Follow up on arm pain/dysfunction

[Jayver17]

Hey ya'll,
I posted a couple weeks back regarding my miserable tennis elbow situation, that's here if anyone wants to read:
https://www.tmswiki.org/forum/threa...elbow-as-tms-manifestation.33584/#post-172530

Got some helpful replies, appreciate that...couple new things have sprung up, figured I'd start a new thread and see if anyone has anything helpful for me.

So first off, has anyone ever encountered an actually visible sign of a physical manifestation of a TMS/neuroplastic condition? I've had TMS in back, hamstring and knee before and never really seen visible evidence of it superficially, so if it's able to do that that's new on me and since new symptoms always trip me up, hearing examples might help to soothe my anxious mind.

I can't quite tell exactly what's going on, but the effected elbow joint looks a little different from the other one - there might be a little mild swelling and redness there, but I can't be sure because I also had multiple cortisone injections at the sight and that can make the skin look a bit weird. It's very sensitive to the touch right now, and there is slightly rounded, more bulbous looking skin surrounding the little bone there. And at first I thought maybe it was looking a little reddish, but it could also be the skin just getting some color back and regenerating some fat after the cortisone turned it white and reduced the fat pads for a few months, I really don't know. But could TMS hypothetically do that, cause swelling or redness? I've not yet seen it, just curious what others have experienced...I first noticed it about a week or so ago.

I also would like to share some of what's going on with my shoulder, see if anyone can relate a similar experience. I've simultaneously been rehabbing the shoulder on the same arm and didn't mention it in my previous post because I'm only recently thinking it could be TMS as well. Last summer (August) I rolled over it in a weird way in a BJJ class - nothing popped, it just felt weird and a bit off. That feeling lingered so I saw a doc. Doc said maybe a minor sprain, and the arm bone was likely not set properly in the socket; it wasn't major, he assigned me PT, I did a month and then thought it was fine (September).

Then (November) I went to Thailand and had a massage done, and the masseuse said that shoulder seemed off, did I injure it before and did I want extra time with it? I said yes and yes; she worked it over, it was very tender and tight, felt super sore for a few days then it cleared up and felt good as new or so I thought. I mentioned just in case it's relevant that a third party, non medically trained person objectively noticed that shoulder wasn't quite right.

Anyway, back to the States and December is when I flared up my tennis elbow for the 4th time. January I started rehab for the elbow; PT does an eval, looks at my shoulder and tells me that's messed up as well. It feels fine I tell her, I had a mild injury but I did rehab and it feels OK now. She says it's super dysfunctional - rolled forward, there's subluxation, and scapular dyskinesis, which could be causing stress on the elbow, so I should just rehab the whole arm.

So that experience was kind of wild because again, the shoulder was not bothering me when I went in, but as soon as I started the rehab exercises for it it was intense - very sore, all the time, for like a month straight. Then after a while it started feeling better - less soreness, also the soreness shifted from back to front, which I was told was normal as the load was starting to now be distributed in a more balanced way.

That PT discharged me because I'd already had all the visits my insurance would allow, but a week later it all flared up again - the elbow mostly, but the shoulder was a bit sore again as well, so I found a new PT and just went out of pocket. She did a more thorough eval, told me things weren't too bad and I was close to recovery with both the shoulder and the elbow. I started her new program, and things went great for a month but then it all started flaring up again, and has been bad for weeks now and so here I now am.

So anyway, the elbow is the worst of it, it's very painful and I'm getting very frustrated and depressed and that's what had me start leaning toward a possible TMS manifestation.
But I still didn't think of TMS for the shoulder at first, for a few reasons: first off, there was that initial acute incident, as opposed to gradual onset like the tennis elbow. And it seemed at least initially to respond to PT.

And when I was later told it was actually still out of whack...I mean I could buy it, the first PT wasn't THAT thorough, plus I got all kind of muscle imbalances from past injuries, I figure why not try and fix it if I can? And there were all those physical signs - the forward roll, the scapular winging - there was visible evidence it was slightly off - even that random Thai masseuse noticed. And then my second PT did an even more thorough eval with instruments - she measured the actual strength and range of motion, and said Yeah, you're weak in these planes and stiff in these ranges, here's what to work on. So there was a lot of objective evidence something was actually wrong. But again, there was no pain, , it just felt dysfunctional, and the right exercises seemed to be bringing that functionality back.

