Dislocations?

Hi everyone,

It's been awhile since I've posted and hope everyone is enjoying life. Just had a question to everyone here: are dislocations possibly TMS? I dislocated my shoulder earlier this year and got better from the ligament and tendon sprains after a couple months, but while simply weightlifting yesterday I seemed to have popped it out real quick and it popped back in by itself (subluxed?).

I've read that people who dislocate a joint will have tendencies of dislocations in the future. Is that heresay, or is there some legitimacy to it? Could it be that dislocations are more likely to occur during times of high stress (TMS)?

Anyone have any dislocations and have any input?

Thank you,

Daniel

 

I am not a specialist, but I am a mechanical engineer and have a 'bad knee' myself.

My knee dislocates pretty easy, because it misses the support of a cruciate ligament (it is either elongated or it has torn and dissolved). It hurts like hell if it dislocates, it pops back immediately but the surrounding tissue sends a truck load of messages that my brain interprets as two minutes of intense pain and a week of protesting tissue. I've seen it happen with MMA fighters, they seem to experience the same thing.

Ligaments cannot grow back or shorten themselves, so once they are stretched or torn you will become more prone to dislocations. Muscles can often make up for it partly, depending on the ligament and the joint it supports. The risk of dislocation is higher when these muscles can't do their job properly, either because they are caught by surprise and not tense (sudden movement) or because they are not trained for it or still recuperating from the last dislocation. If I hit the gym for a couple of months and train my leg muscles, I will be less prone to dislocating my knee, but it can still happen.

There is a TMS factor, but I feel it is small compared to the mechanical factor. When tense/anxious my muscle control seems to be less fluent and precise, my coordination becomes more jerky which rises the risk slightly to dislocate it. But the fear factor also makes my muscles cramp up as if my mind wants to prevent me from doing stuff that have a higher risk of dislocations. It can even cramp up before I start the activity and during plus the aftermath can take longer.

I have known a guy who dislocated his shoulder pretty easily when throwing a basketball, without much pain but he didn't like the feeling either. He could pop it back himself, but he had to be careful with certain actions.

I feel a PT could help you with this. He can give you the right exercises to strengthen your shoulder.

 

A mechanical engineer! Now I definitely need another opinion! Jk

Thank you for your personal and analytical perspective.

 

Now you know why it took me some time to recover

 

Hi Daniel, was thinking about calling you the other day coincideantaly. I've never had a dislocation (that I know of) and it sounds like Gigalos gave you a great reply from personal and TMS experience. Probably a TMS surgeon who specializes in that joint could give you a good answer too. I think Dr. Hanscom and Schechter are surgeons any maybe you could present the question on their web-sites if they have that provision or at the "Ask a TMS Practitioner" forum here. I did date a flight attendant once, who was a good skier, and told me about dislocating her shoulder regularly, while putting luggage up into the bins, it was painful, she would lie down and someone would pop it back in for her, and she would carry-on lifting the carry-on's--this is anecdotal.

Cheers & Happy Holidaze!
tt

 

Hi Giantsfan,

I am not a specialist either, but have a mechanical designer background. My son has had 3 cadiver ligaments replaced in his knee after an accident and my wife has two knee replacements. Naturally I am drawn into this discussion.

Thank you Gigalos for your engineered answer, it describes with firsthand knowledge that a dislocation should not be considered TMS. I like in particular how you describe the tensioning of muscles in relation to the fear factor. The idea that muscles can be tensed by mental activities is not always obvious, especially when pain rears its ugly head.

I do believe however that tendons and ligaments can regenerate and heal, but take nearly forever to do so, very similar to nerve repair. I offer this link where Per Asbenberg in Sweden who has gone into great detail of how this is done, he knows better than I and appears critical with his analysis.

He discusses view on NSAIDS and view points on the three phases of healing, whether to rest or not etc.

I read nothing about the psychological aspect of ligament repair.

http://www.peraspenberg.com/texts/how-do-tendons-and-ligaments-heal/

Hi Tom, volley to your Happy Hilidaze

 

Thanks much! Interesting article, did a quick skim, will read it in detail later--seems to have many TMS implications--yeah!--like use it or lose it. Must go out now and do some "loading" on the courts--more later.

