Movement Notes — Pilates on George — by Olya Kudryavtseva
QUICK ANSWER (TL;DR)
Nocebo is the opposite of placebo. It means – negative outcomes produced by negative expectations. Research (Darlow et al. 2013) shows that the language clinicians use about back pain directly affects beliefs, function, and disability independent of actual pathology. Pain neuroscience education combined with movement is the evidence-based approach. Words shape outcomes.
How we talk about the body
Across every blog post on Movement notes – discs, ligaments, joints, tissues – there’s one thread that keeps coming back.
Read more: The influence of words that you hear about your body on your movement. (The nocebo effect)The way clinicians and movement professionals talk to clients about their bodies shapes how those bodies feel.
The science on this is unambiguous.
What Is the Nocebo Effect?
Placebo gets the headlines. Its opposite – nocebo – is equally well-documented but less talked about. Nocebo describes negative outcomes produced by negative expectations.
In experimental studies, telling subjects an inert procedure may cause pain reliably increases the pain they report and sometimes produces measurable physiological changes. The nervous system listens to the story it’s being told.
How Does Language Affect Pain?
In musculoskeletal care, nocebo language is everywhere:
• “Your spine is degenerated.”
• “Your core is weak.”
• “You have the back of an 80-year-old.”
• “Be careful – that disc could go again.”
These statements, even when factually arguable, plant expectations that affect outcome. They live in the client’s head long after the consultation ends.
Darlow et al. (2013) studied how clinical language influenced beliefs about back pain. Negative messaging from health professionals correlated with worse beliefs, worse function, and more disability – independent of the actual pathology.
Read that again. Independent of pathology. The words alone produced worse outcomes.
What Is Pain Neuroscience Education?
On the more hopeful side, pain neuroscience education (PNE) teaching clients about how pain works as a brain output rather than a tissue signal – has been studied extensively.
Reviews (Louw et al., Moseley et al.) consistently show modest but meaningful improvements in pain, function, and beliefs when PNE is combined with movement. PNE alone is less effective. PNE plus exercise is the combination that moves the needle.
Cues That Subtly Do Harm
• “Be careful with your back.” Encodes fragility. The back is one of the most robust structures in the body.
• “Don’t let your knees go over your toes.” A cue with no evidence base, restricting normal movement and implying knees are vulnerable.
• “Tuck your tailbone.” Creates a permanent posterior tilt that works against natural pelvic dynamics.
• “Your core is weak.” Rarely accurate, often disempowering.
Cues That Help
• Reframe sensation: “That’s your nervous system reacting and asking you to pay attention” instead of “that’s your bad back acting up.”
• Use language around ability and strength: “Your body can do more than it currently chooses to” instead of “You shouldn’t do that.”
• Normalise variability: “Some days will feel different. That’s the nervous system, not the structure.”
• Validate without catastrophising: “That sensation is real. It doesn’t mean damage.”
Frequently Asked Questions
Can words really cause pain?
Yes, and the research on this is robust. Words shape expectations, expectations shape pain perception, and pain perception affects how the nervous system processes signals from the body. Nocebo effects from medical communication have been documented in dozens of well-designed studies.
What is the most harmful thing a clinician can say?
Statements that frame the body as fragile, broken, or permanently damaged are particularly problematic. Phrases like “you’ll have to live with it,” “your spine is crumbling,” or “be careful forever” tend to predict worse outcomes than the underlying pathology would suggest.
How can I find a movement professional who uses helpful language?
Look for practitioners who emphasise capacity over fragility, who explain pain as multi-factorial rather than purely structural, and who progress your work over time. Our Sydney CBD studio is built around this evidence-based, biopsychosocial approach.
Does pain neuroscience education really help?
Combined with movement, yes, modest but meaningful effects across multiple systematic reviews. Pain neuroscience education alone produces smaller effects; the combination of understanding plus appropriate physical activity is what moves the needle.
What is biopsychosocial pain?
The biopsychosocial model recognises that pain is influenced by biological factors (tissue, nerves), psychological factors (beliefs, mood, expectations), and social factors (relationships, work, culture). Modern pain science is grounded in this framework, replacing the old purely structural view.
The Bottom Line
Across the pathology blogs in this series: discs, ligaments, joints, tissues, the thread running through all of them is this: the body is more capable than most clients believe, and the way clinicians work with them either confirms or challenges that belief.
Programming matters. Cueing matters. But the framework brought into the room matters most of all. We are not just training bodies. We are shaping how clients relate to themselves.
The body believes the story we keep telling it. Choose the story carefully.