aggiepsych

Newcomer
Hey y’all,

I am new to posting but not new to these wonderful principles for moving through chronic physical symptoms. I am a psychologist and have studied mechanisms of change for overcoming various mental health struggles and chronic pain. Sarno, this website, and the back pain books were my original way through my own struggles with fatigue and other somatic symptoms. I have a lot of gratitude for this community and for the work of the folks behind it, so since I am currently dealing with some pain of my own, I thought I’d get in the mix for the first time and be brave.

Using these approaches, which are quite similar to mechanisms in psychotherapy focused on graded exposure, emotional processing, and cognitive restructuring, has been tremendously helpful for me. Now I am turning towards the community for some ideas/brainstorming for nagging athletic ailments. I love to play basketball, sprint, and train for athleticism (mostly sprinting faster and jumping higher). Thus far, I have progressed with those things with very little pain, even nearing 40 years of age. Recently, I have started sprinting more and lifting heavy for explosiveness, and I am starting to revisit an old, unwanted amigo that was held at bay for many years: SI joint pain, mild sciatic symptoms.

When I was 20 years old, I “hurt my back” playing hoops. Hunched over for days, couldn’t touch my toes for weeks, tight, in pain. I just lived with it and continued playing basketball in mild to moderate pain for a couple years. Sometimes I wouldn’t notice it or think about it, almost like it was gone for months, then it would flare up during emotionally stressful times. Eventually, I started doing some strengthening and stretching, and it eased up, except for when I would try to high-bar back squat, and boom, I’d be hunched over for days again. I could get completely out of it quickly, though. Even though I was very out of touch with my emotions, I had some nice physical remedies (mostly PT stuff) that’d “reset it.” Onward I’d go.

Fast forward several years: I’m in grad school getting my PhD in psychology. I was drawn to this work because of my struggle with “chronic” fatigue. My dad was sick with early-onset dementia, I was his caregiver, and I just couldn’t handle it, so my brain distracted me with preoccupations around my physical symptoms. Yup yup—I wanted a way out of this funk and thought I had a knack for connecting with people, so this move towards grad school and clinical psych made sense. Over that time, using these mind-body approaches, eventually no more fatigue, back to athletics and living a better life. Processed the grief of my father—old, abstract trauma—you know, the usual thing around here.

From there, several years of progressing back into athletic training and trying to practice what I preached with my own clients in terms of emotional openness and intentional awareness and processing, and now we are at a place of no back issues to speak of. SI twinges here and there, but gone in days. Even doing back squats (lighter weight), focusing on mobility amidst some intense stuff when running and playing basketball.

Up to current times, I have now been sprinting in track meets (100m and 200m), training for speed with lifting to supplement that. Over the last year, the SI stuff is back. It’s different now because my body is different, but I have “thrown my back out” a couple times this year and am walking around with SI joint pain intermittently, especially after intense sprinting, even more so after back squats.

Anyways, I am moving through it. It doesn’t pin me down anymore, but it’s still hanging around more than I’d like. My question today is how we use these approaches to help athletes who are pushing their bodies in intense ways and will inevitably experience pain or overuse of certain tissues. I am interested for myself and for others, as I would like to do clinical work with athletes dealing with chronic pain. Today, it’s all about me though, so how much of my SI pain is physical and how much is mental?

Tough question to answer, right? Here’s the rub: This pain cropped up during a tricky emotional time. My wife of 11 years has metastatic cancer. She’s battled it for almost 5 years. Currently, she’s on an antibody drug conjugate (targeted chemo), and it’s working okay. When the back pain first came back in a real way over a year ago, things were looking bleak. They’ve slowly improved over the last year, but her treatment is not a cure by any means. It tends to work well for a while and then wane. She also carries the physical impacts of her treatment much more on the surface than ever before (hair loss, etc.). It’s much harder to deny that she is very much sick.

So again, all athletes go through physical funks, especially when they start demanding more from their bodies, AND the emotional stuff is also quite present for me currently. How do we acknowledge the physical component of pain (my uptick in pain occurred simultaneously with a tough year for cancer and a more intense year of physical training—I mean, what else am I going to do with all my angst and lack of control) AND not get sucked into less helpful ways of thinking about it/approaching it?

I’m here for all of it though, such as ideas about general athletic pain management, my emotional blind spots, pushing ourselves harder physically when life gets tough/uncontrollable emotionally ;)
 
There are two TMS folks who specialize in athletes: Charlie Merrill who is a PT specifically for competitive athletes through the lens of TMS (there are great interviews with him on Youtube), and Jessica who has a website called the Pain Free Athlete. She has a lot of personal experience, as a person who has experienced TMS and is a life long athlete who used to push herself to extremes. Her blog has a lot of useful information https://thepfathlete.com/ (The Pain Free Athlete | Stay In The Game For Life) co-incidentally, she is also a cancer survivor. Jessica will be the first one to explain that we need to FEEL our angst instead of trying to push it into an activity or into a movement. Placing it within the realm of your activity or sport without feeling and sensing the emotion behind it is another avoidance tactic the same as anyone who tends to sweep emotions under the rug. Everyone has emotional blind spots, all you need is balance. You have some blind spots, but on the other hand, you also learn a lot of awareness through the TMS method. Your goal lessen the visceral reaction that tips you into a lot of fight/flight - some of which is unavoidable. When it happens, you've learned the skills to get back on track. Perfectionism is a strong trait in both competative athletes and TMS-ers ... but armed with the knowledge that EVERYONE has a mind/body connection. EVERYONE feels pain, and that people heal is really what you need to keep in mind. You aren't supposed to control your emotions. You are supposed to feel and experience them.
 