 

Never knew that they could repair themselves. Well, mine didn't, although I kept using my knee the first weeks after it happened


b.t.w. I think it is pretty important that any ruptured ends are in close proximity for healing to take place, just like a bone can only heal when the two broken ends are in close proximity of each other. I just don't see this happen in case of a complete rupture without any surgical intervention to keep the ends close to each other....

 

There was a time when I would look at the proximal and distal insertions of ligaments, muscles, and tendons. I would study how they interacted with one another, their tensile strength dependent on the directional force applied, which ways they rotated upon which axes, and what degrees of motion they could typically tolerate. I eventually realized that people who didn't really analyze things to such an extent and just lived life, didn't really have many pain problems. I am not saying one style of thinking is superior, nor am I stating logic that analyzing = pain, I am merely stating that I (Daniel) am tired of examining and just want to get back to the way I used to think (ignorance is bliss haha).

I really appreciate all the kind and supportive responses, but fortunately a few days after my right shoulder temporarily popped out and began giving me pain I started noticing the same pain in my other shoulder... hmmm.... Well, anyways my shoulders don't have any pain anymore so I suppose there was a TMS element to the pain which followed the dislocation. I almost have enough energy to write about why I think it's possible that non-traumatic dislocations (I do not consider medium-weight dumbbell shoulder press to be considered traumatic) could be considered TMS, but it's Sunday night and I have to go to work tomorrow haha. Back to pumping dee iron next week

Thanks again everyone!

 

When I started mechanical engineering, I and my study mates found that it sometimes can be a burden to always feel the need to analyze how something works.
After a dislocation or when my legs get tired, I start to worry about hyperextending my knee, how to put my foot down correctly, etc. The result is usually a cramped up leg that takes days to relax again. The only wise thing I learned is that when my knee doesn't swell, nothing is damaged. Other than that my analytical view doesn't really help me.
Back to playing dee basketball next week...

 

Giantsfan, Gigilos, Ignorance wasn’t bliss for me. I recently analyzed my neck issue that I’ve had for twenty years or so.

I got into the details of how my neck muscles work, and even found out the name of the offending muscle “Levator Scapulae”. For the first time I actually had physical therapy recommended by a surgeon after MRIs. The PT verified that I actually had a spasm, this was such huge relief that I nearly teared up. Over the next six weeks I asked many questions in the physical realm, everything he told made sense, from the direction of the muscle pull to why my neck is crooked. The only question he could not answer was why my muscle spasms in the first place, he said it was “involuntary, and posture”. I thought TMS.

I came away with very specific exercises for my neck, these are extreme stretches done very carefully. My neck is now much looser, my shoulders have lowered, and I now can turn around to reverse my truck with no problem or neck pain on the left side. While learning about my neck I got checked out “physically”. I have analyzed and gathered enough information for what I need.

So in the case of my lower back in 2000 I did not need to be analytical, but my neck in 2017 I did. I have also had to address the dissatisfaction of not discovering this earlier; perhaps 19 years ago. So now my Yoga routine now includes these stretches, I have to keep fit for dee windsurfing next year.

 

Thanks for the link to Pers Aspenberg--VERY INTERESTING from a TMS perspective!

Some of his points that resonate :

* One might think that the answers to these questions are common knowledge for doctors and physiotherapists, but they are not. The questions seem simple enough, but in reality we cannot give a definite answer to any of them, ...

* Tendons are strong; it would be possible to suspend a small car from an Achilles tendon.

* There are cells sparsely scattered here and there, and their function is to watch over the tendon material and replace it when necessary. This is a slow process, and how it works is not really known.

* The tendon acts like a spring... This provides the background to a normal, yet remarkable, human behaviour, namely that of being able to stand and jump on the spot, at a rave party or whilst country dancing. The spring-like properties of the tendons allow us to keep doing this all night without being too impeded by loss of energy. They are also essential, for example, for long distance running and high jump.

* It is obvious that loading in some way favourably modifies inflammation.

* We also investigated the length of time required for loading to produce a beneficial effect and concluded that 5 minutes once a day is enough. If the time is extended to 15 minutes then a better effect is obtained but increasing the time any further has little benefit.

* Loading triggers a complex cellular machinery,

* It was found that patients given a hinged brace or who are allowed to take off the brace and move their foot now and again are more satisfied and feel that the tendon performs better.

* The treatment effect may be a result of a reduction in oedema around the ankle and the avoidance of other side effects of immobilisation.

