I saw a post on Facebook a couple of weeks ago where a therapist was looking for advice on communicating with their patients.
This is partially because of frustration when a patient has an outdated belief around pain and their body, but you’re now trying to give them a different story.
This can be tough, especially as we learn new research and terminology and try to update ourselves.
Sometimes we want to vomit all the info we know, and people aren’t always receptive to this new information.
So, I figured I’d take a shot at how we can better communicate some of the things in question.
Here we go.
Do I Feel Tight?
This one is a classic.
I’m sure we’ve all had that person get on the table, turn and look at us, then ask, “Am I the tightest you’ve ever felt!?”
The funny thing about “tight” is that somehow as a society, we’ve bastardized this into being something associated with pain. Tight is just a sensation, and it’s a very personalized sensation.
I like feeling tight. When I go to the gym in the morning and do a good workout, I usually feel “tight” for the rest of the day. It makes me feel like I’ve accomplished something, and I’m taking care of myself. However, I don’t associate this feeling with pain (but again, this is a personal, subjective experience).
I think back to an experience I had working with some athletes a few years ago, and this is usually how the conversation goes with someone who asks about this:
Athlete: Do I feel tight?
Me: I don’t know. I’ve never treated you before, so how would I know if you feel tight or not?
Athlete: Oh, well, it’s just that my therapist at home always tells me how tight I am.
Me: Well, the more important thing is how you feel. Do you feel especially tight today?
Athlete: No, I don’t really feel tight at all?
Me: Then you’re probably good!
We then carried on the treatment, and at least for the rest of the camp, the athlete never really worried about feeling tight.
In the case where this is someone who maybe we’ve seen for a while, and they come in and ask if they feel tight, we could change the term to “protected”.
Perhaps we say something like: “well if this area is feeling tight to you, maybe for some reason the body is trying to protect the area, let’s just try to calm the area down and send some safety signals to decrease that protection”.
Whatever language we develop around something like this, let’s make sure we’re not using language that could cause someone to catastrophize what’s happening.
Don’t be the therapist telling people they’re “tight” like it’s a bad thing; let’s reassure them this is okay, normal, and they’re not damaged or broken.
My Posture Is So Bad
Unfortunately, there is so much in the media these days proclaiming that bad posture is the root of all evil.
People have heard things like “sitting is the new smoking” or that they have “text neck”.
Well, we know neither of these things is true, but it’s likely our patients don’t.
But this is where we could take a little time to educate them and even ask questions like, “well why do you think your posture is so bad”?
Depending on their answer, we could try to re-direct their thoughts by making some comparisons.
On things like text neck, we could point out that in the past, we’ve never seen anything like “encyclopedia neck,” “knitting neck,” or in reverse “ceiling painters neck”.
When it comes to sitting, we could point out how any posture held for an extended period will likely get irritating. I can’t imagine how those guards outside Buckingham Palace who have to stand in that “perfect” position all day aren’t going home and just wanting to sit for extended periods after work.
The reality is our best posture is our next posture (I don’t remember where I first heard that to reference it, but I think it was Greg Lehman).
Just showing them that any posture is safe and frequently moving to change your posture is a good idea might be enough to get rid of those old beliefs.
If not, we could cite several research articles that show posture doesn’t correlate to pain, but I’m not sure how many non-therapists want to dig deeply into that info.
Did You Feel That Release?
Well, we know that we can’t actually “release” anything with our hands.
However, many people have been told by other very well-meaning practitioners that they’ve released their fascia, a muscle, or a trigger point.
So what would be a simple way to communicate how we aren’t “releasing” anything but rather are having an influence on the nervous system?
As we mentioned earlier, it could be a matter of changing the language to a chat about protection mode and sending a safety signal to reduce that protection.
Another way is to say:
“Well all the new research has shown us that we’re actually having more of an influence on the nervous system. So, this area is probably a little sensitized right now, we’re not actually releasing something, we’re just calming down that sensitized area. So what you felt is more likely just the nervous system calming down.”
We will all have our way of communicating these things, and I’m sure you can come up with something better than what I’ve jotted down (and honestly, I’d love to hear your take on it).
Let’s make sure that we’re changing the narratives on many of these things along with the techniques we use, and we’re not giving our patients any reason to catastrophize an individualized sensation. We can do better than that.