But now it's kind of bothering me again. Not as bad as the elbow, and it's again, not painful. I just feels off again, like a lot of the progress has been undone - it's sore after use, it feels weaker, kind of out of place, movement is stiffer, it's just feels wonky. Doesn't hurt, but the worry is that if i return to BJJ or anything that's high intensity I'll mess it up again because it's not strong/stable enough to take on those forces, so I'm starting to develop the same anxiety there.

Whenever I start experiencing a lot of anxiety, frustration and depression about an injury is usually when I start thinking along TMS lines, so maybe it's just taken over this whole arm and I wanted to see if anybody could relate an experience - with a shoulder or whatever, a similar situation with any joint. Anybody have that? A TMs condition that's not painful but just dysfunctional - weak, stiff, imbalanced, out of place, etc.? And also seeming to respond pretty well to PT at first, then all of a sudden not?
The elbow thing might be complicating things, I don't know - could be the elbow is TMS but the shoulder issue is legit, and progress has plateaued because the elbow is mucking things up all around. Just a theory. But yeah, curious what everybody's thoughts are as again, this is all new to me, I've only had TMS present as lower body stuff, never dealt with arm stuff before.

Thanks to anyone who reads and responds.

 

[Rabscuttle]

You’ve unfortunately got a bunch of nocebos from well meaning people. Unsurprisingly these comments are going to lead to us obsessing about our bodies. Which is an unfortunate state to be in, because even if it’s a true physical issues that attention and obsession is just going to turn things chronic, especially someone who identifies as a tmser.

I have muscle knots throughout my body, that reliably produce pain when touched, I have muscle imbalances ( which likely stems from fear and Imbalanced use). There’s a misconception in this space that TMS means no physical or outward changes, I’ve even seen people say if there’s inflammation it’s not TMS, it’s all quite preposterous.

I think if you’ll reread through your own post you’ll see the degree to which you are giving too much attention to these physical issues and get your answer. Can you do pt and strength training? Of course but the lens from which you engage them is importantly especially since your current approach seems to just have you in a loop. Sometimes it’s best when starting this work to avoid going to pt so you don’t confuse your brain and start spiraling from comments from people who aren’t aware of this stuff.

I used to do Bjj too! Maybe one day I’ll return.

 

[Jayver17]

You’ve unfortunately got a bunch of nocebos from well meaning people. Unsurprisingly these comments are going to lead to us obsessing about our bodies. Which is an unfortunate state to be in, because even if it’s a true physical issues that attention and obsession is just going to turn things chronic, especially someone who identifies as a tmser.

I have muscle knots throughout my body, that reliably produce pain when touched, I have muscle imbalances ( which likely stems from fear and Imbalanced use). There’s a misconception in this space that TMS means no physical or outward changes, I’ve even seen people say if there’s inflammation it’s not TMS, it’s all quite preposterous.

I think if you’ll reread through your own post you’ll see the degree to which you are giving too much attention to these physical issues and get your answer. Can you do pt and strength training? Of course but the lens from which you engage them is importantly especially since your current approach seems to just have you in a loop. Sometimes it’s best when starting this work to avoid going to pt so you don’t confuse your brain and start spiraling from comments from people who aren’t aware of this stuff.

I used to do Bjj too! Maybe one day I’ll return.

Yeah, I mean...I don't know what to say, I'm obsessed with my body anyway because I'm very fitness oriented and a former athlete. Plus as I mentioned in my previous post, I'm pretty severely ADHD and as such I need intense exercise to regulate my brain chemistry, it's kind of my main treatment and when I can't do it my brain gets out of whack and it becomes super easy to spiral - TMS and ADHD tend to feed off each other and create negative feedback loops, I've learned. I can understand all this from an intellectual angle but that doesn't mean I can think my way out of it easily.

Anyway, so when a professional tells me something is off from a functional angle of course as an athlete I want to fix it and move better. I've mostly been able to do this without falling down a TMS rabbit hole, even for previous TMS manifestations such as my back and knee - I've found that if I approach it right and think of it more along the lines of 'I'm doing these knee/back/hip exercises to reinforce an already strong body' rather than correcting a deficit, it works. Assuming the shoulder thing is TMS I guess that's maybe the crux of it - too many health professionals have told me the shoulder issue is a problem that needs fixing, if I reframe it as improving stability for increased performance that might help.

