Derek S. Is this the symptom imperative?

[stayfit65]

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Question

Hello,
I recently saw a TMS physician about my back pain and diagnosis of TMS was confirmed. Back pain this past week was minimal or gone! But yesterday I went out to do some running and I had terrible pain in the back of both knees (felt like hamstring tendinitis). I've had no problems until now with this. I also had some terrible waves if anxiety while trying to sleep. Would it seem that this is the symptom imperative? I am thinking of making an appointment with a sports physician, and if he says it's tendinitis should I treat it as TMS?
Thanks
Stayfit

 

[Derek Sapico MFT]

Answer

Hey Stayfit,

This one feels like a symptom imperative slam dunk. Your longstanding back pain goes away and, lo and behold, up pops the hamstring pain, anxiety, and sleep problems. That would be one amazing coincidence to all of a sudden develop three new symptom presentations in one week. Your TMS appears to be giving you more rabbits to chase down holes.

If possible, schedule a follow-up appointment with your TMS physician to give you that extra bit of certainty. If that is not logistically possible, I think that you can operate on the premise that these are just symptoms popping up trying to put you back into a state of fear/preoccupation and get you back into that old familiar problem-solving mentality. See your sports doc only if you absolutely must but I worry that this will put the focus back on a "structural pathology" mindset which seems dubious given the fact that you just got cleared by a TMS doc and have your diagnosis. The symptom imperative showing up just as your primary symptom disappears is classic TMS behavior and is to be expected.

Don't let the symptoms scare you or become a focus of fear or concern. Reinforce your tremendous progress and be proud of yourself for getting to this point in your recovery. Every time a symptom pops up, new or old, utilize it as an opportunity to practice outcome independence and to reinforce your shiny new pain-free neural pathways

Good luck and keep up the good work!

-Derek

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[stayfit65]

So in the last week I had hamstring pain one day, then got better and back spasms came back, then went away a again, then hamstrings flared again, with moderate anxiety. Right now I've got no anxiety but still mild back pain and Hammies are feeling some better. This is the first time I've ever seen this much shifting in 3 years. Is this a good sign? Still working on embracing outcome independence but I'll admit sometimes it's hard being a fitness instructor and ignoring these flares.