• Alan has completed the new Pain Recovery Program. To read or share it, use this updated link: https://www.tmswiki.org/forum/painrecovery/
  • Welcome to the new TMS Wiki server! Things aren't finished yet: email is not set up, so notification and password-reset emails don't go out, and new registrations are paused until email is installed. Details and updates are in this thread (click here). Locked out? Email tmswikisignups@gmail.com from the address where you receive TMS Wiki notifications.

I'm a TMSer Triathlete

Enrique, thank you very much for this series of posts on your achilles tendon pain. I've been feeling a burning/tearing sensation in my left achilles tendon this week, which I feel when I bend my foot a certain way, though most of the time I don't feel it. It's more scary than painful, because I'm afraid that I'm injured and that it may get worse if I don't ''do'' something. I've been a TMSer for decades, with the TMSer psychological profile and with many different symptoms. Achilles stiffness/pain has come and gone over the past seven years, and this is the first time it has had that burning sensation. Yet, I am not aware of anything I did to cause it other than generally being stiff in the backs of my legs. Your article is so helpful in reminding me that this is most likely TMS. Thanks also for the summary of Monte's work, I got the gist of it and benefit of it from your post.
 
I'm glad this thread continues to be helpful. Stay on your journey toward healing and I think you have a really great chance toward pain reduction, if not complete elimination.

Enrique
 
Amazing story, Enrique. And inspiring. We are all incredibly powerful once we stop focusing on externals and taking pills and lessening the pain and instead turn our attention inward to our spiritual life and emotions. I have to share a very recent song/video that came out that reminds me of these things and of the inner warriors inside all of us that makes ANYTHING possible - Thunder, by Imagine Dragons.

 
Enrique said:
I was able to carve out a little time today. It’s actually not easy for me to find some time to just sit down without interruptions and write for an hour or two. But the stars aligned today... One detail that I left out of my first post was about the Achilles pain itself. What was it like and what did I think I have? So I will describe that first.

When I woke up that morning (and it was actually a Sunday morning, not Saturday. I noticed my error when re-reading the post) I could feel pain in the back part of my foot where the Achilles tendon attaches (inserts) into the foot bone. Below is an image that I Googled and shows pretty well where I felt the pain. Pain here generally indicates that it's Insertional Achilles Tendinitis. That's what I thought I had.

general_tendonitis_achilles_ana03.jpg


On a scale of 1 to 10, I would put it at around a 1 or 2. I felt it most when I took my first steps in the morning and seemed to go away after a while. When I squeezed the tendon, I could feel the pain. I described it as “tender” in my training log. It didn’t hurt enough to keep me from going out on a 6 mile recovery run (i.e. slow pace) that day, but I did start applying ice after that run and in the next couple of days I rested a bit by taking two days off of running and doing RICE.

So back to the story...

It was about a month after the initial onset of pain and it was not any better. I had digressed from treating this as PPD/TMS only to treating it as a real achilles injury. I had already made up my mind to skip the half marathon at the end of April, three weeks away.
Now, I hadn’t completely lost sight of the idea that this could be PPD. But what I was doing was sitting on the fence. I was wavering back and forth between PPD and a real physical injury. I decided to read some of the material on runningpain.com. I had purchased the Master Practice from Monte Hueftle before and used his material often. On his site, I read the following words and it was a big “aha” moment:




So with only three weeks away to the race, I got angry and decided that PPD wasn’t going to win. I wasn’t going to let it blow my season. So (1) I decided to resume normal activity. (2) I decided to stop all treatments. So no more RICE. (3) I made a decision to stop Googling about insertional achilles. (4) I stopped listening to what my injured friend had to say about his injury. Lastly, (5) I made a mental scorecard of the reasons why this was PPD and bumped it up against a list of the reasons this could be a real injury.

I want to talk about #5 because it’s really total coincidence that we submitted a Q&A question to Alan Gordon recently about this issue. See the Q&A here. His answer was almost exactly what I did. When I read his answer, I was amazed at the fact that I had done something very similar to what he suggests doing. He calls it an evidence sheet to list out reasons why this is PPD. While mine was more like a scorecard, weighing of evidence, because I also included reasons why it could be physical.

