• Why Your Massage Therapist’s Words Matter

    Words Influence Healing

    I cannot tell you how many times new clients have told me about some of the amazing things previous massage therapists, doctors, PTs, etc. have said to them. And by amazing, I mean completely unprofessional and rude. I doubt any of them intend to be unprofessional, but that doesn’t change the fact that they are.

    Placebo vs Nocebo

    Before I go on, you need to know what a nocebo is. The easiest way to explain it is to contrast it to something you probably do know, a placebo.

    Since you’re probably familiar with the word placebo, I won’t spend much time explaining it. According to Merriam Webster, placebo is a latin word that means, “I shall please.” Placebos are good, or at the very least harmless. A common example is: A person takes a sugar pill then feels better. That’s placebo effect. It’s not an imaginary effect; it’s a complex reaction that research has proven to be part of the efficacy of treatments that have been deemed effective by rigorous scientific study. Words are often part of the placebo effect.

    Now, unless you study pain science or have a career in medicine, you’ve probably never heard the word nocebo. It’s a latin word meaning, “I will be harmful.” The word nocebo is usually used in relation to a treatment or substance that has harmful side effects or makes symptoms worse, but it can also be used to describe words. A common example is: The statin drug successfully controlled the patient’s cholesterol but caused severe muscle pain. The muscle pain is a nocebo effect. As with placebo, this isn’t an imaginary effect either.

    Words Matter

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

    ~ Children’s Chant (and a whole load of BS)

    Words have power. They can sting, wound, or cut. They can be cringe-worthy, annoying, frustrating, or maddening. They can also heal, soothe, calm, and reassure. Which words do you want to hear from your massage therapist or other healthcare provider?

    The Worst Kind of Words

    Cartoon shadows of large person yelling at smaller sad looking person
    When you use nocebos in your speech, you make the other person feel bad.

    There are literally hundreds, if not thousands of examples from each of the categories below, so I’m going to keep it to just 1 per category.

    Alarming

    “OMG, your muscles are SOOOO tight!” If you’ve had more than a couple massages, you’ve probably heard this one. At first blush it doesn’t sound too bad, right. They’re acknowledging, in a rather animated fashion, that you really need this massage.

    If you’re really in touch with your body, this will be no kind of revelation to you. After all, that’s probably why you made a massage appointment in the first place. It might even seem needlessly redundant.

    However, if you spend most of your time making sure everyone else is happy and taken care of, or if you’ve been super stressed for so long that it feels normal, you may not be aware of the amount of tension you’re holding in your body. If you booked the massage as a treat, this little exclamation suddenly becomes a nocebo. You might think, “Wait… that sounds like I’m in really bad shape. I didn’t realize I was so jacked up. How did I not realize that? What’s wrong with me that I didn’t know how rough a shape my own body is in?” Are you really going to enjoy the massage as much now as you would have before that little outburst? Are you going to let the therapist convince you to let them “dig in there and get the knots out” when all you really wanted was a nice, relaxing massage?

    This is not a cool thing to say at all. To someone who’s been massaging bodies for 17 years now, it smacks of a therapist who’s such a newbie they’ve literally never felt anyone with a few years worth of stress built up in their body… you know, like a majority of adults. Sadly, however, even seasoned therapists say this and they need to stop.

    Fear Mongering

    “You shouldn’t have waited so long to come in, hopefully I can still help you so you won’t end up in chronic pain for the rest of your life.” Statements like this are often followed by suggestions for a very aggressive regimen of frequent therapy sessions and lots of expensive retail products, which (thankfully) the provider just happens to sell. I’m going to give the providers the benefit of the doubt and assume they aren’t consciously saying things just to sell sessions and/or products. That said, how much fear would this generate if someone said it to you? What do you think muscles do when you experience fear? They contract. What happens to your emotions when fear is triggered? Anxiety and/or depression can both increase. What happens when fear, anxiety, and/or depression increase? Pain increases. Statements like this are nocebos and have no business in a healing environment. PS Don’t let someone pass statements like this off as straight-talking. There are ways to be honest without being a fear-monger.

