The Power of Nocebo: Words That Weaken or Heal.
In physical professions—like physical therapy, chiropractic care, personal training, massage therapy, medical doctors, nurses, and physician assistants—the words we use matter. A lot.
While many know the placebo effect (positive expectations improve outcomes), fewer recognize the nocebo effect—when negative beliefs lead to worse outcomes. And unfortunately, it happens often in our fields.
Phrases like:
• “Your spine is out of alignment.”
• “You’ve got the back of an 80-year-old.”
“Your posture is causing this.”
“Your knee is bone-on-bone.”
“You have a twist in your pelvis, which causes……….”
…can sound like helpful explanations, but they often plant seeds of fear, fragility, and limitation. Patients begin to move less, trust their body less, and expect pain.
Here’s the reality:
Pain isn’t just about tissue damage—it’s influenced by what the brain perceives as danger. When we suggest a person is “broken,” we may unknowingly amplify their pain, delay recovery, and limit their confidence to move.
Instead, try:
• “These imaging changes are common—even in people without pain.”
• “Let’s get you moving in ways that feel strong and supported.”
• “Your body is adaptable—and capable of getting better.”
Bottom line:
Our words can harm—or heal. Be mindful. Speak with clarity and hope. The story you tell about the body may shape how it recovers. As a practitioner, it’s OK to address these issues, such as asymmetries in the pelvis, but research reveals that we are all asymmetrical and pain is not, or rarely, generated by these normal body differences. We also know through research that correcting asymmetries doesn’t necessarily improve them. So, maybe we consider, if the patient is not getting better, to do some corrections by telling them that “I am going to loosen up this joint to see if you can move with less restricton” versus, “lets correct this asymmetry and then you will be better”. Do we need to create a relationship of dependency? Because, that is what is done when you speak in these Nocebic terms.
Let’s be careful what we plant. Because people grow into it.
Here’s why this is connects to the work we do together