An open letter to my follow physiotherapists and healthcare providers


“Digital misinformation has become so pervasive in online social media that it has been listed by the WEF as one of the main threats to human society” (1). So the World Economic Forum has stated that misinformation that is being shared on social networks like Facebook; is a threat to our society.

In the Musculoskeletal and orthopedic field, there are also significant problems with misinformation (2, 3). 

As a testament to this, most people with low back pain believed their pain was due to the body being “broken” like a machine (4). Most people in the study indicated that they learned these erroneous beliefs from healthcare providers.

So here is my plea:

1. Please consider when making recommendations for pain relief or treatments that you might be providing you the person with a short term “solution” and a placebo effect, that might turn out to be in the long term a nocebo effect, hurting your client.

2. Please consider if there is any evidence behind your recommendations or any scientific reasoning. In my opinion, if we accept to treat our clients, we also accept a huge responsibility to treat our clients responsibly, to the best of our knowledge, and concurrent with science and evidence.

3. Please consider that if you are passing on a lot of myths, clinical “hearsay” and misconceptions, this could also harm our clients.

Misinformation in the musculoskeletal filed is a very serious problem. This becomes evident if we start to read qualitative literature and hear patients’ beliefs (4, 5, 6). Then we will suddenly realize that most patient has many erroneous beliefs about their pain, and about what pain is, and most critically; what the solution to their problems is. An excellent clinician should correct the misinformation, not promote it.

Our interventions should be first and for most be plausible. As stated by Dr. Steven Novella (in his article Plausibility in Science-Based Medicine): “Plausibility is essentially an application of existing basic and clinical science to a new hypothesis, to give us an idea of how likely it is to be true. We are not starting from scratch with each new question – which would foolishly ignore over a century of hard-won biological and medical knowledge”.

As healthcare providers, we should not perpetuate myths or base our clinical reasoning on logical errors, unproven theories, or false traditionalist beliefs. It should be viewed as inappropriate for any clinician to let misinformation and myths go unremarked. Misinformation and myths can potentially negatively impact the very people we are supposed to help.

Scientific research can inform and facilitate change for the better, but only we as clinicians can implement the change, and every person we take under our care – deserve this change. They deserve that we use the best current scientific knowledge to better our treatments and interventions.

As stated by Prof. Rothstein (7): “We need to make certain that, as we move to a better form of practice, we continue to put patients first. Nothing could be more humanistic than using evidence to find the best possible approaches to care. We can have science and accountability while retaining all the humanistic principles and behaviors that are our legacy”.

Thanks to Dr. Derek Griffin, and Nicolas Ng for inspiration to this post.


1. Del Vicario M, Bessi A, Zollo F, Petroni F, Scala A, Caldarelli G, Stanley HE, Quattrociocchi W. The spreading of misinformation online. Proc Natl Acad Sci U S A. 2016 Jan 19;113(3):554-9. Epub 2016 Jan 4.

2. Starman JS, Gettys FK, Capo JA, Fleischli JE, Norton HJ, Karunakar MA. Quality and content of Internet-based information for ten common orthopaedic sports medicine diagnoses. J Bone Joint Surg Am. 2010 Jul 7;92(7):1612-8. doi: 10.2106/JBJS.I.00821.

3. Ferreira G, Traeger AC, Machado G, O’Keeffe M, Maher CG.
Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review. J Med Internet Res. 2019 May 7;21(5):e13357. doi: 10.2196/13357.

4. Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW.

 Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskelet Disord. 2017 Nov 17;18(1):466. doi: 10.1186/s12891-017-1831-7.

5. Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013 Nov-Dec;11(6):527-34.

6. Demoulin C, Baeri D, Toussaint G, et al. Beliefs in the population about cracking sounds produced during spinal manipulation. Joint Bone Spine. 2018;85(2):239‐242. doi:10.1016/j.jbspin.2017.04.006

7. Rothstein JM. Thirty-Second Mary McMillan Lecture: journeys beyond the horizon. Phys Ther. 2001 Nov;81(11):1817-29.