Popping your disc – when ‘elegant simplifications’ are ‘catastrophic trivialisations’

I know a good number of well meaning clinicians who love telling patients how bad their injury is – “Wo George – you are lucky you didn’t end up in a wheelchair!” – “Martha – you have the back of an 80 year old” – “Jeepers John – it’s bone on bone in there!”.  How many surgeons visit their patient a week after surgery and say, with a glint in their eye, “you certainly messed it up in there didn’t you!?!”  Well I reckon we could do well to think carefully about the accuracy of not only what we say, but what we imply, when we tell patients what is happening inside their body.  We are, after all, their main source to very important information about how danerous this situation really is. This point was made particularly clear to me when a fellow tried to sell me an educational model of the lumbar spine, at a conference on low back pain.  Heidi filmed me telling some physio’s about it. It is dodgy film, but it saves me saying it again.



  1. I don’t believe that any normal person of at least average intelligence and a reasonable amount of common sense would believe that their discs were popping out no matter how much their back was hurting.

    What sort of health professional would demonstrate such a thing? Who was buying these spinal demo models with popping discs?

    I would say that these dynamic models are a useful tool for a physio to use to show just how robust a spine can be especially when working well with a good muscle co-ordination.

  2. Anonymous says

    Aaaah, it reminds me of this beautifully awful patient info sheet that we blogged about a while back.


    I still keep a copy to amuse/appall me from time to time

  3. Adam Rufa says

    I think it goes to expectations. The expectations we have greatly affect our perception. Studies such as the invisible gorilla and placebo studies have shown this. If patients are primed to expect a placebo to produce a positive effect it is more likely to produce that effect. I would imagine that expectation of a negative experience would make it more likely to have a negative experience.

  4. Luke Parkitny says

    This is certainly well recognised in the pain field and examples of “bad advice” abound.
    What is interesting here is to speculate why this happens… so, Luke’s abstract and “going off on a tangent” hat goes on…The visual and understood (i.e. this thing makes sense to me in context of my knowledge) message is powerful and seductive. We, as humans, look for patterns in nature and for simple explanations of what are complex events. We look at the sun and see it as a bright disc moving across the sky rather than an enormous sphere of plasma millions of km away, gravity is something whose effect I feel as a pull rather than understand as (?) curvature of space-time being manifested through our senses, that sound of expanding and contracting wood due to the change in ambient temperature is a ghost, and colour is just wavelengths after all. I guess that we are designed for interpreting and even creating practical solutions to very complex phenomena.
    So, do we have a crumbling spine, slipped disc, or just believe in a simple physical solution because we have been designed to do so to survive (in the tundra)?
    These simple visual/creative solutions are much more intuitive to us (I believe) than the scientific explanations which are just so difficult to imagine when they can be so complex. This is why, I think, explain pain and related approaches work – they provides a simple image; but they ARE competing with other images that can be delivered just as powerfully.
    Heck, the ad guys have known this for…ever! We’re programmed for it!

    neil goodenough Reply:

    I agree with some of Luke’s comments, and i am reminded of a piece by Robert Sapolsky on using metaphors to access parts of the brain..
    I try to bear the power of these metaphors in mind in my own endeavours to help patients overcome pain.

  5. I recall an episode of the Simpsons, where Lisa needed braces. The dentist had a simulation program which demonstrated what would happen without corrective braces. There were a number of progressive images of Lisa’s teeth becoming more and more deformed, with the final slide showing a rampant tooth exploding through her eye socket from her lower jaw……

    Funny, over the top stuff.

    Over the top???

    Have seen models of the lumbar spine in Chiropractor’s waiting rooms demonstrating progressive spinal “degeneration” with L1/L2 looking fairly normal, progressing through “Stage 1” to “Stage 3” spinal degeneration with the L4/L5 segment showing massive osteophytic lipping, fusion and virtually no ‘disc’ left.

    Of course, Stage 3 could be avoided with regular visits to the Chiro for adjustments……..

  6. 🙂 “Crumbling spine” seems to be a favourite amongst GPs here. One of my poor patients now has two crumbling knees in addition to her crumbling spine and her GP is cross that she sits and watches TV all day! She has this vision of bits falling off her vertebrae (and now knees) whenever she stands, so she does the ‘sensible’ thing and does as little of it as she possibly can!

  7. I am NOT one of those therapists who tell people how terrible they are, or how right their muscles are. I tend to focus on what they can do, and the changes made in therapy. People do seem to like being told they are the worst though. In a practice where I work with another LMT, who while well meaning, seems to do this. People rarely split their therapy between the two of us. It seems that people feel special being the ‘worst’. Sigh.