Pain decreasing the longer I do the activity I fear

Good afternoon, all. I've been lurking on this forum for years while on my TMS journey, and I'm at a point where I feel like I need some input rather than going at it alone, which has been my M.O. for the most part.

Long story (hopefully) short: I'm a court reporter by trade. In September of 2019, during a particularly brutal court session with self-represented family law litigants, I noticed a burning and generally tight sensation along the pinky side of my right hand along with some numbness. Having never dealt with any chronic pain before, I went the work comp route, and it was probably the most dehumanizing experience I've had in my life. After navigating that awful process for about a month, I got taken off work, had an EMG done, and met with a hand surgeon in January of '20. The EMG revealed mild slowing in not just the ulnar nerve that had been bothering me but in the medial nerve.... and it showed it in both arms/hands despite only my right at the time being symptomatic. Sure enough, despite being off of work and diligently doing as little as possible with my hands, wearing braces, and doing PT, symptoms slowly started in the left mirroring the right. I still to this day have never had any classical carpal tunnel symptoms despite the EMG.. it's always the pinky side that's bothering me.

This test result was one of the most confounding things I'd encountered in my life, and coupled with the meeting with the hand surgeon (your hands are fine; don't even get a second opinion; if you take a handful of people off the street, half would have abnormal findings with no symptoms), it led me to the TMS world. I read a lot of the books, and I had an appointment with Dr. Stracks in May of '20, shortly after COVID exploded. He diagnosed TMS, agreed with the surgeon re: the EMG and its findings being unrelated to my pain, and advised that I should consider how to make my work a place where I can thrive. I have yet to find that, unfortunately. It's a very difficult job, and when the standard is as close to 100% accuracy as possible, it's difficult to shed the perfectionism that I know is enraging part of me.

Regardless, at some point a few months after going back to work (still in pain but in both hands), the symptoms on the right totally resolved, and the ones on the left started to crawl up to my neck and shoulders. I don't know if it was simply the new focus or getting into TMS methods, but it worked for me. I kept working full time (and have to this day). I have been limiting myself, though, from doing the most physically intense work out there. I'm in a rural county where multi-day trials are very rare. I very much want to do the most physically intense work (also most lucrative), and to that end I started pushing myself by practicing hard in my time out of court. I felt like I was getting some confidence back, and all of a sudden, the week before July 4 of this year, I woke up and started getting the exact same symptoms in the right again (numbness, that same feeling of tightness, etc.). I've had times where it's felt like it wanted to break through on my right again but it never had to that point, and I took it as a massive setback and it shook my confidence in the diagnosis. And that brings me to now.

I'm back to being mostly confident, and I'm pushing myself again. There is one thing that a PA said to me that sticks in my mind, and I wanted to get input on it. He cautioned against pushing past the pain at the risk of re-injuring my hand. It sounded ridiculous to me at the time and it still does especially in light of how I recovered the first time while pushing past the pain by necessity. Until the pain/sensations are gone I am always going to have to push myself past some amount of pain. Lately my evidence log is a lot of: "Poor night of sleep, pain/sensations higher than usual. Spent all morning practicing at high speeds, and by noon, pain/sensations minimal." I'll get a good boost and feel good for a few days or however long, and as soon as a potentially heavy week is coming up or a lot of life happening, the focus on the symptoms ramps up and the cycle will start again. But that instance recently of resolved pains coming back really messed with me.

Allll of that said, what do you all think of this idea of 'pushing past the pain'? It has generally been a good thing for me with that one exception, and I guess I'm looking for reassurance that it's a good way to move forward. Thank you all for this resource.. it has got me through some very tough days.

 

100% it’s all about fear. Push yourself as much as you can mentally handle. That”s what I did at least.