C
There are two TMS folks who specialize in athletes: Charlie Merrill who is a PT specifically for competitive athletes through the lens of TMS (there are great interviews with him on Youtube), and Jessica who has a website called the Pain Free Athlete. She has a lot of personal experience, as a person who has experienced TMS and is a life long athlete who used to push herself to extremes. Her blog has a lot of useful information https://thepfathlete.com/ (The Pain Free Athlete | Stay In The Game For Life) co-incidentally, she is also a cancer survivor. Jessica will be the first one to explain that we need to FEEL our angst instead of trying to push it into an activity or into a movement. Placing it within the realm of your activity or sport without feeling and sensing the emotion behind it is another avoidance tactic the same as anyone who tends to sweep emotions under the rug. Everyone has emotional blind spots, all you need is balance. You have some blind spots, but on the other hand, you also learn a lot of awareness through the TMS method. Your goal lessen the visceral reaction that tips you into a lot of fight/flight - some of which is unavoidable. When it happens, you've learned the skills to get back on track. Perfectionism is a strong trait in both competative athletes and TMS-ers ... but armed with the knowledge that EVERYONE has a mind/body connection. EVERYONE feels pain, and that people heal is really what you need to keep in mind. You aren't supposed to control your emotions. You are supposed to feel and experience them.
Cactusflower, this really spoke to me. Thank you. Having some realizations during this “toward” week. I kept thinking that my pain was purely psychological and that I could overcome it by validating safety, calming my nervous system, ignoring the physical and turning toward the emotional. This is a fine approach but just pushing onward was another distraction strategy. Even if I was in no danger pushing forward, sprinting/training and that athletic hyper focus is a distraction strategy in and of itself. It is quite difficult to feel what is there to be felt when having this intense focus because it naturally gets in the way of emotional processing and slowing down. The pain isn’t there just to be overcome it’s a signal that there may be something underneath in the emotional realm that needs some attention, love and time. If I was pain free I’d just continue forward with my hyper focus and not open myself up more to the possibilities of my life and internal experience.

It’s also not all or nothing. Over time I can push my body hard AND feel my feelings. The hip is probably in pain more because of accumulated load than just some structural issue that needs specific fixing exercises (distraction strategy staying focused on the physical), or some emotional processing then back to hard training. Sprinting is maybe the most intense thing you can do for the hips/low back connection and my hips have actually demonstrated great resiliency. Its just asking for more care, respect (load management) and is signaling me to slow down and open myself up to other areas of my experience.

Hyper focus is hyper focus no matter where it’s placed and it can get in the way of feeling. For a long time I was just quite scared of pushing my body because of fatigue. Overcoming that took some amount ignoring uncomfortable physical sensations so I didn’t want to give too much credence to them. It’s a major dialectic and learning lesson in balance for us border collies.
 
Perhaps the hip is more in pain because of a few things: Predictive coding - you have experienced the pain and now it's hard to let go of it. You are expecting it, and you search for it. You might not even be aware of this because of course 85% of what goes on in the brain is under the radar. I just try to refocus when I find myself consciously focusing or expecting.
I'm trying to start lifting weights and start a more strident physical workout, starting basically from ground 0. I used to be very physically fit although never an athelete, I was a dancer. I'm struggling to move forward because symptoms keep popping up. I'll go for weeks or months with success and then wham, I tighten up and feel like I'm back to square one. Of course I can worry about "what I've done wrong" etc. but I refuse to go there. It is simply part of that TMS cycle of worry and fixing etc. But I can choose to slow down, accept what I can do and as you say, open yourself up to other parts of the experience. Jessica's blog has an excellent story about her own experience on one of her crazy, punishing long distance gravel bike rides. She has been very competitive in life and is the kind of person who always wants a new challenge. On the ride she was with her sister, which was an emotional experience because their dad had recently died. So there was a great level of emotional charge and Jessica began to feel it physically. She has a routine of things she can do to feel better and more aligned: physically and mentally which she did, but she also showed herself kindness by going for a massage. The next day she got her thoughts in order and decided that enjoying the ride and the experience of time with family, the scenery etc. was far more important than pushing herself beyond capacity. It's a great lesson of picking and choosing your personal battles wisely and knowing what is truly best for you by listening to your body.
 
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