jelly donut would illustrate the most involved and serious form of disc injury called disc sequestration. This condition often involves surgical correction for management.
However, more often than not, people are told that they have a disc protrusion or "bulging disc" which is usually the least involved disc injury and often does not even demonstrate any of the "jelly filling" (aka the nucleus pulposus) escaping the confines of the donut (aka annulus fibrosus). Look at you understanding those anatomical words now!
As it turns out, lumbar spine discs are incredible structures that can become injured just like any other tissue in the body - but, they are most certainly not delicious, morning treats.
Encouraging. Informative. Hope providing. Changing this language instills optimism that something can be changed and that the spine is built for protection.
Joints that are "unstable" or "out of place."
This one is for all of my hypermobile people out there that have genetic, neurologic, autoimmune, or acquired forms of excessive joint movement.
When used in context of joints, the words "unstable" or "out of place" tend to make people automatically feel one way...easily breakable and afraid of movement.
Imagine building a pyramid with playing cards. You lean one card on the other. Repeat. Set a card across the top of those two triangles. So on and so forth. It only takes one wrong movement and the whole pyramid comes crashing down.
Telling people that their joints are "unstable" or "out of place" is like telling people their joints are similar to a pyramid of playing cards. Inevitably, there will always be something on the horizon that will cause them to tumble and limits their ability to improve upon or manage their excessive joint movement.
The same is true regarding the spine being "unstable" or "out of place." Take the description of a lumbar spine disc (from section above) and apply that many times over to make up a complete spine full of discs and bones. Add even more dense, taut ligaments, more muscles, and really cool bone structures and you will build a picture of resiliency, structure, and strength related to the spine. Telling someone that their spine is "out of place" leads to an intepretation something similar to an air hockey puck sliding on a table. It just zips back and forth without resistance. The main times that the spine experiences this sudden "out of place" movement is with high forces involving high velocities which often is a result from a traumatic injury. We don't simply just slide joints in and out of place by moving throughout our day - especially not in the spine.
Intead of "unstable," let's start explaining to people that excessive motion of joints does exist and can be addressed, and that something "out of place" should be said only regarding joints that are truly dislocated.
Help people build a more structured pyramid of cards by giving them the tools and words that can act as tape, glue, scaffolding, and structure. Sometimes you cannot change the hand you were dealt, in this case joint hypermobility, but you can be provided with language and treatments that make you feel self-reliant, confident with movement, and able.
Supportive. Promoting independence. Confidence boosting. Changing this language instills feelings of ability and belief that things can be improved upon.
Now it's your turn...
What language have you been told about your body that seems limiting and discouraging?
What language have you heard as a healthcare or medical provider that makes your ears turn red with frustration?
What part of this blog do you agree or disagree with?
Let's have a conversation and build a better community. I would love to hear from you!
Keep REACHing,
Dustin Lee PT, DPT