 

Yes you will have to push through the pain, these flare ups are where you will finding lasting success. If you believe it to be TMS, and it sounds like based on Dr visits, it absolutely is, then you aren’t doing any damage by doing normal activities while in pain. That said, I think you need to respect where your mindset is at, if you’re still in the fear cycle and worried about how you’ll respond to the potential pain, then I don’t think it’s wrong in that specific moment to not continuously push through the pain. Because pushing through and panicking at the increase in symptoms (and they will inevitably have moments where they’re worse- all part of the game) is not accomplishing anything productive.

I deal with RSi as well, I know how annoying it is. Especially when one side goes away and then the other side gets bad, and on and on it goes. None of it makes sense lol. My elbows were really bothering me the last few days, but I went and played volleyball tonight and had zero issues with them, didn’t even notice any pain, obviously now I notice them lol. I think we reach a moment where we just totally lose the fear of a specific symptom, and that’s the moment where we can really push through and make lasting progress. I’m sure some people can just force it and fake it, it’s tough for me and takes a lot of trial (pun) and error. I think an evidence log is so so important, so you can catch the moments where your TMS brain overplays its hand (moving symptoms, not noticing them during activities, etc)

 

There’s push and there is force..
You need to work through the pain without forcing self-pressure. Basically it’s a form of inner resolve, but with a bit of kindness and understanding that it’s not easy but it will happen.

 

Hi, Gareth!
Welcome to the forum! And congratulations for coming out of the lurkers into the light. I always tell people, we don’t bite.

One of my major symptoms is the tingling you describe and it even evolved into my hands clenching. I was a journalist, but I had to retire because of it (I was at retirement age anyway. I just didn’t want to retire.) But months ago, my hands completely released. It was overnight and I was so shocked and ecstatic! So happy, you can imagine. And after two weeks, they went back. I was devastated at first, but then I realized it proved it could go away— If and when it wants to.

Pushing through pain won’t hurt you with TMS— Unless you are scaring your brain by being too aggressive. If your TMS brain is afraid, it will kick you down again. Usually small steps forward are most successful in the long run.

Aside from pushing through the pain, are you doing any other TMS work to heal? At some point, you’ll need to do some emotional work. We have a really good free program here called the Structured Educational Program. A lot of people find it a good place to start. I’ve seen a number of people even get all the way better doing that program.

 

Thank you all for your feedback and insight.. I really appreciate it.

John -- I read your story, and, wow.. truly incredible. I can relate in a lot of ways. I'm very skeptical by nature and into gaming.. that used to be an activity I feared when this all came about, but thankfully it isn't any longer.. I can usually just focus on enjoying the game time and not worry about 'damaging' anything. That definitely wasn't always the case so I need to acknowledge that better as a win.

Rabscuttle -- awesome avatar.. such a good game. And thanks for your input. It is such a tricky thing to come at it with a clean mindset when so many days start with a feeling bordering on dread. The weird thing to me is how, as I was getting at in the post, the symptoms dial down the *longer* I do my thing on the steno machine. Starting out is the hardest step, and probably what I focus all that fear and attention on without recognizing that I almost always come out the other end feeling better than where I started. Part of it is getting into the zone and really moving my concentration from attention to symptoms to actually doing what I need to do, capturing words at a very high rate of speed. Once I'm in the groove, they don't disappear, but they certainly dissipate. I think the recurrence of right side symptoms came on because of the pressure I was putting on myself, but I also feel like I need to to keep moving forward.. such a conundrum.

Cactusflower -- I think you're right.. when I can find that happy medium I find that I'm at my best.. the trick is finding it for me, though.

Diana -- thank you I am getting back into therapy. It was after having a good course of therapy that the right side resolved in the first place, but I didn't attribute it to that at the time.. I have no idea why. I have all kinds of issues around my work. It's a very specialized skill and I feel stuck in what I'm doing if I want to keep making a good living, not to mention my clients are lawyers, probably the most universally hated profession out there, a lot of times for good reason. As a sensitive person it's tough not to take on the emotional energy of encountering people at their worst. I'll give the program a real try.. I've read Alan's book and listened to his podcast quite a bit.. I think my reluctance to deep dive into the emotional realm is a signal that I really need to.

 

Bravely said.