"Chronically acute" pain - need a way to judge my activity level

[Focuser]

I've been dealing with various muscular pains for 10-15 years. In the past, many of them have lasted for months. And some of them have been proven TMS; by "proven" I mean that:

1. they persisted for months until I got a correct diagnosis of no structural problem, and then they vanished; or,
2. in one case, I was able to resolve it (pain in both forearms) using Pain Reprocessing Therapy.

Yet I've also had pains which pop up in different body parts, and which react more consistently to my physical activity.

In April I visited Dr. Ira Rashbaum, and a rheumatologist to whom he referred me, who pronounced me free of structural or systemic problems.

Most recently, I had a sudden spasm in both sides of my neck and traps while doing rehab exercises for a pulled hamstring (another story)... the exercises didn't involve or stress my neck or traps at all. It's now been four days, and on the left side, the pain and weakness aren't resolving as well as similar events usually do. (And similar events in the past have typically been triggered by some kind of exercise of the affected area.)

The question is whether to "rest" this area, which has real negative effects for moving forward with life activities important to me, or to just let it hurt and go ahead anyway.

Here's the underlying issue. Of late, my pain has been what you could call "chronically acute:" I am repeatedly in the position of having "hurt" myself just days or weeks ago. The typical advice, to get cleared by a doctor and then treat as TMS, doesn't work--I'd have to see the doctor over and over and over (and it's not that easy to get in to see a TMS-aware doctor). But I'm not comfortable just assuming things are TMS and pushing them in a way that might be bad for me. For instance, maybe tension is contributing to muscle spasms, but then the muscles themselves need real recovery time.

For comparison, I'm currently on a walking restriction placed on me by my PT who is working on my strained hamstring.

Any advice about a sensible physical approach would be much appreciated. To most people, "sensible" means "let the pain be your guide"; I think it's obvious why that's not foolproof. But "ignore acute pain and push through it" doesn't seem right either.

 

[Ellen]

Of late, my pain has been what you could call "chronically acute:" I am repeatedly in the position of having "hurt" myself just days or weeks ago. The typical advice, to get cleared by a doctor and then treat as TMS, doesn't work--I'd have to see the doctor over and over and over (and it's not that easy to get in to see a TMS-aware doctor). But I'm not comfortable just assuming things are TMS and pushing them in a way that might be bad for me. For instance, maybe tension is contributing to muscle spasms, but then the muscles themselves need real recovery time.

Our TMS brains are so creative at finding an "out" for us so that the TMS can continue. I think that is what is going on for you here. I'd double down on exploring the psychological need you have for the TMS distraction. You've been successful in the past, and just need to do more to overcome this current block you've created.

 

[bobbyPT]

As a PT I would say you do not need to be checked every single time you have a symptom. It depends on if there was an injury or if you have other red flags symptoms which would warrant a visit. You also want to look at patterns, is it getting better or worse at certain times? Start at a time of stress? things like that. For muscle spasms I would not push through them as most people say it just gets worse (I can say from experience as well). Take a break and practice self care, healthy self regard. Wait until it calms down enough that you feel comfortable enough to get back to some level of activity. Start small. When I had a neck spasm from exercising I just took some days off and slowly incorporated the exercises again. We usually say if you have some soreness/discomfort then the level sounds appropriate. If you have higher levels of pain it means the activity was just too much at this time and to back off. If you need to do daily activities like bathing, cooking etc if it is too painful on one side just compensate on the other for now until pain improves. People may give advice to push through but that just becomes pressure and more pain.

 

[Focuser]

@Ellen absolutely, I am... but I have decisions to make in the meantime about what to do and not to do.

@bobbyPT thank you so much for your detailed response. Just to give you a broader idea:

• I'm getting PT for a "hamstring strain," which is healing more slowly than expected over multiple weeks. But, from what I understand, what the PT can actually perceive is the muscle spasm, which might or might not actually be surrounding injured tissue. There was never swelling or redness, and no one moment at which a clear, sudden injury event occurred. (I can perceive the spasm too: it's physically hard when the therapist gets in there and massages it.)
• Since starting PT, I've had a spasm in my left calf, and then in my right calf. They have me doing simple stretching exercises, but I'm not convinced they help more than they hurt.
• The PT has me on a steps restriction: walking 3-5k steps per day instead of my usual 10k. This was fine with me when the picture was a clear "heal up an injured hamstring," but if the situation is "multiple, erratic muscle spasms" (and I've got the one in my shoulder as well!), then restricted behavior bothers me a lot more--and makes me wonder if it isn't even creating problems.