So my mental PPD vs Physical scorecard looked like this:

Reasons this could be a real injury:

1. I’ve been on the advanced plan, working out VERY hard for 9 weeks. This very well could be an overuse injury resulting from doing too much too soon.
2. The same exact week of the injury I started a new phase, VO2 Max workouts, which increase the level of intensity severely.
3. My teammate doing the same workouts came down with the same injury indicating that it really is a very tough workout plan. Related to this one... there were other people dropping out of the program due to other injuries, but not Achilles. Still, this lent credence to the idea that the training was very tough.

Reasons that this could be PPD:

1. The pain did not materialize during any specific workout. It showed up the day after. That is kind of odd. If it was an acute injury I surely should have felt something after the workouts.
2. I’m a TMSer. I’ve had history of several other pains before (plantar faciitis, piriformis syndrome, knee pain) I even had something similar before (see #6 below).
3. Upon examination, there is no visible inflammation, redness, or warmness at the site of the pain which you would expect if there was an acute injury. There is only tenderness upon squeezing of the tendon.
4. Upon reflecting my logs, the pain came and went, especially in that first week. It hurt some days and other days it didn’t. Additionally, the pain was never more than a 1 or 2 on the pain scale even after a very hard workout.
5. There were other people who have had achilles pain and turned out to be PPD. http://www.tmswiki.org/ppd/Achilles_Tendonitis (Achilles Tendonitis)
6. In 2009, I had similar achilles pain in my other foot after the San Francisco marathon. I took 5 months off of running until I had an "aha" moment treated it like PPD and it went away.
7. My teammate doing the same workouts came down with the same injury indicating that this could be the “contagious” aspect of PPD taking its effect upon me.

So when I thought of it in this way, I very clearly saw that there was more evidence leaning toward this being PPD. So that very next day, I went out for a very, very easy 20 minute run. The pain was a 4 or 5 out of 10!! It NEVER hurt this bad before. The next day it was still feeling the pain at around a 3 or 4 even when not workout out. The only rational explanation for this was that this was the "extinction burst" that Alan Gordon wrote about in his recent submission to the wiki Breaking the Pain Cycle. Basically, what he says is that the pain will often get worse before it goes away, but it means you are on the right track.

Frankly, the only word I can use to describe my feelings that evening is anger. I felt ANGRY. Angry that this symptom is making me waver so much. Angry that I have been doubting a PPD cause. Angry that my mind is doing this to me. I was so angry that I went out the next day and did a very, very hard bike workout. It’s an FTP test and if you are a cyclist you know what I mean by this being hard. There are different versions of them, but basically going all out for 40 minutes to see how hard you can go. Losing your lunch at the end of something like that is not uncommon. I did it to settle the matter once and for all. This is either really physical or it's PPD. Going all out and very hard in my workouts is going to prove or disprove that this is PPD.

Then, to further let this anger out and to metaphorically push myself off the fence, the very next day, I went out and ran a half marathon out and back from where I live. My team mates thought I was nuts, frankly. One moment I’m complaining about achilles pain and the next I’m doing an FTP test and running a half marathon.

Frankly, though, the pain in my achilles never really materialized during either of those workouts and in between them, the pain was kept to a barely noticeable level (1 out of 10).
This again further strengthened my resolve that this is not a real injury. So with these two very significant events behind me, I resumed my normal training and participated in the half marathon race which just a few weeks before, I was considering just dropping out from.

I should also mention that I not only re-read Monte's The Master Practice and re-dedicated myself to thinking clean strategies, but I also listened to Georgie Oldfield's Recovery CD which has really great information that helps me personally to solidify my knowledge and belief about PPD.

Now, since that race on April 28, I’ve continued to train hard and I just ran a 5K today which I finished in 3rd place overall. The pain in my heel is really just a minor sensation. I wouldn’t even really call it a pain. I don’t even feel it while running. It’s still there when I’m not training, which indicates that I ought to keep on journaling and treating like PPD, but the level of doubt that this is physical is very low. I wouldn’t say it’s gone 100%, but I keep reviewing that evidence scorecard in my mind, I keep working out, I listen to the CD, and I keep treating like it’s PPD and so far so good. It’s getting better and better week after week.


