Poor old Peter Piper has knobbly knees and degenerative disc disease

By David Butler Metaphor and language, Education for all, Poetry 28 Jun 2018

Reflect a little, just a little, next time you hear or use terms such as tight traps, bad back, subluxing shoulder, multiple myeloma or you’ll be on a slippery slope with that sciatica. These are all examples of alliteration. Alliteration is the use of similar sounds in the first consonant(s) in adjacent or nearly adjacent words. Along with rhyme, it is one of the best memory enhancers for written and spoken word.

We all know what Peter Piper pecked and have stumbled over the terrible tongue twister sea shells on the sea shore. Advertising gurus have used it with Coca Cola, Dunkin’ Donuts and Krispy Kreme, as did Walt Disney with Donald Duck and Micky Mouse.  Oh and I so love the slinky slightly sexy feel of my new Lululemon T shirt.

Alliterative language is picked up from the age of 3 months (Hayes & Slater 2008). It’s everywhere – what was it about the bunsen burner that made it so memorable? Why do clinical case conferences sound so impressive and important? The percussive sounding consonants such as ‘p’,’b’ and ‘f’ are probably more memorable; in fact, there is an article in the British Medical Journal where the author pondered the puzzling profusion of the letter ‘p’ in medicine (Hayden 1999). Fractured femur has quite a ring about it too, especially if it’s in four places and it’s Fred’s femur.

Well that’s sort of interesting, but how is it useful to me in the clinic?

One of the many fields that Explain Pain draws upon is linguistics and memory. We seek strategies to make stories more sticky and retrievable in the learner’s brain. Activities that release hormones of happiness can be made more memorable, you can prescribe exercises to make you long and loose rather than tight and troubled and eventually  your clients will be as good as gold and maybe even right as rain.  Make sure you let your clients know that you provide tried and true techniques too.

It goes the other way too, into more DIM (danger in me) language. Degenerative disc disease is an alliterative disaster. Not only is it false (it’s not a disease, it’s more about age changes than degeneration), those who use the term are embedding danger. Bad back and subluxed spine are other terrible terms. We are talking about clinical wordplay here. It’s all about using with the mnemonic power of alliteration to enhance the supportive SIMs and destroy the damaging DIMs.

An intriguing research finding (Boers et al 2014) suggests that while alliterative mnemonic power exists without awareness, it is enhanced when learners are aware of it. Perhaps we could get clients to play with alliteration – healing hips, mending malleoli, ripper reflexes and lovely, lean loins.

Word play could be a missing element of pain treatment, for some. The last blog on rhyme touched on this, as will next week’s blog on aesthetic language. Essentially, while the brain might have some sensitivity to metaphor, rhyme, rhythm and alliteration, it’s the context of the language which gives it power – things such as personal relevance, timing, familiarity and congruence.

Please share your greatest alliterative gems. I hope this post has nourished your neurones, greased your glials and make your dendrites dance.


Hayden GF 1999 British Medical Journal  319 (7225) 1605-8

Hayes RA, Slater A 2008 Infant Behaviour and Development 31:1: 153-156

On wordplay – Benczes R 2013 Metaphor and Symbol 28: 167-184

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  1. Hi David,

    I love when you take us down these pathways. THANKS.

    MOJO MOBILISER would be my most common alliterative SIM I use – although I have never been aware that that was what it is called. I dreamt it up whilst walking the Noosa National Park walking track, pondering the sea and how I could engage patients to want to get their MOJO back. And so it was born. It refers to anything that “Mobilises the MOJO” of a patient.

    I also use “Let’s go and check out how you “STRUTT YOUR STUFF” instead of saying Let’s go and look at how the pain has affected your walking pattern. I talk about stimulating your “SILENT SPRINGS” (for legs) for those who land, run, walk, climb stairs etc, heavily of loudly.

    I LOOK FORWARD to reading more of these ALLITERATIVE phrases.

    Thanks again


  2. William Gillespie

    flat feet, or perhaps there is still hope for you because you have fairly flat feet.
    tight t-spine
    I have a botched back
    pressure point
    sh**ty sleep

  3. By the way, my dendrites are dancing, my astrocytes are aggitating, my serotonin is souring, my myelin is multiplying, and my dermatomes are dazzling.

    1. davidbutler0noi

      nice …serotonin soaring!

  4. Loved reading this – such a believer in the using helpful terminology with patients!
    My personal favourite has to be “motion is lotion for your joints” it takes away the fear of movement and highlights the benefits!

  5. William Gillespie

    My last entries were more DIMs than SIMs, so here are a few more in the SIM category;
    1. practice makes perfect/permanent
    2. strong spine
    3. power position, power posture (vs perfect which could be more DIM if misused)
    4. fun & functional (putting the fun in functional)
    5. focused, free and flowing

  6. This post was persuasive and prime
    I’d read it at least one more time.
    A great explanation
    Of alliteration
    And it’s relative reach within rhyme!

  7. hi Dave,
    thanks for such an insightful post!
    I’d like to highlight the point of how DIMs and SIMs are contextual.
    For example, I have seen the alliteration “if I rest I rust” “act” as a SIM to a person who had been highly movement avoidant and I’ve seen the same idea prime someone else to believe that they could not rest, which fed this person’s difficulty in being able to relax for as little as 10 minutes… which did not help with her sleep:)

  8. Karnik

    Loved reading the article. Lately, I am realizing the association of words and affection. Here are some SIM’s:
    Soothing Shoulder
    Bright Brain
    Healing hands

  9. Chris

    Replace bad boom busting with perfectly planned pacing

  10. Your beautiful back has a strong supple spine which can carry you continuously through your long life

  11. timbeames0noi

    Sizzled my synapses 🙂

  12. davidbutler0noi

    Thanks everyone! – potentially powerful prose!


  13. Jason Therrien

    I use alliteration, acronyms, and metaphors (likely in excess) in the clinic and in classes I teach about pain science and recovery strategies. Here are a few:
    -“Synaptic cementing” – when discussing neuroplastic changes as we make more “laps around the track” in their neural networks, facilitating excitatory changes; I also use “we’re going to use your hardware to rewrite your software” in this same context
    -“Loosen, lengthen, load” – my way of categorizing different exercise/movement types and intentions: “loosen” – gentle ROM, muscle relaxation, breaking up protective and compensatory motor patterns (co-contractions); “lengthen” – stretches, “breathe out while you stretch out”, “loosen before you lengthen”; “load” – strengthen, demand, challenge, cardio, activity, etc.
    There you go. Suggestions, insights, hateful remarks are all welcome. Cheers, and thank you, David!

  14. davidbutler0noi

    I have just read all these aqain – thanks for sharing. “laps around the track’ is a beauty Jason! as is the memorable “loosen lengthen load”
    Keep “strutting your stuff” and “mobilising your mojo”(Leanne) and my word – that is a “power posture” (William).



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