    Disparaging or Insulting Remarks

    “You know, if you lost weight, your muscles wouldn’t be under so much strain and you wouldn’t have so much pain.” Yes, massage therapists and other healthcare professionals have actually said things like this to people who were not looking for weight loss advice, weren’t even looking for any type of service or treatment regarding their weight. Here’s a newsflash: Fat people know they’re fat; they don’t need someone to tell them. A provider bringing up weight as the absolute cause of a client’s woes is not just unprofessional, they’re peddling an untruth. I know a lot of overweight, fat, and obese people (some clients, many not) and none of them have muscular pain because of their weight. That’s fat bias and it’s a nocebo; it causes real harm to real people.

    Here’s the truth: Not all fat people have zero self-control around food and zero activity level. In fact, many fat people eat less than some thin people. Some of us exercise more than many people who are naturally thin. There are many, many medications that have weight gain as a side effect; medications that people need. Medications that can’t be discontinued or changed because there either aren’t any alternatives, insurance won’t pay for (and they can’t afford) alternatives, or the untreated condition is far worse than being fat. PS despite what our thin-centric society would have you believe, there are way worse things than being fat. Massage therapists and other healthcare providers (because this happens across the board) need to nix the assumptions and keep their fat mouth shut about their client’s weight.

    Here’s another truth: Stress, anxiety, and depression are far more likely to be causing muscle pain than being fat.

    The Best Kind of Words

    smiling woman shaking hands with smiling man

    Finally, the good stuff. Again, there are hundreds, or even thousands, of examples from each of the following categories so I’m just going to pick 1 from each to talk about.

    Reassuring/Normalizing

    “Yes, there is a fair amount of tension in your muscles, but it’s a pretty normal amount for people with your stress level.” This is what I tell my clients when they ask if they have the worst neck, shoulders, legs, low back, etc. that I’ve ever felt. There is literally only 1 person in the entire world, all 7.7 billion of us, who has the “worst tension” or the “tightest muscles.” There’s very little chance that person is you. I promise. After 17 years in the biz, I can honestly say that most of the people on my massage table have “excess muscle tension” and very few have muscles that are chillaxed to the max. No matter what tension level your muscles have, they’re in good company.

    Compassion and Understanding

    “I know that your fibromyalgia pain is real and doesn’t feel or act like injury pain. Because I don’t want to create a pain flare, we need to work as a team during each massage. If at any time you want me to change the pressure I’m using, especially if you need me to use less, you need to speak up and tell me. For my part, I’ll adjust my pressure when you ask then check back in to make sure it’s ok.” People with chronic pain are used to hearing that their pain isn’t real because they don’t act like someone who has an injury. The truth is, chronic pain and injury (also called acute) pain don’t feel at all the same. Chronic pain is just as debilitating as pain from an injury but it never goes away. It waxes and wanes with work and rest, and sometimes it flares up for no discernible reason at all. None of that makes it any less real. In fact, some new research has recently found biomarkers for fibromyalgia, which are not present (or not present in the same amounts) in people without it. However, we shouldn’t need a test in order to believe someone when they say they’re in pain and show them some compassion.

    Planning or strategizing

    “The car crash certainly caused a lot of pain and dysfunction, but if we take it in steps, we should be able to gradually decrease your pain and increase your function. Let’s start by making a list of the things you want to be able to do… put on a coat, tie your shoes, reach above your head, reach behind your back to hook/unhook your bra, etc. May I suggest starting with ones involving safety, like checking your blind spot while driving?” This is an example of the type of thing I say to people who come in telling me how broken they are. First, I acknowledge their pain and limitations. Then I try to help them set realistic goals and expectations for progress. When people feel hope and have realistic expectations, they have better outcomes.

    That Was Long, Can You Sum It Up?

    Tl;dr

    Don’t stay with a provider who uses language that increases fear, anxiety, depression, or stress. Don’t stay with a provider who doesn’t believe you or hard sells you products or services. Don’t stay with a provider who insults or shames you. Not only do you deserve better, you’ll get better a whole lot faster without all the negativity.

    Do find a provider who wants to understand you and the issues that are bringing you in. Do find a provider who meets you where you’re at physically, mentally, and emotionally. Do find a provider who helps you set realistic expectations and goals. You’ll find that you heal a whole lot faster when you feel understood and believed.