* We therefore carried out a study where patients with a ruptured Achilles tendon received surgery (it is not at all certain that this is better than no surgery)...

* The group that was allowed to load the tendon was found to have a substantially stiffer tendon both after three months and one year! However, they did not notice any difference themselves.

 

Interesting discussion here! I think the above is definitely true for tendons and ligaments. In my opinion as a PT, I really believe that not much good can come from micro-analyzing the specific interaction between all these muscles, tendons and joints for anyone except a surgeon...mostly it just causes anxiety in patients. Though a basic understanding is of course helpful, not denying that.

Here is how I think of this- a physical tendon rupture or dislocation of a joint is not TMS, it's a physical phenomenon caused by a mechanical force. But there are lots of things to consider. First, many of these injuries are not bad enough to warrant a surgery. Like was said somewhere above, though tendons and ligaments take a while to hear, a small or partial tear can be compensated for by the rest of the structure. Using severity of pain as an indicator for whether or not to do surgery seems like bad practice and there is little evidence to support it. There are clearly instances that require a surgery such as complete tear of the Achilles or ACL...and then there are instances such as rotator cuff tears that show up on MRI that are truly incidental findings. A good TMS doc could differentiate the nuances of this (and sometimes it is absolutely not clear cut!)

Another important point is that many of these tears or dislocations that are not complete can have a major TMS component, as was mentioned above. Even if you have a knee or another area of the body that is prone to popping in or out/non-traumatic dislocation for various reasons , the mechanical component of this will resolve pretty quickly and the pain accompanying may or may not correlate. I've found this to be true with people who have something like Ehlers-Danlos...they are quite prone to dislocation due to the elasticity of their tissues, but the chronic pain they experience is more TMS-y than structural.

One last thing- I saw a few people above discuss chronic muscle spasm of the neck, or muscles around the knee. I really think the overanalyzing is more of a hindrance than a help. Chronic muscle spasm is pretty much always due to TMS, which is what is meant by involuntary (mentioned by someone's PT above). I haven't seen any evidence (either clinically or in the research) to suggest that "bad posture" causes muscle spasms, which is a basic tenet of TMS theory. Trust me, I have had so many patients with "terrible" posture for their whole lives who experience no chronic pain in those muscles. That being said, if stretching or other physical methods help, there is nothing wrong with that! I've had plenty of people not open to TMS methods who are helped by stretches and hot packs, not a big deal. Just keep the symptom imperative in mind when figuring out your approach to this stuff.

 

MindbodyPt,
Thanks for your insights..

Could it not be that muscle spasms can be caused by real physical issues in combination with TMS, the clamping of muscles around arthritis for instance? We all agree muscle clamping around a broken bone clamps to protect and isolate, the message is: “pay attention and let it heal”. Once upon a time my Levator Scapulae muscle was loose (pre 1998). Since then perhaps due to old age, bad posture-genetics arthritis has formed between vertebrae. Would it be right to assume the muscle clamping causes increased tightness and more pain or am barking up the wrong tree, woof?

The PT I had over the last six weeks has proved very successful, my neck is lose, my head has full rotation, and my shoulders have dropped. My investigation into the physical and getting checked out has ended with this success. The PT said the Levator Scapulae was a prime location of tension in many of his patients, I somehow felt a comfort from this comment.

I asked many questions to the PT, he relieved my neck and tension every session using physical methods which I now try and replicate in my Yoga routine. He helped reduce my fear especially with the extreme stretching that caused: “oh so nice pain”. Prior to this I was scared of breaking my neck. We did not discuss why I have tension in the first place. I began to realize from our discussions, that perhaps my tension is a reactionary habit, similar to a flight or fright reaction. I have learnt incorrectly to over react as the muscle prepares itself for the next event.

I have actually never been able to think my neck pain away. It’s always been after exercise and activity that a reduction of tension and pain is noticeable. Now I can (against TMS protocol) re-tune my neck at a whim by doing these exercises if need be, much better than taking a pain killer. In addition two 10 min Yoga sessions a day, one before bedtime are in order. I check in with TMS on and off during the day, but you can’t beat a Yoga session to ask: “What’s going on emotionally, why am I tense in the first place and now to give thanks for the new knowledge I’ve gained?”

 

Hi Andy,

I think the truth often lies somewhere in the middle! In terms of muscles spasming around inflamed or injured areas- yes this definitely happens. This is an acute phenomenon that happens in the short term and you're totally right- let it heal and pay attention works well. I myself experienced a Levator Scap spasm due to an old neck injury a while ago that kept coming back as TMS and has since resolved.

