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Andrew Terry
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I’m in pain because of my posture… and other flawed language
why is language in pain important?
I want to talk a little about language today, and why it has such an important role on the journey out of pain. Medical professionals (osteopaths included), have often been so keen to explain to patients their findings that they can leave them with a feeling of dread about their body. We show them scans, talk about their “bad posture” (more on this later), and things being out of place (as if somehow a body part can be lost within its own body) that even if they manage to get them out of pain initially, the patient is left with the feeling that something was really wrong and can often become fixated with their diagnosis. They may seek constant treatments to fix their perceived ailment, or be on the lookout for future pain. The problem with this is, and patients who come to see me know I say this a lot, is that pain comes from the brain, so if you’re on the hunt for pain within your body, more often than not you will find it. Understanding of this intricate link between our psychology and pain is growing by the day, with more and more studies suggesting that negative pain beliefs have a direct correlation with our levels of pain.
So I want to talk about some of the flawed language you may have heard in relation to pain. Whilst I’m not going to sit here and say that these hold no importance at all, their perceived importance and actual importance are often further apart than you think.
1. I need to strengthen my core
Another version of this is “I am in pain because I have a weak core.” I often wonder how this one started. I would imagine it’s because of the huge prevalence of back pain in Western culture and our need to find a common cause. There are a few problems I have with this statement, like, “why do so many people with a “weak core” have no back pain?” Or on the other end of the spectrum “why do so many people with strong cores have back pain? “At what point is a core considered weak?” And “why if a strong core is so important (it’s not), is this not important for other parts of the body?”
But most importantly, it’s the fact that those who feel they have a weak core then think that their back is weak and fragile. Even worse, you may even stop moving about as much because you’re worried that your back will let you down. So let me say this now, your back is AMAZING. It’s incredibly adaptive and strong, and in my years of practice I can probably count on one hand the number of times I have said weak muscles in the back may have been a contributing factor towards their pain. In fact I would say I spend more time fixing tight muscles in backs than I do weak ones. The studies that have gone into comparing exercises that stabilise core muscles in comparison to general exercise or manual therapy have shown that they have little affect, and only marginally better than placebo (Ferreira, Ferreira et al. 2006, Ferreira, Ferreira et al. 2007, Costa, Maher et al. 2009). So please, do not stress about your core, just make sure you move around as much as pos
2. "My back goes out of place every now and then"
You can add to this, “my hip pops out,” “I have a slipped disc” and “my <insert body part here> is out of place.” My usual response to this is “where did it go?” Now I’m aware that this is a common phrase related to having back pain (or whichever body part you’re referring to) that reoccurs, and I also know this pain might be excruciating. But I want to reassure you that your hip or back didn’t actually pop out. It might have felt like that, you may have heard something click and you felt pain, but it hasn’t literally slipped out of place (Palsson, Hirata et al. 2014). Again this might seem like I’m being a bit of a pedant in my use of language, but this is what this article is all about, how language influences your pain. You’ve injured yourself. That’s it. Some of these may be more serious than others, but you do not need to go down the path of thinking that your body has given up on you or it’s broken. The anxiety of thinking that parts of your body may pop out when you move can lead to. It’s why I always tell my patients that I am an osteopath that believes in homework. I want to reassure them that their body is fine, and that the most important thing they can do is to keep moving within pain-free levels, or what I like to sometimes call, comfortably uncomfortable ranges of movement. The best route out of pain is an active one.
3. "I know I'm In pain because of my bad posture"
I actually like my patients to have good posture, but it’s probably not for the reasons you think, and this is definitely one of those ones where perceived importance and actual importance are much further apart than you realise.
The reason I like my patients to have good posture is actually partly down to aesthetics. If you think you look good and enjoy having good posture, then it’s likely you’re going to have a more positive relationship with your body, and I want to promote that as much as possible. But in reality the most important thing in regards to posture, is to not be in the same position for extended periods of time.
Our body is constantly repairing itself, and these new tissues get aligned through movement. The key word here is movement. If you have perfect posture all the time, but don’t move much, then you’re still going to develop restrictions, which mean you’re likely to be less dynamic and are then much more likely to experience pain. In fact you’re just as likely to experience pain if you have perfect posture but don’t move, as someone who has poor posture and doesn’t move. Our bodies are a bit like pumps. Changes in pressure are occurring all the time, through a mixture of breathing, movement and other clever processes that allow everything to flow throughout your body, from blood to lymph, and keeping this flow healthy is extremely important in helping us reduce the chances of pain and discomfort. So the next time you’re worried about poor posture, just get yourself up and about rather than stressing about the best position you should be in. There is no poor posture, only a body that lacks movement.
4. "I've had a scan which shows degeneration so I know I will always have a certain level of pain"
As modern medicine has progressed, our eagerness to use scans as a means to get a diagnosis have increased. The problem with this is that even scans can throw up a few problems of their own (if you’d like to read more on scans you can read one of our other blogs). Let’s dissect a couple of the most common issues.
They show you everything that has happened to your body:
There have been numerous studies into abnormalities found on scans in asymptomatic people. One found that 37% of 20 year olds, and 96% of 80 year olds had some form of disc degeneration. What’s important to remember in this study is not how many people have some form of disc degeneration, but how many people have something show up in a scan but have no pain at all. If so many of us have degeneration but no pain, how useful is it to be told that degeneration is the cause of your pain?
You might get a different diagnosis from different physicians from the same scan.
When you go and get a scan you would expect a degree of consistency. After all it’s just an image. However different diagnosis from the same scan can vary dramatically. Take a study of a 63 year old woman with chronic low She had 10 different scans at 10 different facilities, with the result yielding 49 distinct findings. So is one right and the rest wrong? Or are all of them right? How would you feel if you were given 49 different diagnosis? Scans are of course a really important part of modern medicine, but we might be overusing them. Pain is complicated and it’s important we don’t associate our levels of pain with scan results.
5. "My glutes aren't firing"
If you’re able to walk, then your glutes are “firing” just fine. This term has become dramatically oversimplified, and is often linked with running or squats. Running, and even squats are actually rather complicated movements for the body, with chains of muscles working together. For any number of reasons, sometimes these chains can become out of sync, but this doesn’t mean that something isn’t working properly, it just needs a little guidance in getting back in sync, either through treatment, dynamic exercises or ideally a bit of both.
6. "I've been told it's all in my mind"
This is something that you may get told after you’ve had scans that have yielded no meaningful results. And whilst technically it’s accurate, how useful is this information unless you’re given an explanation as to why this might be happening, coupled with guidance in how you might overcome it. Just because it might be “all in the mind,” doesn’t make your pain any less real. Our job as primary healthcare practitioners should be to explain to you how and why the brain creates pain, and then offer you support so you can begin to make the steps towards being pain free.
Here’s a great Ted Talk by the amazing Lorimer Mosely who explains this better than I ever could.
If you would like to know more about your pain, what might be happening, and how you can go about getting pain free then please don’t hesitate to get in touch.
You can call us on 0208 088 0533 or book online and have a chat with one of our osteopaths.
