When I talk to my patients about their diagnosis, imaging results, and symptoms, I try my best to always remember how powerful my choice of words can be. Pain and dysfunction-centered conversations should be replaced with positive phrasing and encouraging discussions about how Physical Therapy will help decrease their symptoms and improve their function. We have an opportunity at every step of the treatment process to change our patients’ outcomes, and this starts with how we react to and discuss their diagnosis.
There are times when I make a mistake in how I talk about a symptom, a diagnosis, or a procedure my patient has had or plans to have. Almost immediately, I have seen the negative effects this has on a patient’s beliefs, attitude toward their rehab and potential for improvement, and my ability to form a therapeutic alliance with them moving forward. One label in particular that can have this effect on patients is “degenerative disc disease.”
The American Academy of Orthopedic Manual Physical Therapists (AAOMPT) recently came out with a position statement (found here) that opposes the use of “degenerative disc disease” as a diagnostic term for the cause of neck and back pain. They state that the changes denoted by this term are often related to normal age-related changes in the size and shape of the vertebral discs. Labeling these changes as a “disease” can and does sometimes lead to unnecessary and invasive treatments including injections and surgical procedures.
They also state that patients respond to this label by “avoiding beneficial physical activity for fear that exercise and movement will worsen their condition, possibly leading to chronic pain.” Another area in which we as Physical Therapists can have an effect is the over-utilization of opioids for management of neck and back pain related to these age-related changes.
Physical Therapists play a key role in the management of spinal pain, and can help decrease opioid prescriptions and unnecessary procedures. We can help patients to improve, manage, and learn about their neck and back pain before it becomes chronic.
Physical Therapy should be a key component in the first line of care for patients whose symptoms do not improve initially on their own. Furthermore, practice guidelines for low back pain suggest a completed trial of conservative management, Physical Therapy treatment, before discussing or ordering any imaging studies. Let’s be part of the solution and think about the power of our words when talking to our patients about their diagnoses and symptoms.