My feelings on arthritis are this- everyone over 40 or less has arthritis in different areas of their body...it's a normal part of aging and should not be the cause of severe pain or spasm that is chronic in nature. It can cause some stiffness when more severe. I think many people experience arthritic flare ups with swelling and spasm sometimes if overworked but again, these usually calm down within a matter of weeks. For the swelling and spasm to go on for months to years without injury or strain is a mind-body phenomenon that probably began with a physical cause but turned into TMS (the "piggybacking" phenomenon).

It's great that your PT helped you so much with your neck spasm! It sounds like in addition to giving some relieving and comfortable stretches, a lot of what they did was help normalize the pain and spasm and take away the fear factor, which is key. I don't think its necessary in all cases to figure out the "underlying cause" of the tension TMS style. It can be sufficient to have a skilled clinician tell you that what you are experiencing is common and normal, which breaks the anxiety-tension-pain cycle and thus helps the muscles begin to relax.

TMS healing doesn't always have to be about purely thinking the pain away, that works for some people some of the time. But like you experienced, it can be a good strategy to simply have a great clinician tell you not to be worried, and then use whatever strategies help you relax! Some may respond well to stretches, some to heat or ice, etc. It's so individual. Mind-body truly means mind-body...if using a more body based strategy helps your mind relax, that is great. If you get the most out of yoga instead of journaling TMS style, that's great too!

 

Hi MindBodyPT,

Thank you so much for your response about my personal issues. I concur with all that you said, and it was great hearing it from someone else in the medical profession. I have been involved with TMS since 2000 and have made many U-turns in my thinking along the way. My thinking now has to be 50/50 Mind and Body. Since 2000 I have been able to manage my back pain very well with both Yoga and mind body awareness, my TMS issues are personality trait driven, and not so much past or present family or work stress.

Stretching wasn’t encouraged in my early years on the forums, so I kept silent and did Yoga to reduce pain. It’s worked well for my lower back for 17 years and I am hoping the same outcome for my current neck issues. I was delighted to find out that exercises specifically for my neck actually exist, I did not know there were any until my recent PT treatment, but they certainly work, as I was rendered completely pain free, with full head mobility. I don’t care if it was only temporary.

I am very much into “repression” and the psychology of how the sub conscious mind works these days I have a post named such. It is possible that I repressed the very idea of getting well with my habitual way of thinking by accepting my neck pain as the status quo, similar to a strange friendship? I was not really aware of the “fear factor” as you put it. I must have had one, as I had an acute reluctance to go to the same surgeon that planted two implants in my son’s neck. My initial reason for the visit was a fracture sacrum, this turned to heavy discussions about my neck, subsequent MRIs and PT treatment. The surgeon said I would do well with PT, and I could see that he recognized my ability to self-heal.

I am really glad I asked this question and thank you once again for answering it.

 

Thanks for the link to Pers Aspenberg--VERY INTERESTING from a TMS perspective!

Some of his points that resonate : (My comments are in parentheses, I tried putting them in color but the color button isn't working for me.)

* One might think that the answers to these questions are common knowledge for doctors and physiotherapists, but they are not. The questions seem simple enough, but in reality we cannot give a definite answer to any of them, ...

(tt : There's a lot medical "science" does not understand about the intricate mysterious workings of the mindbody--but the white-coats are good at making us believe the know it all.)

* Tendons are strong; it would be possible to suspend a small car from an Achilles tendon.


(tt : That's an amazing factoid--Dr. Sarno always counseled that the body is STRONG!)

* There are cells sparsely scattered here and there, and their function is to watch over the tendon material and replace it when necessary. This is a slow process, and how it works is not really known.

(tt : The mindbody is it's own best healer.)

* The tendon acts like a spring... This provides the background to a normal, yet remarkable, human behaviour, namely that of being able to stand and jump on the spot, at a rave party or whilst country dancing. The spring-like properties of the tendons allow us to keep doing this all night without being too impeded by loss of energy. They are also essential, for example, for long distance running and high jump.

* It is obvious that loading in some way favourably modifies inflammation.

(tt : Use it or lose it--drawing circulation to "injured" joints, muscles, ligaments and tendons speeds the healing process.)

