A 44-year-old woman recovering from a partial knee replacement got an unusual instruction from her physical therapist: swear out loud during the hardest, most painful exercises. She did, and she later said that repeating the word was funny, took her mind off the work, and made her feel more confident.
The case, published in November 2023 in Health Psychology Research, was described by its authors as the first known report of a patient swearing during a course of physical therapy. It has become a touchstone for researchers who think taboo words may have a rehab place.
An earlier report from the same research group points to a catch that gets less attention. When the swearing came from the therapist instead of the patient, the effect on the relationship depended on who was listening.
Swearing Written into a Plan of Care
The woman had undergone patellofemoral arthroplasty, a procedure that replaces the surfaces where the kneecap glides over the thigh bone. Her therapist formally added swearing to her plan of care, and she swore out loud during the most challenging parts of treatment. She and her therapist both reported a strong therapeutic alliance, the working bond between patient and clinician that research links to better rehab results.
The authors included Nicholas Washmuth of Samford University in Alabama and Richard Stephens, a psychologist at Keele University in England whose lab has studied swearing and pain for years.
The report is candid about its limits. Her improvements in pain and physical performance were typical for someone completing standard rehab after this surgery, the authors wrote, so swearing may not have changed those measures at all. One possible reason they offered is habituation, meaning people who swear often in daily life may get less out of a swear word when they need it.
The benefits she described were self-reported by one patient, with no comparison group. The case cannot show that swearing reduced her pain or sped her recovery.
The Case Where a Therapist Did the Swearing
A case series by Garrett Trummer, Stephens, and Washmuth, published in April 2023, flipped the setup. This time, a 32-year-old male physical therapist did the swearing, using what researchers call social swearing to motivate patients and build rapport.
Both patients were young men. One, 19, was a college baseball player treated for a hamstring strain. The other, 23, was a medical student recovering from surgery to reconstruct his anterior cruciate ligament. The therapist waited until the third visit to begin, so rapport would already exist, and swore two or three times per session after that.
The results split, though only modestly. On a standard questionnaire scored from 19 to 114, the ACL patient's rating of the relationship rose from 110 to 113. The hamstring patient's rating slipped from 94 to 89, even as the therapist's own rating of that relationship went up. The authors called both changes small.
The hamstring patient also said the swearing did not affect the relationship or his motivation. Both men said they did not find therapist swearing unprofessional or offensive; both agreed therapists should be allowed to swear around patients, and both said they swore more than four times a day themselves. The authors concluded that therapist swearing can have positive and negative effects and that it is hard to justify in practice without more research.
Why Swearing Seems to Work, and Why It Can Wear Off
Laboratory research offers a possible explanation for the benefits and a hint about their limits. In a 2009 Keele experiment, volunteers held a hand in ice water while repeating either a swear word or a neutral word. When they swore, they held on longer, rated the pain as lower and showed a bigger rise in heart rate.
A 2011 follow-up in The Journal of Pain involving 71 volunteers found a twist. The more often people swore in daily life, the less extra pain tolerance they gained by swearing during the test. At the time, Stephens said he would not advocate prescribing swearing as part of a medical pain management plan, but that people who swear during acute pain deserve tolerance.
A 2024 mini-review in Frontiers in Psychology, written by Washmuth, Stephens and colleagues, concluded that swearing has reliably reduced acute pain in laboratory studies. Those studies, however, mostly involved young, healthy volunteers and ice water. The review said the effect of being sworn at, rather than swearing yourself, has not been tested, and that more work is needed before swearing can be used as a therapy.
Who Chooses the Word May Matter
Taken together, the reports suggest the source of the swearing may matter as much as the word itself. In the knee case, the patient chose to swear and found it funny and empowering. In the case series, the swearing came from the clinician, and the two patients responded differently.
The case series authors noted that age, gender, culture, race, and region can all shape how a taboo word lands, and that their results might have differed with a different therapist or different patients.
None of this amounts to clinical guidance. The evidence consists of laboratory studies in healthy volunteers and three individual cases with self-reported results. No trial has shown that swearing improves recovery after surgery.
For patients, the practical takeaway is modest. People who find that an occasional expletive helps them push through a hard exercise can mention it to their therapist, who can consider whether it fits the setting. Anyone whose pain is worsening or not improving during rehab should raise it with their care team rather than rely on coping tricks alone.
Key Questions Answered
What happened in the knee replacement case?
A 44-year-old woman in physical therapy after a partial knee replacement swore out loud during the most painful exercises as part of her plan of care. She said it was funny, distracting, and confidence-building.
Did swearing reduce her pain?
That was not shown. Her progress was typical for standard rehab, and the authors said swearing may not have changed her pain or performance.
What happened when a therapist swore?
In a two-patient case series, one young man's rating of his bond with the therapist rose slightly, while the other's dipped slightly. The authors described both changes as small.
Does swearing lose its effect?
A Keele University study found that people who swear more often in daily life gained less extra pain tolerance from swearing during a pain test.
Is swearing a recommended pain treatment?
No. The evidence is early, and no clinical guideline recommends it.
Should patients try it?
Patients who think it helps can talk it over with their therapist, and anyone with worsening pain should tell their care team.
Published by Medicaldaily.com