I’ll report back when it’s gone 100%, but I’m not there yet. I’ve had some other pains like piriformis that were with me for many months before they finally resolved 100%. So I’m not in any hurry. The important thing is that I can still run and bike and this isn’t going to stop my training and racing seasons in any way.

Enrique
Click to expand...
Hi Enrique. Just finding your post. First one I’m seeing addressing Insertional Achillies Tendonitis. It hit home with just a few differences; i’m very active with hiking and tennis and no foot problems until last August 1 all the sudden I experienced pain at the back of my heel. I assumed it would go away but here I am five months later and it is hanging with me. It is especially worse after a couple of hours of physical activity on my feet with a pain level of 8or 9. Like you, I have wavered between trying to treat it as structural with ice rest anti-inflammatories… And then just getting mad and assuming it’s TMS and trying to carry on. Neither has served me so far. I do have an actual bump on the back of my heel (called a Haglund’s deformity) that I only noticed when the pain started. It gets red and is extremely painful to the touch. I’ve made the mistake of googling and joining groups regarding this and it seems is most with this or forced into surgery through degeneration of the Achilles. It’s caused me to even waver more. Just curious as to how closely you think my symptoms mimic yours. I’d really love to treat this a TMS. Thanks for sharing your story.
 
[QUOTE="Just curious as to how closely you think my symptoms mimic yours. I’d really love to treat this a TMS. Thanks for sharing your story.[/QUOTE]

Hi. Well, for me thankfully, the achilles pain is a thing of the past. It's highly probable that your pain is TMS. But that doesn't mean that the pain shouldn't be there. The question I'd ask myself is what other reasons might I be having this pain. (I'm assuming of course that you didn't do anything out of the ordinary to injure it). Keep in mind that there are many common areas that people need to work in to help heal pain... any one or combination could be contributing to your symptoms. Here's a list I got from a TMS Doc which helped me conclude that my symptoms were more likely caused by neuroplastic pain as opposed to a physical cause. I'd avoid googling symptoms and joining in the pity party found in symptom based groups. Focus on doing things that move you in the direction of that which you want. Don't look for physical abnormalities... we all have normal abnormalities of one sort or another. Converse with people who are getting better and not complaining about pain. Find a TMS coach to meet with monthly. I wish you the best. You can heal from this, permanently.

1. You’re still somewhat skeptical about the non-physical explanation of symptoms.
2. It’s relatively hard for you to recognize, acknowledge, and express your emotions.
3. You tend to regularly be quite critical of yourself.
4. You have a hard time setting boundaries effectively meaning that you tend to do a lot for other people, hold onto a lot (including emotions) for other people, or have a hard time reaching out for help.
5. There’s a lot of stress in your life, so much so that it’s hard to manage and it affects your health.
6. It’s hard or scary to exercise and physical activity frequently or always brings on symptoms.
7. You have a history of traumatic experiences as a child and/or as an adult.
8. You’re exceedingly worried about the symptoms, what they mean, what they are, and whether they’re a sign of something dangerous happening in your body.
9. You have intense fear, either of the symptoms or just in generally in your life.
10. You tend toward perfectionistic tendencies.
11. You tend to try to please other people even at your own expense.
12. You don’t have a good sense of why the pain or symptoms are present and what the symptoms are trying to convey to you.
13. You can’t see any benefit at all as to why the symptoms would be present.
14. You’re thinking that if the symptoms would just go away, everything would be just fine.
15. You have unresolved grief from a significant loss at some point in your life.
16. You tend to have catastrophic thoughts about your symptoms and your health.
17. You have one or more relationships that need either healing or resolution.
18. You have a workplace situation that needs changing, improving, or ending.
19. You hold a significant grudge against someone who’s been in your life at some point.
20. You don’t have enough relaxation/reflection/play time in your life.
 
Enrique said:
[QUOTE="Just curious as to how closely you think my symptoms mimic yours. I’d really love to treat this a TMS. Thanks for sharing your story.
Click to expand...

