John Seivert: Resilient bodies, respectful words | Lifestyles

“Your core is weak—that’s why your back pain won’t go away.”

“Your tight hamstrings are probably the reason you hurt your back.”

“Your discs are crushed.”

“Your posture is terrible. Sit up straight or you’ll get back pain.”

“Never bend or twist your back, especially when lifting.”

These phrases—and many more like them—are heard far too often in healthcare clinics. And they need to stop.

Statements like these are not just misleading or outdated—they’re harmful. Research consistently shows that such language can increase fear, worsen pain, and promote disability, even when the patient’s condition is not serious or threatening. We now understand that words carry weight, especially when spoken by trusted medical professionals.

This happens in every corner of medicine, including physical therapy. I’ll be the first to call out my own profession when we use fear-based language to try to “motivate” people.

Years ago, while mentoring postgraduate physical therapists at Kaiser Permanente in Hayward, California, I overheard a PT tell a patient that her back pain would never improve unless she strengthened her core. He also warned her that if she kept bending and twisting while doing housework, she would further tear the discs in her spine.

I was shocked—and I spoke to him later that day. I explained that the evidence does not support those claims. Worse, he had unknowingly planted a seed of fear, encouraging the patient to avoid normal movements. This kind of fear-avoidance behavior can prolong pain and lead to worse outcomes.

Here’s the good news: that PT took the feedback seriously. He dove into the current research on low back pain, movement, and patient education. He learned about the dangers of using nocebo language and the benefits of promoting confidence and movement. Today, he leads the back care program at that clinic—and his vocabulary is filled with words that heal, not harm.

Here’s another example: A patient of mine had recently undergone bypass surgery. His cardiologist told him his left anterior descending artery (LAD) was 90% occluded and called it a “widow maker.” Though he hadn’t had a heart attack, he was told he was “one heartbeat away.” That term—widow maker—terrified him. Even after surgery, he was afraid to walk upstairs or do anything aerobic.

In rehab, we focused on re-educating him: his heart was repaired, and under my supervision, he could safely begin aerobic exercise. With reassurance and a tailored exercise plan, his fear faded. Today, he’s a healthy, active 74-year-old who runs regularly. But that initial label stuck with him for months, delaying his return to life.

Clinical research—especially from Australia and other international leaders in pain science—shows that focusing on structure (like discs, joints, and degeneration) often correlates poorly with pain and disability. Instead, we need to shift our focus in rehab toward movement, function, and resilience.

Unfortunately, the language we hear from healthcare providers is often repeated in daily conversations. A year ago, before I had both knees replaced, I caught myself telling a friend with “knee arthritis” at the gym, “I can’t squat anymore—my arthritis is so bad, I’m bone on bone.” It slipped out without thought. As I tried to backtrack— “But I still ride my bike regularly!”—he just smiled, loaded up the barbell with 225 lbs. and knocked out ten full squats. Message received.

Let’s be clear: there is no strong evidence that normal, age-related changes in our joints or spine cause pain. In fact, imaging studies show that many people with “degenerative” findings (disc bulges, arthritis, etc.) have no pain at all. So why do we continue to use language that turns natural aging into a diagnosis?

We have an opportunity—and a responsibility—to change that.

As healthcare providers, family members, and community members, we must use language that builds people up, not breaks them down. Instead of saying, “Your back is a mess,” how about:

• “Your spine shows normal age-related changes. Most
  • people your age have similar findings and do just fine.”
  • “Your back injury has healed—it’s time to start moving again. You’re going to be fine.”
  • “This is like an ankle sprain—it just needs some time, movement, and confidence to get better.”
  • “Our spines are strong and adaptable. They’re made to bend, twist, and carry us through life.”

  And most importantly: Pain does not equal harm. Especially for active, aging adults, some soreness after activity is not only expected—it’s a sign that you’re living. “Movement is medicine.” I think I say this about ten times a day.

  Let’s retire the fear-based phrases. Let’s educate ourselves and each other. Let’s use words that heal.