Exercise and the rise/fear of pain

Hi all,

I have battled with my most recent onset of back pain for about a year now. I was a "book cure" many, many years ago, and I also employed Sarno's methods for small flares here and there. This time I seem to be stuck. I don't know if it's the complete shit storm that is my personal life right now, aging and entering another shit storm with hormones, or any number of things. This is worsened by the fact that I am a PA and am constantly looking for differentials and treatments to apply accordingly. I go around and around in circles, but I always come back to TMS as the things that makes the most sense. And the fact that I keep letting my brain go to these different diagnoses and treatments makes me feel like I'm failing at the TMS "protocol."

So, to overcome my fear of the pain, I have started to re-engage with exercise. I grew up an athlete, and I truly enjoy moving my body. I also believe maintaining strength and flexibility as I age is important to my future overall quality of life. I am currently 45yo, and I want to be that fun 75yo who is still traveling, playing with grandkids, doing yard work, and exercising without limitations.

The problem is that due to the back pain, and the fear associated with it, I have become deconditioned. I will work out a reduced level for one day, and then I hurt for several days thereafter. It's so disheartening. The workout itself does not usually hurt, but my back muscles scream and my spine feels so damn fragile the following day. I have lost count how many times I have given up and gone back to "protection" mode and forgoing any progress of regaining strength.

I have read the Great Pain Deception multiple times, especially to see how Steve threw himself back into activity. Is this the answer? The balls to the wall approach? That's typically been my mentality, but it doesn't usually serve me well in the end. Should it be more graded exercise? But MOST IMPORTANTLY, what is the best way to handle the pain/fear when it arises? It's all consuming at times. I just need some advice on how to continue safely while also talking myself off the ledge that my spine is breaking in half (I know it isn't, but it sure as hell feels that way).

I'm sorry this turned out to be so long, so I thank anyone who takes the time to read it!

 

Steve actually stepped back on that and admitted some time later that he would have probably healed more quickly if he had paced himself better.

I've gone both routes - pushing full steam ahead and then earlier this year I stepped it back and started to build again. I experience symptoms both ways, so I've had to shift my focus to knowing that while I do feel the pain after, there's nothing actually wrong with my body. It's not easy and there are days I think I would be better off giving up exercise, but then I tell myself that just means muscles will atrophy, my back will stiffen more, and it's possible my brain will see quitting completely as a sign that any activity is dangerous, and next I start hurting just walking around the house.

I don't think there's one answer for everyone. That's the short version.

 

Don’t give up no matter how much it hurts the next day. Consistency retrains your brain to stop trying to protect you with pain. Very very slowly increase your workouts. How to handle fear is hard. Keep your mind on your new future that you will one day obtain. Keep hope alive. You healed once, you can do it again. Have you ever watched Dan Buglio on YouTube? Painfreeyou.com. He might give you strength. He talks about all this.

 

Even though you may feel pain the next day after, keep doing your normal routine. "I'm scared, but that's okay and it's allowed, however there is nothing wrong with me and I will workout". You know structurally there is nothing wrong with you. If you need to take it slow, take it slow. I have no patience especially when it comes to physical routine, so I have ripped off the bandaid quite quickly a la Steve Ozanich when it came to physical symptoms - it's worked for me, but others will disagree with this and that's okay.

 

You say you want to be a specific way in 30 years. Specifically a fit person without restrictions. What do you think these thoughts are conveying to the TMS brain that is prone to panic? This is why I think it’s really wise for people to examine their physical outlets and how they engage with them. Because for some the stakes are so unbelievable high. If I can’t do x, who am I? If I can’t do y how will I be fit in 30 years and be able to lift my grandkids?

sorry to get morbid, but nothing here is guaranteed. We can all drop dead tomorrow. So thinking this far into the future is unwise. Yes exercise is a good thing, yes it’s good to be fit. But we gotta find a way to lessen the pressure. Because right now your brain views exercise as dangerous, and you view the inability to exercise as potential doom decades down the road. We need to lower the stakes. Live more in the moment. Do things because they’re both good for us and bring us joy. Of course we can plan for the future, but we need to recognize the reality of the TMS brain that is constantly scanning for threats and trying to keep us in a bubble. It’s trying to predict every bad thing that can happen down the road. It’s pretty much all bullshit and lies.

you have really good evidence that this is all TMS (no pain upon exertion but pain the next today that always returns to baseline), I think just losing the catastrophization is wise, and maybe baby stepping exercise. Is the pain equal for all forms of exercise? Right now you can’t do your desired exercise outlet. What can you do? Walking, gentle yoga,swimming etc. we can get very pigeon holed with our activities. I’ve had to give up so much and pretty much all of it always comes back. It’s all temporary, the pain, life, on and on!

