Throughout the often complex and challenging process of musculoskeletal rehabilitation, the words that we use can have a significant impact on the clinical outcome. Words contain both the ability to heal and harm. Gaining an improved understanding of the frequently hidden influence that language can have on musculoskeletal rehabilitation is of paramount importance. This Viewpoint article highlights the powerful consequences of the words that we use in clinical practice and discusses the practical considerations for adapting the current language of musculoskeletal rehabilitation. J Orthop Sports Phys Ther 2018;48(7):519-522. doi:10.2519/jospt.2018.0610.

A dialogical approach does not require us to discard the findings of earlier theories about clinical reasoning, but provides us with a means of integrating what we know in ways that are more useful in the reality of clinical practice.

Most health professionals are unaware of the extent to which aspects of language, such as metaphor, influence their practice. Sensitivity to metaphor can deepen our understanding of healthcare and, arguably, improve its quality. This is because metaphors, and the linguisticality of which they are a part, shape medical practice in important ways. Examples are the metaphors used in pain management. By exploring the dialogical tension between such metaphors, we can better understand the ways in which they influence medical practice.

Medical education needs to be well informed by learning theories, and preferably more than one theory. Medical teachers need to be familiar with a range of learning theories and should be able to critique them in ways that allow us to combine good ideas from one theory with good ideas from other theories. This can give our teaching real depth and help us avoid common pitfalls that arise from misapplying a theory due to a superficial understanding. We provide an example where a number of learning theories were usefully combined.

People caring for chronically ill or disabled people living at home undertake a difficult and grueling job, even though family members and carers may view this caring as a 'labour of love'. Regular visits from a community-based physiotherapist provide an opportunity to develop and improve the quality of physical care for the client concerned and can give much needed support and hope to families and carers. The relationship that develops between physiotherapists and 'family care teams' in such situations is more complex than has been previously acknowledged. In this qualitative study, hermeneutic phenomenology was used to explore the lived experience of the relationships that develop between physiotherapists and members of these 'family care teams' and what these relationships mean to those involved. Semi-structured home-based interviews were held with clients, families, carers and their visiting physiotherapists across NSW, Australia. Findings revealed that relationship-centred care in the home healthcare setting evolves in complex ways as the interpersonal relationship between the physiotherapist and the 'family care team' develops. In particular, physiotherapists use composite relationship-treatment approaches to practice. The personal interaction is just as important as the therapeutic interaction; indeed, such embodied dialogue supports the therapeutic interaction in a variety of ways, which are not usually discussed as part of physiotherapy practice. In particular, these relationship-treatment approaches are used to enhance communication and interaction with clients and family care team members in ways that engender confidence and comfort for all participants. Deeper understanding of these social interactions may enhance awareness of such issues in professional practice and advance the development of mindful, therapeutic relationship skills.