* We also investigated the length of time required for loading to produce a beneficial effect and concluded that 5 minutes once a day is enough. If the time is extended to 15 minutes then a better effect is obtained but increasing the time any further has little benefit.

(tt : It doesn't take much movement to get the "healing" process started.)

* Loading triggers a complex cellular machinery,

* It was found that patients given a hinged brace or who are allowed to take off the brace and move their foot now and again are more satisfied and feel that the tendon performs better.

(tt : Exercise feels good and is good for us--traction didn't work.)


* The treatment effect may be a result of a reduction in oedema around the ankle and the avoidance of other side effects of immobilisation.

(tt : Such as atrophy.)

* We therefore carried out a study where patients with a ruptured Achilles tendon received surgery (it is not at all certain that this is better than no surgery)...

(tt : Dr. Sarno said surgery is the best placebo.)

* The group that was allowed to load the tendon was found to have a substantially stiffer tendon both after three months and one year! However, they did not notice any difference themselves.

(tt : TMS is part of the human condition, symptoms fade from memory to be replaced with new ones--the SYMPTOM IMPERATIVE--unless we understand the Good Doctor's theory and take control of our mindbody health.)

 

Hi Tom,

Good TMS translations, I was attracted to his tendon link for good reasons and read it all. He appeared to have critical analysis in his reasoning. After viewing his video: “ Too much medicine”. I would say even as a surgeon he would agree with your translations. From his cartoons he seems to be very much the cynic, I think most of them are targeted to other doctors and used for enhancing his message.

He made reference to the good old days when surgeons ripped out your total knee meniscus at a whim, I knew someone who had this done. He was actually told by the doctor: “You don’t need it”.
I just worked out when my friend had his meniscus totally removed it was 57 years ago in 1960.
Crap I'm getting old.
http://www.peraspenberg.com/videos/too-much-medicine/

 

I can confirm your statement right here is indeed true. Very wise, MindBodyPT. You are spot on. I don't just "like" your post - I wish I could "love" it!

The problem is that over 84% of people with my kind of Ehlers-Danlos are subject to autonomic nervous system dysfunction (dysautonomia), and factors such as anxiety, depression, stress, emotional trauma, etc. critically heighten one's existing autonomic dysfunction, leading to sympathetically-mediated pain (including pain that mimics neuropathy, but isn't true nerve damage), worsened postural orthostatic tachycardia syndrome (POTS), circulatory and blood flow issues (including Raynaud's), digestion issues, etc. I try to avoid forums such as DINET and Neurotalk at all costs because while I do believe some of the patients have less control over their conditions (Ehlers-Danlos and hypermobility lie on a spectrum where not everyone is the same), you'll find others who note that their dysautonomia didn't become severely debilitating until after a highly stressful life situation occurred, but honest discussions around the mind-body connection aren't really encouraged and/or understood. The best neurologists I've ever had were the ones who said, "OK, yes, you do have Ehlers-Danlos, which means you have a higher incidence of autonomic dysfunction, but you can't blame everything you're going through on your connective tissue. You might never be perfect and without a little pain or some problems, but you have more control than you realize. A good life is still possible for you, but you have to work at it, too."

I hope this helps anyone who might be searching for specific keywords one day and needs to see this post. You can have something structural, but still have some control in your health outcomes and quality of life.

 

Happy holidays Andy! If it's any consolation we're ALL getting older with you--another TMS stressor on the Rahe-Holmes. There's a great book out there called "GROWING OLD IS NOT FOR SISSIES" :

https://www.google.com/imgres?imgurl=https://images-na.ssl-images-amazon.com/images/I/91xNmQ519ML.jpg&imgrefurl=https://www.amazon.com/Growing-Old-Not-Sissies-Portraits/dp/0876540582&h=1920&w=2560&tbnid=BBwrRA8wvlKfOM:&tbnh=160&tbnw=213&usg=__d1RQ1vMRtIiy0DeJGfbYna0zUs8%3D&vet=10ahUKEwiTvvHKmJzYAhURxmMKHfRuD6QQ_B0IlwEwDw..i&docid=aUQgMEc7kCOfbM&itg=1&sa=X&ved=0ahUKEwiTvvHKmJzYAhURxmMKHfRuD6QQ_B0IlwEwDw (Google Image Result for https://images-na.ssl-images-amazon.com/images/I/91xNmQ519ML.jpg)​