"Your joints are crumbling." "It's bone on bone." "You've got a degenerative spine." If you have heard words like these, you probably left the appointment feeling frightened. At Zero Jargon Health, we believe language is not just a description; it can shape how you feel and what you do next.
Frightening words can create a "nocebo" effect, where negative expectations make you feel worse. They can also lead to fear of moving, which weakens muscles and can make pain worse (Stewart and Loftus, 2018).
The big shift: from "wearing out" to "adapting"
The old view treated joints like machine parts that simply wear out. The modern view sees them as living tissue that is constantly reacting, repairing and adapting.
1. From "wear and tear" to "wear and repair"
"Wear and tear" makes joints sound like brake pads: used up and beyond help. Arthritis UK describes it differently: everyone's joints go through a normal cycle of wear and repair, and as joints repair themselves, their shape can change (Arthritis UK, n.d.). Osteoarthritis happens when a joint can no longer repair itself as well as it once did. And a diagnosis does not mean it will get worse, because there are things you can do to improve your symptoms.
2. Retiring "bone on bone"
"Bone on bone" conjures up images of raw surfaces grinding together. What an X-ray actually shows is narrowing of the joint space, because the cartilage has become thinner. This is a more accurate description, and less frightening. Exercise can still help, whatever your X-ray shows, and NICE recommends as a core treatment for osteoarthritis (NICE, 2022).
A plain-English phrasebook
| Instead of | Try | Why |
|---|---|---|
| Wear and tear | Wear and repair | Joints are living tissue that constantly repair themselves. |
| Degenerative joint disease | Osteoarthritis | "Degenerative" suggests steady, unstoppable decline, which is not inevitable. |
| Bone on bone | Narrowed joint space | Describes what the X-ray shows, without the horror imagery. |
| Crumbling spine | Normal age-related changes | Spines are strong. These changes are common and often cause no pain. |
| Deformity | Change in joint shape | Neutral and factual, rather than stigmatising. |
| Sufferer or victim | Person who has arthritis | The UK government advises avoiding phrases like "suffers from" (GOV.UK, n.d.). |
More than a "sufferer"
Arthritis is something you have, not who you are. You are still a worker, a parent, a friend, maybe an athlete, who is managing a condition. UK government guidance on inclusive language advises using neutral words like "has" and avoiding phrases like "suffers from", so disabled people are described as active individuals in control of their own lives (GOV.UK, n.d.).
Many disabled people prefer to be called "disabled people", rather than "people with disabilities", because they are disabled by barriers in society. The best approach is simply to ask each person what they prefer.
The evidence: words can hurt
Key insight
In a Dutch trial, 169 people watched a physiotherapist explaining back pain using either negative or neutral language. Those who heard the negative version felt significantly more anxious, were more worried, and expected their condition to last longer (Linskens et al., 2023). Your brain acts like a volume control for pain: fear can turn it up, and reassurance can help turn it down.
How to talk to your doctor
If a health professional uses words that frighten you, it is fine to ask questions, for example:
- "Would it be accurate to say my joint is trying to repair itself?"
- "What can I do to support my joint, rather than just resting it?"
- "What does my X-ray actually show, and does it mean my pain will get worse?"
For clear, calm information, see the NHS guide to arthritis, or order Arthritis UK's free information booklets.
The bottom line
Next time someone tells you your pain is "just wear and tear", gently correct them: it's wear and repair. It is a small change in words, but it can make a big difference to how you feel about moving, treatment and your future.
References
Arthritis UK (n.d.) Osteoarthritis of the hip. Available at: https://www.arthritis-uk.org/information-and-support/understanding-arthritis/conditions/osteoarthritis-oa-of-the-hip/
GOV.UK (n.d.) Inclusive language: words to use and avoid when writing about disability. Available at: https://www.gov.uk/government/publications/inclusive-communication/inclusive-language-words-to-use-and-avoid-when-writing-about-disability
Linskens, F.G. et al. (2023) 'Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: a randomised controlled trial in healthy respondents', Patient Education and Counseling, 110, p. 107649. Available at: https://pubmed.ncbi.nlm.nih.gov/36764063/
NHS (n.d.) Arthritis. Available at: https://www.nhs.uk/conditions/arthritis/
NICE (2022) Osteoarthritis in over 16s: diagnosis and management (NICE guideline NG226). Available at: https://www.nice.org.uk/guidance/ng226
Stewart, M. and Loftus, S. (2018) 'Sticks and stones: the impact of language in musculoskeletal rehabilitation', Journal of Orthopaedic & Sports Physical Therapy, 48(7). Available at: https://www.jospt.org/doi/10.2519/jospt.2018.0610
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Important medical disclaimer
The content provided in this blog post is for educational and informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your GP, psychiatrist or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Never start, stop or change a prescribed medicine without speaking to your prescriber first.