This is the challenge of what I called "chronically acute" pain: the line gets blurred between things that require just a psychological TMS approach, and things that require a physical response.

 

[JanAtheCPA]

Hmm. Is there any suggestion of OCD in your personality traits, @Focuser? Because this all sounds pretty obsessive, in my completely unprofessional opinion (based purely on 13 years of observations on the forum).

Continuing to run to a medical professional to get outside corroboration for every single symptom is certainly quite obsessive, if not completely counter-productive to the whole point of learning to heal ourselves. Most people who do this work get over this need once they discover the work and learn to trust their instincts. These are the ones who recover, and who are subsequently successful in dealing with the setbacks that inevitably surface as a consequence of living our lives. We always have to remember that the TMS mechanism is not a disease or an aberration - it is a normal, but unfortunately primitive, brain survival mechanism, that pretty much works for shit in the modern world, and which definitely goes into overdrive when combined with a hyper-anxious and highly-sensitive nervous system.

The thing about OCD behaviors that we see here is that they are anathema to TMS recovery. Just like regular anxiety, OCD in all of its variations must be dealt with and mindfully managed in order to achieve freedom from constant TMS symptoms.

 

[bobbyPT]

Hi Focuser thanks for the details. Yeah if you have a hamstring strain without an injury that wouldn't add up. Plus if you have multiple areas of spasms that also does not add up unless you had a central nervous disorder but you would have many more symptoms beyond that. TMS can cause spasms/tightness/hard muscles bc it also all controlled by the nervous system which is what this type of work will heal. I had severe hip pain on my left side which was most likely a spasm and when I tried to stretch it became much worse. Once I read Dr. Sarno's Healing Back Pain and stopped fearing my movement and being too focused on it the pain went away in a week. I can understand activity limitation due to injury but if you feel fine walking all those steps and you are not afraid of doing it then go for it. A lot of what we can teach as PT's becomes fear based advice and only makes things worse.

 

[Focuser]

Hmm. Is there any suggestion of OCD in your personality traits, @Focuser? Because this all sounds pretty obsessive, in my completely unprofessional opinion (based purely on 13 years of observations on the forum).

Continuing to run to a medical professional to get outside corroboration for every single symptom is certainly quite obsessive, if not completely counter-productive to the whole point of learning to heal ourselves. Most people who do this work get over this need once they discover the work and learn to trust their instincts. These are the ones who recover, and who are subsequently successful in dealing with the setbacks that inevitably surface as a consequence of living our lives. We always have to remember that the TMS mechanism is not a disease or an aberration - it is a normal, but unfortunately primitive, brain survival mechanism, that pretty much works for shit in the modern world, and which definitely goes into overdrive when combined with a hyper-anxious and highly-sensitive nervous system.

The thing about OCD behaviors that we see here is that they are anathema to TMS recovery. Just like regular anxiety, OCD in all of its variations must be dealt with and mindfully managed in order to achieve freedom from constant TMS symptoms.

Hi Jan, I appreciate your response and I see where you're coming from. I've specifically not run to medical professionals over and over, for the reasons you describe. It's actually pretty unusual that I'm seeing a PT right now (referred by my GP). And the visit to Dr. Rashbaum et al. was a one-time thing to eliminate serious disease, that won't need to be repeated.

That said, I can certainly fall prey to obsessive thinking, and micro-focus on symptom details may indeed be part of my problem.

 

[Focuser]

Hi Focuser thanks for the details. Yeah if you have a hamstring strain without an injury that wouldn't add up. Plus if you have multiple areas of spasms that also does not add up unless you had a central nervous disorder but you would have many more symptoms beyond that. TMS can cause spasms/tightness/hard muscles bc it also all controlled by the nervous system which is what this type of work will heal. I had severe hip pain on my left side which was most likely a spasm and when I tried to stretch it became much worse. Once I read Dr. Sarno's Healing Back Pain and stopped fearing my movement and being too focused on it the pain went away in a week. I can understand activity limitation due to injury but if you feel fine walking all those steps and you are not afraid of doing it then go for it. A lot of what we can teach as PT's becomes fear based advice and only makes things worse.

