Sticks and stones may break my bones, but words will never hurt me

This wasn’t true in the school yard, and it’s not true now. Although we belted it out in the hopes that would make it true. The reality is words mattered then, and they matter now. And not just with insults.

Whether you’re talking about yourself or you’re a trainer talking about your client, be aware of the impact the words you use may have. Placebo is a familiar term to most of us, and it is well documented in scientific literature. In fact here’s a very cool example:

“In a study testing whether the relationship between exercise and health is moderated by one’s mind-set, 84 female room attendants working in seven different hotels were measured on physiological health variables affected by exercise. Those in the informed condition were told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General’s recommendations for an active lifestyle. Examples of how their work was exercise were provided. Subjects in the control group were not given this information. Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index[1]

I’ve said it before, and I’ll say it again: The brain is amazing.

Equally interesting, less known, and possibly more important, is the nocebo effect. Nocebo is basically the opposite of placebo. If a person thinks something will hurt, that can make it actually hurt. Or if a person thinks something is weak, it can make it actually weak. Here’s an interesting example of a nocebo effect:

A group of untrained men did bicep curls, and then did so again 48 hours later. Half of them were given a fake pill (made of gluten-free cornstarch) and were told it would “increase muscle soreness”increase blood flow and inflammation following exercise leading to increased muscle soreness and decreased exercise performance for their follow-up visit 48 h later”[2], while the others were given nothing and told nothing. After each workout, elbow range of motion was measured with a goniometer, pain was measured using an algometer and pain scale, and the number of repetitions completed and perceived effort was noted.

The result:

“Perceived soreness was significantly higher in both control and negative-belief groups 48 h after exercise (p < 0.001; ?2 = 0.23). ROM was significantly lower 48 h post in the negative-belief group (p = 0.004; d = 1.83) while no differences existed for controls (p = 0.999; d = 0.16). Average RPE was unaffected between groups (p = 0.282; ?2 = 0.07). Total repetitions were significantly lower 48 h post in the negative-belief group (p < 0.001; d = 2.51) while no differences existed for the controls (p = 0.999; d = 0.08). ” [2]

People had less range of motion and were able to do fewer repetitions in the second workout, solely because they expected they would be more sore. Now think about all the times you tell yourself or your client something that will make you expect a negative outcome. Here are a few examples I’ve either said or heard:

“If you deadlift like that, you’ll hurt yourself.”

“Running is bad for your knees.”

“This is my bad side.”

None of these statements is meant to cause harm, but considering what we know about the nocebo effect, each one can be harmful. The first two can inadvertently instill a fear of movement, and just hearing that sentence from a trusted source could make the person hearing that more likely to get injured. The third statement will guarantee that the person continues to have a “bad side”.

If we gave consideration to placebo and nocebo effects, we might replace the above statements with:

“Let’s go over your deadlift form to make sure you have good form.”

“If you find running painful, it probably isn’t a great choice for you at the moment. That may or may not change as you get stronger and more fit. If it changes, great! If it doesn’t, that’s okay too as there are lots of great alternatives to running.”

“This is the side that’s not as strong yet.”

Is anyone rolling their eyes thinking this is fluff-talk for weak-minded people? I know it can sound that way, but the fact is we humans are alarmingly affected by the words; for better and for worse.  

Being mindful of the words we use about how strong you are and how worthy you are might be the easiest positive change you can make, and the science is clear that it is both real and important.

This post is an excerpt from the book I’m writing about training around injuries. I’ll be posting one each week for the foreseeable future.

Elsbeth Vaino is a personal trainer and the owner of Custom Strength in Ottawa. She is also keen to announce that she has recently converted her popular Get Healthier 8 Week Challenge into an ebook, that you can find here.

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4 Comments

  1. I love the idea of the focus on the therapy part of chemotherapy and your visual of a technologically perfect fluid injection. So great. Thanks so much for sharing this.

  2. I couldn’t agree with you more, Els…the proof probably lies in the mental setup I adopted when diagnosed with cancer two years ago. When told I would need (in order) surgery, chemotherapy, another surgery, and finally radiation–I immediately stated to myself that I was not going to let Any of that get in the way of all my physical activities (curling, tennis, daily running with my dogs, 3x/week workouts (at Custom Strength!) and also dog sports. I also made sure that every time I mentioned the word ‘chemotherapy’ that I stated it in full, with emphasis on the “…therapy’ half of it! Each week when I went to the hospital for this, I would sit back in the big armchair and imagine a pure, refined, technologically perfect fluid being injected–never a toxin! The result of all of this is that I went through all of this treatment over a period of eight months…and never missed a single session of physical activity…and never felt unwell for even a single day! The only small concession I had to make partway through was to switch from running to speedwalking for a few months when my hemoglobin went down somewhat below normal. (but I was still able to maintain a pace above 130 steps/minute every time…) Since that time, I have maintained the same level of activity–and am back to running, too, of course! The brain really does have amazing powers…

  3. Els…what a FABULOUS post! I couldn’t agree with you more. Clinically, I would see this in my patients all the time! When in doubt: encourage, motivate, support! People will then feel more confident, have less fear of movement and will be more apt to try new tasks! Our words are so important. thanks for highlighting this:-)

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