But that point is somewhat moot for the moment anyway as the elbow is still the main issue. I don't really have the option of not giving it attention because in it's current state it hurts when I do pretty much anything, and it's my right arm so I use it for basically everything. Most critically I work with my hands so I'm not currently able to do my job, so I kind of don't really have a choice but to laser-focus on getting over it however that needs to happen. It's already chronic, has been for a while. And I can't just pick up weights and start strength training normally, at least not until I get a handle on it as it hurts immediately the heavier the weight. And in any case, that's not how tendons actually work, they don't respond to normal resistance exercises the way muscles do, totally different tissue type.

I started with PT of course because I didn't think I had a better option at the time, PT has served me well for acute problems at least and I hadn't yet thought of TMS as a cause because it was a new injury and new injuries always fool me - you have to be sure and rule out something structural, right? I've seen a couple TMS doctors over the years, they all tend to want to do physical exams and maybe even look at imaging just to be sure. Unfortunately I don't have easy access to a TMS doc so I see a conventional one first because what else am I going to do? And it is true, doctors often lead me into a very negative head space with unnecessarily catastrophic comments. But like I have no medical training so I don't know for sure that they're wrong, and in any case it's typically an acute injury at first that turns into TMS later, so often they're right at least initially until they're not. It is a damned annoying cycle, but I haven't figured a way out of it yet. I may just need to again get another MRI and spend a whole day driving to another TMS doctor as much as i don't feel like doing that. I wish I had one in my area, I would just see them first whenever these things pop up and maybe save myself months of misery but I don't have that option, I haven't even found one in my state yet.

Anyway...hearing other people's experiences does help a bit I think, since I've never had arm injuries before and so am unfamiliar with how they can present neuro-plastically, just getting the information that others have had similar problems and gotten over it might cause it to sink in eventually and possibly help facilitate a mental switch at some point. I hope. So stories welcome.

 

[Ellen]

You're overthinking this, as is common with us TMSers. Practically no one is 100% sure their symptoms are TMS. Some doubt is OK. But you need to commit to treating your symptoms as TMS and undertaking a TMS Recovery Program, and giving it some time to work. Some may disagree with me, but I don't think we have to be complete TMS purists to progress to TMS recovery. I took pain medication for my TMS symptoms when I started my recovery program, and I still recovered. Then I weaned myself off medication. Some people can do PT or other physical interventions while working on their TMS, as long as they can stay clear in their mind that they have TMS and not a physical problem. It's a challenge to do that, but it can be done in my opinion. Almost nothing in life is black and white, as much as we might wish it to be.

 

[Adam Coloretti (coach)]

Some people can do PT or other physical interventions while working on their TMS, as long as they can stay clear in their mind that they have TMS and not a physical problem. It's a challenge to do that, but it can be done in my opinion. Almost nothing in life is black and white, as much as we might wish it to be.

I think this is especially true if you're prone to TMS. Whilst what you have currently may or may not be TMS, if you've had various TMS manifestations before and haven't done the inner work, it's a sign. Even if this work doesn't go to the current symptom, it may ward off future TMS issues. I'm not saying you're necessarily doing this OP, but as a general comment one can't run from the message of the symptom(s) forever.

 

[Cactusflower]

@Jayver17
I agree with what @Ellen wrote, and I'm also reading a LOT of victimization into what you last wrote. You have become a slave to your ADHD diagnoses.
What would have happened if you had never been diagnosed as ADHD and still had those symptoms? Would you be worrying about it so much and using as a block to your further personal development? In essence, don't let it hold you back from doing ANYTHING or thinking you can accomplish anything.
The "annoying damned cycle" is really part of your nervous system working overtime. Since people who seem to operate on high alert already run on a little more nervous system gas, your scale simply tips towards the high end of the nervous system from time to time.
There is nothing to fix. Your nervous system is doing what it is intended to do which is to kick into a bit more high gear.
What that does is make your mind work harder, that is all. It is temporary, and will eventually dial back a bit. You've learned that exercising seems to help, but it is a kind of "fake" help in many senses - it works temporarily too. When you can learn to blend that need to move - to burn off that extra energy in combination with learning to relax in a way that trains your brain that you it doesn't need to spin it's wheels, you'll have more of an internal balance.
Your constant laser focus on what is "wrong" is completely robbing you of noticing what is "right". You've bought into listening to "professionals" who, make money and keep clients by constantly asserting your need for them to be present in your life so they can earn a paycheque. That is not to blame them or say what they are doing is "bad" - but they've learned to exploit the side of the human mind that biases towards the negative. The "TMS work" is to begin to slowly flip that switch to bias more to the positive. It is incredibly challenging, but you know, once you get the hang of it and let it become more natural (which again, is hard when you have ADHD symptoms) in daily life, it really makes you feel so much more personally powerful.
You've gained your sense of power from the physical, but many body builders also engage in internal practices to let them feel that power from their internal core. How about approaching the work from that angle. Does that make it seem more palatable? Notice I've not talked about your physical symptoms. Why? Because they are a bi-product of the internally built up stress.
However, you worry about the injury to TMS ratio.
An injury is damage to the physical body that heals.
TMS can result after injury when the mind becomes obsessive about the injury, the healing, along with worry, perhaps depression, often a distorted view of the healing itself (not being able to accept that it is temporary), and often, once you learn about TMS, obsessing that you will struggle with the work.
The only thing real here is that the work is hard.