Thank you for your comments. Yes, I think that after the period I agreed to limit walking (basically ending this Friday), I'm going to just start doing whatever feels OK. My PT is helpful and means well but I don't want to let him unwittingly pull me into a limitation/guarding cycle.

 

[Cactusflower]

I have similar situations. Every time I try ang get out of my “physical box” symptoms increase and can feel pretty strong.
I do not judge them or give them names like “acute” - that’s mental hole that your subconcious
brain will enjoy falling into. I do see a PT every month, he gives me movements to slowly challenge my brain’s safety mechanism and has explain the reactions of “acute” pain are pretty similar to a mental freak out. Now he understands more about TMS we are simply trying to retrain neural pathways of conscious and unconscious reactions - basically you are still stuck in fight/flight/freeze and your brain thinks you must be in danger when you feel the sensations and your body simply tightens in protective mode. The suggestion I have been given is to do TMS mental/emotional work plus some nervous system re-training (so blending Sarno and Gordon) at the same time you are trying to become less sensitive physically. Find a baseline set of movements you do regularly that you do not consider exercises that challenge: I have some easy warm ups, breathing, walking, basic qui gong videos and I do one of these daily since I now find them relaxing. I exercise daily, and if symptoms increase and movement is more challenging I continue to do one of my other more calm movement activities. I’m teaching my brain that doing nothing and going back to no movement is not acceptable with TMS. I am not injured and nothing acute is going on..my brain just interprets things that way (mainly because I’m still so tight). As my brain begins to recognize some things are not threatening (heavier chores, or excercise) I can add them to my calming movements and not back off on them when symptoms increase.
Some folks can just whole hog challenge physical symptoms and push through symptoms, some folks brains can’t do that right away. It’s no big deal.
Dropping judgements, forcing-
/striving and self-pressure is a must for some folks. You don’t even realize you are doing it.
Mentally I felt I needed to be constantly productive, and I figured out why. It has just been a lifelong habit and hard to break.

 

[Focuser]

I have similar situations. Every time I try ang get out of my “physical box” symptoms increase and can feel pretty strong.
I do not judge them or give them names like “acute” - that’s mental hole that your subconcious
brain will enjoy falling into. I do see a PT every month, he gives me movements to slowly challenge my brain’s safety mechanism and has explain the reactions of “acute” pain are pretty similar to a mental freak out. Now he understands more about TMS we are simply trying to retrain neural pathways of conscious and unconscious reactions - basically you are still stuck in fight/flight/freeze and your brain thinks you must be in danger when you feel the sensations and your body simply tightens in protective mode. The suggestion I have been given is to do TMS mental/emotional work plus some nervous system re-training (so blending Sarno and Gordon) at the same time you are trying to become less sensitive physically. Find a baseline set of movements you do regularly that you do not consider exercises that challenge: I have some easy warm ups, breathing, walking, basic qui gong videos and I do one of these daily since I now find them relaxing. I exercise daily, and if symptoms increase and movement is more challenging I continue to do one of my other more calm movement activities. I’m teaching my brain that doing nothing and going back to no movement is not acceptable with TMS. I am not injured and nothing acute is going on..my brain just interprets things that way (mainly because I’m still so tight). As my brain begins to recognize some things are not threatening (heavier chores, or excercise) I can add them to my calming movements and not back off on them when symptoms increase.
Some folks can just whole hog challenge physical symptoms and push through symptoms, some folks brains can’t do that right away. It’s no big deal.
Dropping judgements, forcing-
/striving and self-pressure is a must for some folks. You don’t even realize you are doing it.
Mentally I felt I needed to be constantly productive, and I figured out why. It has just been a lifelong habit and hard to break.

Thank you, this is an excellent perspective! Yes, I've noticed that if I can do a certain physical action repeatedly, and I find it comfortable, then it filters into the "mentally OK" slot and becomes no longer a potential problem.
I like your approach because it acknowledges the role of targeted physical activity, while keeping the understanding of TMS as a mind-body problem.

 

[bobbyPT]

Thank you for your comments. Yes, I think that after the period I agreed to limit walking (basically ending this Friday), I'm going to just start doing whatever feels OK. My PT is helpful and means well but I don't want to let him unwittingly pull me into a limitation/guarding cycle.

sure good luck