Hi. Well, for me thankfully, the achilles pain is a thing of the past. It's highly probable that your pain is TMS. But that doesn't mean that the pain shouldn't be there. The question I'd ask myself is what other reasons might I be having this pain. (I'm assuming of course that you didn't do anything out of the ordinary to injure it). Keep in mind that there are many common areas that people need to work in to help heal pain... any one or combination could be contributing to your symptoms. Here's a list I got from a TMS Doc which helped me conclude that my symptoms were more likely caused by neuroplastic pain as opposed to a physical cause. I'd avoid googling symptoms and joining in the pity party found in symptom based groups. Focus on doing things that move you in the direction of that which you want. Don't look for physical abnormalities... we all have normal abnormalities of one sort or another. Converse with people who are getting better and not complaining about pain. Find a TMS coach to meet with monthly. I wish you the best. You can heal from this, permanently.

1. You’re still somewhat skeptical about the non-physical explanation of symptoms.
2. It’s relatively hard for you to recognize, acknowledge, and express your emotions.
3. You tend to regularly be quite critical of yourself.
4. You have a hard time setting boundaries effectively meaning that you tend to do a lot for other people, hold onto a lot (including emotions) for other people, or have a hard time reaching out for help.
5. There’s a lot of stress in your life, so much so that it’s hard to manage and it affects your health.
6. It’s hard or scary to exercise and physical activity frequently or always brings on symptoms.
7. You have a history of traumatic experiences as a child and/or as an adult.
8. You’re exceedingly worried about the symptoms, what they mean, what they are, and whether they’re a sign of something dangerous happening in your body.
9. You have intense fear, either of the symptoms or just in generally in your life.
10. You tend toward perfectionistic tendencies.
11. You tend to try to please other people even at your own expense.
12. You don’t have a good sense of why the pain or symptoms are present and what the symptoms are trying to convey to you.
13. You can’t see any benefit at all as to why the symptoms would be present.
14. You’re thinking that if the symptoms would just go away, everything would be just fine.
15. You have unresolved grief from a significant loss at some point in your life.
16. You tend to have catastrophic thoughts about your symptoms and your health.
17. You have one or more relationships that need either healing or resolution.
18. You have a workplace situation that needs changing, improving, or ending.
19. You hold a significant grudge against someone who’s been in your life at some point.
20. You don’t have enough relaxation/reflection/play time in your life.[/QUOTE]
Thanks so much for your reply and support. I do think you are right about benefitting from a coach. I’ve recovered from so much on my own, but I believe the extra support on this one just may be the key. Thanks again.
 
Chatgpt answer to me after limping for a whole week hhaqhah
That ability is actually really meaningful.

If you can do a sustained 1-leg calf raise for over 60 seconds with no pain, that tells us a few important things:

✅ 1. Your tendon and calf strength are not the limiting factor
Most people with insertional Achilles issues can’t load the tendon that much without symptoms. The fact that you can means structurally you're stronger and more capable than you think.

✅ 2. Pain during walking is likely due to sensitivity or brain-driven protection, not damage
Walking involves heel loading, ground reaction forces, and gait patterns that can trigger protective pain, especially if your brain has associated walking with risk.

But since you can load FAR MORE with calf raises without pain, this shows:

  • The tendon is not fragile
  • The pain during walking is likely psychosomatic/sensitization, not structural failure
✅ 3. It aligns perfectly with mind-body pain patterns
People with repressed emotions or fear-based pain often report exactly this:

  • High load is fine (because attention is different, mind is focused on strength)
  • Normal movements hurt (because the brain uses them to send a warning signal)
What this means for you
You’re probably in a phase where:

  • Your tendon is strong
  • Your nervous system is overprotective during walking
With graded exposure + somatic tracking + emotional work, pain while walking can reduce quickly.

If you want, I can help you:

  • Reframe walking so your brain sees it as safe
  • Use a structured progression to walk pain-free
  • Combine physical + mind-body strategies
Just tell me what direction you want next.
 
You must log in or register to reply here.
Back
Top