The folklore surrounding intervertebral disc injury has inspired some wildly descriptive and unhelpful language. Slipped disc wins by a mile, but you can also blow a disc, bulge a disc, pop a disc, even say I’ve got a disc”. I once heard someone say that they had mulched a disc! You could use more medical terms and say you have a ruptured, herniated or prolapsed disc. Googling images of prolapse is definitely not helpful.
I heard a new one the other day that made me recoil. “The doc’ said I’ve shunted a disc out in my neck.” I didn’t know how to respond initially! Shunt – I thought – that’s what trains do. Shunting is a powerful and almost unstoppable force. The term is quite ideophonetic as the sound and the association provoke ideas and imagery. I thought of a shunting train moving between other trains at a railway station. And then I thought you can’t really unshunt either. What a mean word when applied to an already linguistically unstable body part.
I couldn’t let it go of course but I couldn’t resist starting my story telling with “let me stop you in your tracks for a moment. Your neck is no railway station and it’s certainly no train crash in there”.
I am sure it’s best to leave shunted for the railway yard.
Has anyone heard of any other language for perceptions of disc injury?
My friend’s disc has “gone”, and he said the doc said it’ll never come back.
I didn’t actually know “shunt” referred to trains, I think because they sound vaguely similar I was reminded of “stents” as in the procedure to open blocked arteries…which is a rather nasty sounding procedure in all respects, not least of which being that they insert the stent through the inguinal artery….feel free to google that one. I’m quite happy to keep my neck loose and light, confidently supporting my big beautiful brain – Great post David!
I agree that the language we use is very powerful in helping patients recover and liked your quick thinking to counter the misconception and stay with the metaphor.
I’ve learned over the years to be wary of accepting unquestioningly that patients are quoting their doctors correctly; clearly the patient has an unhelpful mental image of their neck problem which the doctor didn’t appreciate or correct, but it doesn’t mean that the doctor used those words.
I quite often here my back is out (gone to lunch I suppose), or one person told me that the surgeon referred to their disc like it was fetta cheese. This picture in my head had me feeling slightly nauseous and I did not know where to go from there initially. I wanted to keep the specialist and patient in favour so I said ‘ok’ and started working to influence another viewpoint without being too challenging. It takes time and the temptation is to call the surgeon a nutjob and tell them it is not like this, but from my experience I have not been successful with that approach
The worst I have seen was a young woman who was told that her disc had ‘exploded’ it was not within my power to shift this thought bomb which had been planted by a spinal consultant who she trusted.
She lived in fear of the next flexion movement that might cause the next explosion in her spine. Any sensation triggered the thought.
She needed a bomb squad more than a humble PT.
Not the worst thing said by a spinal consultant either.
That goes to the following phrase – “Jeez mate yer backs bent like a dog’s back leg I can’t believe yer still walking!” How to cripple a guy in 2 seconds. Add Irish brogue for accent effects.
I’ve had a few along the lines of “I’ve got the discs (or spine, or joints, or whatever) of an 80 year-old!”
Sounds familiar! When I was in my early 50’s the Orthopaedic Surgeon said that I had the spine of an 87 year old. Wish I had never heard those words 17 years ago. Unfortunately, I can’t seem to release the fear and I’m certainly trying.
‘Fragmented’ – understood by the patient to mean ‘ there are fragments of disc like bits of a broken plate that stick into my flesh when I move’ . Happily she was very pleased to be offered another explanation for her pain.
The last years when I try to explain to a patient about a disc funktion is to speak about a pressure regulation structure what is best in function in regular movement and needs time to recover also. If there is a dysbalance you have to look at these aspects to recharge the battery for proper pressure regulation restoring. ( excuse me for my english).
Best one this week was..”My disc exploded “.
My mother has a spinal infection that was “eating away her vertebra” and was called at home and told by the neurosurgeon to sit down. Then immediately go to the ER so they could take her to the Boston hospital as she was about to become spinal cord injured. They said don’t fall or get in a car accident on the way! So she showered, cleaned her house, paid her bills. Then I took her to Boston (85 miles away from her home!) the next day. We even stopped for lunch. Thankfully the Boston surgeon told her since she had no symptoms of cord compression or compromise, to go to PT and live life, have more fun!
