Day 16 The dismay I experience when people reject the TMS theory

So today in the program it asked us whether I've discussed this with people yet....

Discussed it? I've virtually been shouting it from the rooftops!

Well, not quite, but early on I was telling anyone that listened. I found that though people were receptive to the idea that chronic pain is linked to psychological issues, the conventional wisdom of what actually causes the pain always seems to trump the ideas of TMS for them.

Also I always got the impression they were a bit embarrassed because the presumption then is, I've got chronic pain, so I'm volunteering personal information about having mental problems etc. Or maybe I was the one who was embarrassed...

Nevertheless, after discussing it with a few work colleagues, I was surprised how much they have wanted to defend the conventional wisdom that says: sitting in a chair for extended periods causes sore backs. And therefore, exercises and stretches are the only things that will cure a bad back.

I don't even bother talking to doctors about it.

In the end I give up trying to make my point or win the argument. I think from their point of view it's like someone doggedly spouting forth belief in magic that all the scientific evidence rejects.

I had a big argument with my brother which was telling. Because we're brothers we don't hold back. He seemed to win the argument when he yelled: "Then how do you explain old people getting bad backs? They suddenly come down with psychological problems? No, it's because all the years of work and wearing them out, their backs are damaged."

I couldn't argue against this at the time. But afterwards I thought about it. When we see really elderly people who can barely stand up straight, it's not just because of pain in their back. It's most likely because of osteoporosis. And do old people (never defined in the argument, but maybe he means 80+, but I don't mind if you're thinking over 40 ) naturally have bad backs? I'd like to see the figures on it, I would think it's evenly spread among all the ages.

It's not just about winning the argument. The problem is that when I encounter this resistance it really takes the wind out of my sails and I start to doubt myself.

I suppose I shouldn't let it bother me. Maybe I'm being too scientific about it. Rather than add up all the pros and cons of each argument and tally all the evidence for and against, maybe I should see this as a matter of faith. After all, faith is really a state of mind, probably involving the subconscious.

Faith...if only it came naturally to me! Can anyone lend me some?

 

Hi there!

I've had a struggle on other people not accepting concepts of TMS theory as well. I really have faith it in as i've obviously seen it heal my own pain and others. Where I struggle is with my patients. Not everyone is ready to accept this seemingly radical theory...I think this has been true throughout history with many things in science.

I actually find that science works out wonderfully with TMS theory...I think i've had to think through things logically, look at both anecdotal evidence and studies that point towards TMS (such as no correlation with spinal abnormalities and pain). I try to bring these concepts to my patients- some are ready to accept them, some seem not to be at all and then I can't push. I see TMS in almost all of my patients and it's a struggle not to be able to tell more of them about it.

As a PT, I know there are a huge myriad of reasons why someone 80+ would be limping or barely able to stand, the list is long. It could be a "real" injury like a stroke or something like that...people are obviously more susceptible to disease processes at older ages. It could also be someone with TMS who is in the pain/disuse cycle...i've seen that too.

Older people don't all have "bad" backs (I assume you're meaning pain). Being hunched over could be osteoporosis or other issues that may or may not come with pain at all! I've also seen people with the mindset "well i'm old so I guess i'm all worn out"...hence the TMS begins and so does the limping. And on the other side i've had patients in their 80s, 90s and 100s who have no pain and feel great, despite having some arthritis or other "normal abnormalities" on imaging.

It all just makes so much sense once you look at it...even more so from a medical standpoint.

 

Hi PT, thanks for your answer, I wish there were more PTs like you!

Can you answer me this one, it's been bugging me the whole time.

I know I've got TMS, I've had 25 years of all sorts of treatments culminating in injection in my spine a couple of months ago, and all have failed. I've had MRIs showing not much in particular other than general wear and tear. So it was easy for me to accept the TMS theory.

So since starting this course naturally the pain has gotten worse. But I've noticed two types of pain. There's the pain that just happens when I do the things I've always associated with bad backs - mainly, sitting at a desk. This just happens, and is simply there, no matter what position I adopt.

But there's other pain that I'm going to call restrictive pain. It's not happening unless I make certain movements, and usually I recoil from it. The movements include bending acutely (such to put on shoes and socks, especially in a standing position), or if I'm sitting or lying, raising a straight leg. It also happens if I put my head on my chest. The pain from all these actions I feel as a sharp, thin pain like a knife that runs across across my back at the belt line from one hip to another.

My question is firstly, is this actually structural pain? From my time seeing physios they have said that the connective nerves in my body are really tight and I need to loosen them up. The fact that I feel this pain when I put my head on my chest or raising a straight leg seems to support this theory.

So if it is physical, do I go back to stretching? I've deliberately kept away from that to break the association with the idea that my back pain is due to physical rather than psychological causes.

Or do I, which I was doing until recently, deliberately antagonise it, by doing these things it doesn't like? Like in the same way that people on this forum might push themselves to walk for longer when the pain is telling them to stop (I'm hoping you'll say this isn't the same thing).

I started to think antagonising this restrictive pain was making it worse. And I wondered if it was playing into the idea of bullying myself that I think is a big part of my brand of TMS.

I don't want to ask a conventional PT about this because I know they'll just steer me back to the usual protection and prevention strategy.

What would you say as a PT who knows the physical and the psychological causes and also as someone who's been through this experience? Many, many thanks in advance!

 

Ok, this is how I think about it:

Is your pain structural? Yes in the sense that the TMS has caused you to have learned pain patterns in those muscles and nerves. Sarno's theory is mild oxygen deprivation (not well proven but its possible) being the cause of that pain. HOWEVER...the true underlying cause of the pain is, of course, psychological. Yes the nerves and muscles are irritated...but remember the ultimate solution to un-irritating them is to think psychologically. This was my experience. You could have pain while sitting, or pain with straight leg raise, and that all makes sense given the muscles/nerves targeted by the TMS. This could be a result of conditioning.

Regarding activity: there is nothing wrong with stretching or using a heating pad occasionally but remember this is a TEMPORARY relief like taking Tylenol. Curing your pain will consist of TMS programs and uncovering your repressed emotions and stress.

Regarding "deliberately antagonizing": I would do exercise that doesn't cause you severe pain. Work on your TMS program and incorporate general exercise like walking and such that doesn't irritate you. Increase your activity with time as the pain diminishes. Know your limits on pushing through pain. In my experience it took a month or a bit more to get back to my full activity after starting the SEP. Everyone is different on that.

One last piece of advice- be kind to yourself! Don't beat yourself up...this is a process. Practice self-compassion and understand it will take time!

 

Thanks PT, good advice.

I'm doing swimming at the moment which has always helped (but never cured) my back. It doesn't antagonise unless I do tumble turns so I'm just not doing them for a while. The real test will be something like tennis but I'll work up to that.

 

Swimming is one of the best ways to be active in TMS. I am confident that it will help you to get back to playing tennis. Go gradually into that. Maybe just hit the ball against a backboard, without a partner.

 

I was that patient, I'm so very sorry now. Even as my poor beleaguered PT kept telling me, no, it's not sitting, it's not your age, it's not your weight, I kept thinking, yes, it totally is. It could be. It's like that for many people. I know lots of fat people with bad backs. Right? No, not right. He didn't really offer a clear explanation, such as TMS, though. He obviously doesn't think knowledge is penicillin!

Other than that, I don't feel the need to convince other people. I know how irritating it can be when people tell you what helped them, and then they want you to try this or that. Nope, not going there.