Recently, there have been many TMS "personalitites" - coaches who interview people who have healed from TMS, and they are often reporting that they now view their ADHD as a symptom of a dis-regulated nervous system and that the work no only changes their views on how it impacts their life, how they notice they became a victim of it's label - they also notice it not showing up so much, or having such an impact on their life.

I have a mix of what might be physical symptoms with TMS, and also new medical diagnoses (that is not TMS). I can't focus on the "might be physical symptoms". I used to see a PT who was constantly trying to "fix" me. Every month it was a barrage of new things to patch me up. Every month I had new pain along with my old symptom. Even with a smile on his face, his own need to keep me as his patient outweighed my progression, and not in any malicious way. Eventually I began working with someone who now has TMS knowledge and charges about 1/10th (or less) of what the other guy charged. I see my newer PT once every 2 months and don't often change the "exercises" he's given me because my nervous system can't take all that barrage of change, and it also plays into the TMS big time with my subconscious thinking something is wrong and it needs to be fixed. My new PT constantly reminds me of what I CAN do, how far I have come, to go SLOW and when I have some symptoms that feel "scary" he reminds me to do the TMS work and be willing to dial it back for awhile until I can do things more easily again - in essence, when I get a flair up it's temporary. Now a flair up might sound scary but I'm still just working through TMS so it's not a big deal.

So TEMPORARILY you might not be able to lift, but you can do all sorts of other movement to burn off a little energy, can't you? You might not like what you can't do, but let's slowly change that focus to what you can do. It might be figuring out what HITT you can manage, or chair yoga, or whatever. It's simply "for now". What your nervous system can manage.

Think about adding in one more thing to your life that will do the same "job" as your max. exercise routine does but in quite the opposite mode. Walking quietly in nature, meditation, perhaps some mode of Tai Chi or Qui Gong that is slow, and controlled instead of fast and explosive. Things that support dialing back a nervous system on high alert.

That's it. Make one manageable change this week, and work on making one mindset change (my focus would be on self-victimization or the feeling of powerlessness or that something external to your mind is controlling your situation). Nothing more and do this for a week or two and see how that sits with you. In a few weeks, maybe a month, if you are feeling confident with those, make another change, and perhaps begin working on the SEP or taking some other next step. Go slow, go purposefully, gain confidence. Claim your power.

 

[Cactusflower]

P.S.
I was just on social media and SIRPA posted about this book which might be of interest:

"Mind Drama by Donna Jackson Nakazawa explores why we can become caught in repetitive thought patterns, and how understanding rumination can help us begin to work with the mind in a more compassionate and empowering way.
For anyone interested in the connection between thoughts, emotions, the nervous system, and healing, this looks like a fascinating read."

I haven't read it, but this might be of interest to anyone worried about the looping thought cycles, hyperfocus and mind business of ADHD and OCD like thought patterns.

 

[Ellen]

P.S.
I was just on social media and SIRPA posted about this book which might be of interest:

"Mind Drama by Donna Jackson Nakazawa explores why we can become caught in repetitive thought patterns, and how understanding rumination can help us begin to work with the mind in a more compassionate and empowering way.
For anyone interested in the connection between thoughts, emotions, the nervous system, and healing, this looks like a fascinating read."

I haven't read it, but this might be of interest to anyone worried about the looping thought cycles, hyperfocus and mind business of ADHD and OCD like thought patterns.

I've read a couple of her other books and they were good. This one sounds interesting.