 

yes! We are all such driven people and perfectionists—and it has gotten us where we are today. It’s hard for us to do anything without putting pressure on ourselves. I’m currently making progress with a gentle exercise program (seated chair yoga) that seems way too easy now. But I’m taking it super slow and successfully added some squats and walking in the living room on some days. While I’m doing it I think about what a success I am. Who wants to be beaten up? I used to berate myself that I have become so weak etc. But this TMS isn’t my fault. It’s just a circumstance that I’m living with right now. Everything is relative. This is my current workout and I get to be proud of myself for doing it each day.

 

Hi!

I wouldn't beat yourself up - but instead I'd really reflect on the evidence I have gathered. How convincing is it? Remember that TMS is the syndrome itself and not the treatment (although it involves that) so it's not really a choice - if you have TMS then treating it as such is the only thing that will work. Reassure yourself with your evidence

I think it's risky to look at it from a place of strength. I understand what you mean, but assuming your general fitness level is okay, it's highly unlikely that the weakness and deconditioning is what is causing the pain (it can cause delayed onset muscle soreness yes - but that's not a concern/is temporary and that's different from TMS). A lot of people do no exercise whatsoever and their backs are completely fine at 45 (they may be weaker than average, but the weakness isn't an issue - at least for now). Genuine muscle weakness is often associated with muscle dystrophy and is tested neurologically (that's when you have a real problem from a weakness standpoint - but you'd know if it was a real problem). Your back doesn't necessarily need to be strong for you to recover from TMS (if that's what you're inferring to yourself, then you're telling yourself it's a body problem and stoking unnecessary fear). It is important to get normal range of motion and movement back to heal absolutely (that's been avoided because of the pain), but my point is that I would be careful with how you frame this to yourself (it might seem like semantics, but mindset is everything). I'm happy to explain that further .

It's not my preferred method but each to their own. It is interesting what Rusty Red said about Steve's confession above I was not aware of that. I actually think that this goes back to what I said before. If you think your back is massively weak, then naturally you're going to fear that your spine is breaking in half (as that's the visual you've given yourself). Assuming that it is no less weak than the average person (or at least the average sedentary person who has no issues with their back), there's no need to fear it (I appreciate that it feels that way, but whilst the feeling is real it's just an illusion based on your beliefs).

Hopefully that helps but let me know if it didn't make sense

 

You said that the workout itself usually doesn’t hurt, but the reaction comes the next day.

That’s usually where the whole thing tends to get decided.

It’s really easy in that moment to interpret the soreness or pain as “I did something wrong” or “I set myself back,” even if part of you knows that’s not true. That interpretation is what keeps the fear loop going.

What if, instead of finding the perfect level of exercise, you changed how you relate to what shows up afterward? When the next-day pain comes, you start treating it as your brain being on high alert rather than evidence of damage. Not in a forced or positive-thinking way, just recognizing it for what it is and continuing on without trying to fix or analyze it.

Part of that is also recognizing that normal soreness and recovery don’t mean anything has gone wrong, even if your brain is quick to label it that way. Perhaps giving yourself that time to recover, then considering any lingering pain beyond that as your brain being on high alert might take a lot of the pressure out of the whole process.

 

I can't tell you how many times this exact dialogue plays in my head. Week after week. I have plenty of evidence that this is all, or at least a great deal, is TMS. I need to be kinder to myself in this process and rather than give up, maybe move a little slower.

It's just those damn twinges that hit in just the right (wrong??) spot that cause that immediate adrenaline surge that piss me off and the fear floods. I'm getting better at redirecting, and as Alan Gordon has said, not every uncomfortable sensation is dangerous. I tell myself that repeatedly. Slow and steady.