The idea of a placebo effect is a commonly know concept.  A placebo is a pill or treatment that has no intended consequences and is held as a control against the variable intended to be studied.  The concept that there could be a beneficial effect, produced by a drug or treatment, that cannot be attributed to the properties of the placebo itself, and consequently could only be attributed to the patient’s belief in the treatment.  This concept has been researched extensively and is a part of the fitness and heath lexicon.  However, the reverse is less commonly understood.  Many previous posts have discussed the power of self talk, internal stories and the expectations we have of ourselves, but I have not touched on the concept of the “nocebo.”  This is the reverse of the benefits or positive effects unintended by a innocuous placebo treatment .  Regularly, I meet with athletes or normal active people who have been given a label, diagnosis, syndrome or “itis” that suddenly becomes their reality.  Advanced medical imaging, orthopaedic testing and comprehensive histories can give us a very strong understanding of our medical concerns; however, they cannot be the only way we make decisions and address our concerns.  Many studies have shown possible limitations on medical imaging, often showing that x rays, MRIs and other systems for diagnosis can label a person with an issue despite no symptoms and that often symptoms may not be confirmed by that same imaging (a picture may be worth a thousand words but sometimes none of them say you have that labral tear your symptoms might indicate).  Worse still, I will work with a younger athlete who has the idea that they are somehow broken, often too broken to fix in their mind, because of offhand or ineffectively shared information that has become entrenched in that athletes mind.  As fitness and rehabilitation professionals we are held in a position of trust and often when we speak using medical terminology or when we introduce theories and possibilities, they can be misconstrued.  We should strive to make patient education and empowerment, in spite of whatever testing, imagine or a diagnosis tells us, a priority.  To borrow from the great book/movie Fight Club: “You are not your diagnosis, you’re not a label but a person. You are not the injury you have. You’re not the contents of your diagnosis.”