I think I had one yesterday to match the shunting train, a patient in his 40’s had told me that his last MRI scan showed the spine of a 70 yrs old and that his discs were spinning round and bits were breaking off at the edges.
my imagery was of a circular saw between the vertebral bodies I’m sure his was much worse sadly was not able to get the pictures to discuss with him
however he looked very well all things considered
I have often wondered what is the appropriate language to explain a symptomatic disc herniation. Obviously, not by using this terminology! But what are some neutral terms when the patient 1) may be facing neurosurgery and 2) may suffer permanent neurological deficit?
Patients’ recollections of surgeon saying “well we fixed the pinched nerve but the disc was splintered”, and “it was like cleaning up shrapnel in there, but I think i got it all” .
“I’ve done a disc” is an occasional patient complaint. I’m still not sure of the correct procedure to “undo” it though
Phew! So a disc can also explode, be fragmented, eaten away, splintered, be much older than the rest of the body , spin around with the edges broken off, (that’s a winner!) resemble fetta cheese and be done ! I hadn’t realised there were so many disc linked terms in use until this blog!
Symptomatic disc pathology occurs of course but in general, the poor old disc really cops some unfair language from all professions. Much of this language may related to normal age changes or the “kisses of time”. These changes rarely alarm the nervous system, but the language certainly does.
Steve asks “what are the neutral terms”. I liked Phia’s response equating the disc to a “pressure regulation structure which needs time to recover.” Similar to this I have used wording along the lines of ‘ not bulging or exploded – (insert patient’s words) but more like a tyre on your car has gone a bit flat – but you can pump it up’. In Explain Pain, Lorimer and I tried to change the name of the intervertebral disc to the LAFT – the living adaptable force transducer. Clearly we weren’t that successful but we do have a few rusted on name changers out there.
This language that we have all shared can be so destructive. We all know that. Take Jeana’s reply. She was told that she had the spine of an 87 year old when she was 50. Jeana wrote “Wish I had never heard those words 17 years ago. Unfortunately, I can’t seem to release the fear and I’m certainly trying”. It won’t be easy changing from a concept of a fragmented exploded, spinning piece of fetta to a living adaptable force transducer. It usually requires time, rhetorical skills, media and stories – essentially a curriculum. But we can do it! The “Get to Know Your LAFTs” section on page 54 and 55 of Explain Pain should help.
Thanks for the replies.
Thx David and Phia…I like your explanations. Sometimes I think we do something wrong when we use the D… word. We need to explain pain (….) and not in a reductional way. ” The kisses of time” is a very nice one and can be useful for something that depends on local and central mechanisms.
Disabling pain can feel like a catastrophic event, which may trigger pain depression and a fear of loosing autonomy, After 30 years in practice I have heard some extraordinary and perhaps less than objective interpretations of Dr’s findings. A neutral refrain that I have found to be successful is: When – in the past – have you failed to heal and what makes you think this time different? Providing the patient with an opportunity to explore a dialogue about their healing journey’s can be a wonderful antidote to fear/despair
well there is blown or blown out a disc
the term of art “derangement” is also interesting, perhaps it was prescient that psychosocial factors are better predictors
then there is the erudite surgeon that tells the 44 yo sufferer that they “have the disc of an 80 year old”
there is also “collapsed” and the related “my vertebra are bone on bone”
then there is the existential crisis of a finding becoming the complaint becoming the essence of the person
Provider: Hello, how can I help you?
Sufferer: I have (subtex: I am) a 5 mm posterolateral herniated disc
then there are those from my hometown, NYC who succinctly state
“hey doc, I have F*&^!#+-up my disc”
finally in search for better language what about “adverse, but negotiable, internal pressure dynamics”
Great contributions here – I also love sharing and discussing the age related prevalence of “abnormal radiological findings” in asymptomatic people (AJNR Am J Neuroradiol. 2015 April ; 36(4): 811–816). We don’t call wrinkles degenerative skin disease do we! The kisses of time…