 

[Rabscuttle]

Yeah, I mean...I don't know what to say, I'm obsessed with my body anyway because I'm very fitness oriented and a former athlete. Plus as I mentioned in my previous post, I'm pretty severely ADHD and as such I need intense exercise to regulate my brain chemistry, it's kind of my main treatment and when I can't do it my brain gets out of whack and it becomes super easy to spiral - TMS and ADHD tend to feed off each other and create negative feedback loops, I've learned. I can understand all this from an intellectual angle but that doesn't mean I can think my way out of it easily.

Anyway, so when a professional tells me something is off from a functional angle of course as an athlete I want to fix it and move better. I've mostly been able to do this without falling down a TMS rabbit hole, even for previous TMS manifestations such as my back and knee - I've found that if I approach it right and think of it more along the lines of 'I'm doing these knee/back/hip exercises to reinforce an already strong body' rather than correcting a deficit, it works. Assuming the shoulder thing is TMS I guess that's maybe the crux of it - too many health professionals have told me the shoulder issue is a problem that needs fixing, if I reframe it as improving stability for increased performance that might help.

But that point is somewhat moot for the moment anyway as the elbow is still the main issue. I don't really have the option of not giving it attention because in it's current state it hurts when I do pretty much anything, and it's my right arm so I use it for basically everything. Most critically I work with my hands so I'm not currently able to do my job, so I kind of don't really have a choice but to laser-focus on getting over it however that needs to happen. It's already chronic, has been for a while. And I can't just pick up weights and start strength training normally, at least not until I get a handle on it as it hurts immediately the heavier the weight. And in any case, that's not how tendons actually work, they don't respond to normal resistance exercises the way muscles do, totally different tissue type.

I started with PT of course because I didn't think I had a better option at the time, PT has served me well for acute problems at least and I hadn't yet thought of TMS as a cause because it was a new injury and new injuries always fool me - you have to be sure and rule out something structural, right? I've seen a couple TMS doctors over the years, they all tend to want to do physical exams and maybe even look at imaging just to be sure. Unfortunately I don't have easy access to a TMS doc so I see a conventional one first because what else am I going to do? And it is true, doctors often lead me into a very negative head space with unnecessarily catastrophic comments. But like I have no medical training so I don't know for sure that they're wrong, and in any case it's typically an acute injury at first that turns into TMS later, so often they're right at least initially until they're not. It is a damned annoying cycle, but I haven't figured a way out of it yet. I may just need to again get another MRI and spend a whole day driving to another TMS doctor as much as i don't feel like doing that. I wish I had one in my area, I would just see them first whenever these things pop up and maybe save myself months of misery but I don't have that option, I haven't even found one in my state yet.

Anyway...hearing other people's experiences does help a bit I think, since I've never had arm injuries before and so am unfamiliar with how they can present neuro-plastically, just getting the information that others have had similar problems and gotten over it might cause it to sink in eventually and possibly help facilitate a mental switch at some point. I hope. So stories welcome.

other people already gave good advice. Just want to add that I think non guided spiritual based meditation would be super beneficial for you in terms of calming the nervous system and detaching from the body a bit. I Imagine a lot of your self worth is wrapped up in your appearance, Your physical fitness level, not to mention needing your hands for work. I get this completely. I was and still in many ways am too absorbed with my appearance, fueling my ego with sports or strength or whatever, but I’m trying to shed this stuff because frankly whether we want to admit it or not most of us grow old and eventually lose physical agency, it’s best to start detaching now rather than hitting a rock bottom on our death beds (or earlier!) because we’ve wrapped our identities up in temporary stuff. There is probably an element of repression and childhood influences that drove you to be so fitness oriented, and it’s worth exploring but ultimately it’s going to be a decision in the present to decide how much importance you want to give that stuff. Because life is much less enjoyable if at every injury or flare of pain we’re thinking our life is over because we temporarily can’t engage in outlets how we used to. Pressure and TMS do not go well together. Lower pressure, lower the stakes, thoughts like I need to fix this asap because work depends on it. Yes I get the metaphorical gun to our heads saying work or starve, but be careful about the thoughts you are conveying the brain. If pressure worked then the brain wouldn’t allow people to end their lives over this stuff. We need to take it easy on ourselves and actually start loving ourselves. And that requires long hard looks in the mirror about how we’ve been living and shedding bullshit that is doing nothing for us.