Reduce pain and then resume activity, or vice versa?

Something I'm wondering about: I was watching a Sarno lecture on YouTube a couple of nights ago, and he advises that people wait until the pain is pretty much gone before resuming normal activity (link below, it's at about 1:47:45). But isn't it necessary to resume some normal physical activity in order to help the pain go away in the first place?

I'm trying to push myself to do basic, everyday things like cooking, grocery shopping, etc. since I feel like need to confront some of the pain head-on and not just spend my life sitting at home, but how does one decide when an activity is too much? I realize that everyone has a different pain threshold, but I'm curious about how other people have negotiated that balance.

(, 1:47:40).

 

Hi em, and welcome!

I think you already have your answer, which is that you should absolutely do what feels right for YOU.

Remember, Dr. Sarno came from a very traditional medical and treatment background, which always advised rest (and heat or ice) for pain. He was without a doubt a true pioneer when he came up with his TMS theory, but honestly, I think we know even more now, about physiology, psychology, and neurology - we really are not limited to whatever Dr. Sarno said, by any stretch of the imagination.

This video is pretty old - it starts out with a shot of The MindBody Prescription, which I believe was written in 1998? That's 20 years ago! He looks quite a bit younger in this video than he did before he died in 2014. And in fact, he himself was hinting in recent years that some of his ideas were still evolving.

It's interesting that he tells us (~14 mins) that he might have come up with a different term if he'd realized earlier that chronic pain involved more than muscles. I've heard that at some point (like after the turn of this century) that perhaps "TMS" should stand for The Mindbody Syndrome. Personally, I rejected the oxygen deprivation theory early on - I believe that our symptoms are 100% generated by our fearful brains.

 

Hi Jan,

Thanks for your response.

I think you already have your answer, which is that you should absolutely do what feels right for YOU.

Part of the issue is that I'm trying to reestablish a sense of what feels right. TMS has really chipped away at my intuitive sense of that. For a long period, everything I tried just made the pain worse, and of course I couldn't figure out why, and so I just backed away from doing everything. I know when an activity is way too much for me to handle (I'm definitely not ready to try running yet, for example), but when things are less clear-cut... I guess learning to trust myself again, and accepting that there is no clear roadmap, is a big part of healing from this.

 

Make no mistake about it - if you do something with fear that you will have pain, your primitive brain will be very happy to accommodate that fear, and give you pain. So the mindset with which you approach your return to activity is the key to your experience.

It's fine to go slow, but you have to keep going, and you have to keep progressing. ANd you have to tell your brain that you're safe, and that it is completely unnecessary to create pain.

 

See, I know that intellectually, and I keep trying to remind myself of it, but really believing in it 100% is a lot harder.

 

And that's your fearful brain, totally in control, and letting you try to get away with the "yes, but..." thing.

That ain't gonna do it.

You need to be in charge!

 

Struggling with this at the moment too, I know how hard it is Em! I've managed to get over back pain and two episodes of foot pain in the past, but having another flare and jogging (which I literally have to do as I have lung problems and it's an essential part of my ongoing care) is making me more and more anxious, so guess what I'm still getting loads of symptoms after I go out! And then knowing I'm not doing enough so my lungs are suffering..... a whirlwind mind of stress and fear. So useful words Jan thank you, 'it's fine to go slow but you have to keep going and keep progressing'. It's so easy to think 'I can't face up to my fears today, I'm not going to go out' but I know that's feeding it all.

Em, in the past, looking for inconsistencies has really helped me get over the fear if getting back to normal activities, like why could I drive for 15 minutes but 17 minutes set me off onto a ten day increase in pain. Have you got anything like that, even if it's a really small thing, just something for your brain to go, oi, that doesn't make sense, and boost your confidence you're not doing harm (if that is your problem, which it certainly is for me). I can't find any inconsistencies at the moment, jogging is my only trigger which is therefore feeding the 'physical' preoccupation, I wish I could as I really think it would help me progress. Although I rarely have pain and stiffness at work, only at home in the evening..... hmmm...... Trying soooooo hard not to get frustrated but it's really difficult!

 

This is why practices like yoga can be so beneficial. They enable us to rebuild our relationship with our body~mind in a very gentle, very mindful way. Clearly this approach is opposed to the typical Western physical-focus on poses and instead leans much more into stillness, restoration and meditation. Yoga also works directly with the nervous system.

There is a brilliant doctor called Gabor Maté whose work goes well beyond Sarno in his understanding of the role of repressed emotions and health. In a recent interview he was asked out of all the many practices and therapies he had tried and advocated, if he had to choose one, which would he choose. He answered 'yoga'. He stated that his morning yoga practice was the one and only thing he would keep because of the way it integrated the body~mind, the emotions and the spirit.

I offer this as a little food for thought on ways of pushing through gently and easing fear while building confidence. Remember that there is nothing wrong with your body. As Jan says this is your primitive brain running high. In the soothing of this defence mechanism you will experience sweet success.

 

Yes, when I think about it, I do have some inconsistencies: I can be doing pretty well in the evenings now, before I go to bed, but then I'll wake up in the middle of the night with my feet hurting for no reason. Or they'll be ok for a little while after I wake up and will then start to hurt spontaneously, even though I'm just lying in bed. The pain is completely irrational.

Or a couple of days ago, I managed to get on the spinning bike for 15 minutes and be basically fine the whole time. That was a big deal since the spinning is what triggered my ankle pain back in February. (Is there any logical reason spinning made my ankles hurt? No, not really. It was an excuse for my brain to shift the pain.) My feet did flare up later, but not right then, and that wouldn't be the case if there really were a structural problem. I just keep trying to remind myself of that.

Jogging... that's probably going to be my biggest trigger as well. I was a runner before all this happened, and that's still the activity I fear the most. TMS still has the upper hand there. I was doing a lot better at one point in January, and I tried running for just five minutes then. It was the best five minutes I'd had in months, and I was completely fine while I was moving, but then it triggered a terrible relapse. Had I know it was TMS then, I could have managed the setback, but at that point I had no idea why those few minutes of activity had such a huge effect. Even now, if I have to speed up for a few seconds to cross the street, I get a little panicked. I think knowing all I know now will help once I try, and at some point I'll have had enough and just pick up my running shoes and give it a go, but I'm not quite there yet.

 

Thank you Plum. I'm just getting back into meditation (I haven't really tried yoga) and I do love that quiet time for my mind. I pick up techniques, then when I get better I forget about and then wham, backwards I go!

Em, sorry but I'm smiling to myself in sympathy as I read myself in your story! I'm currently dealing with 'Achilles tendinitis' (even though I wrote a success story on here about a year ago, so I know I can get better - I'm just really struggling again to get back into the right mind set to start my path to recovery). If you think about it, how could spinning really hurt your feet? You're not really putting that much pressure on them and they don't really move, so yes I would find that pretty easy to put any subsequent pain down to 'you get what you expect' so if you expect pain, bingo. Still very hard to break that cycle.

My problem is I don't yet totally accept this isn't physical even though I've had loads of signs pointing to TMS - my heel pain fits the classic Achilles tendinitis described on the internet (oh no, wrong move again) like getting up to go to the toilet in the night or first thing in the morning, all flared up after jogging. And even though I know about conditioning etc etc, which really helped clear my back pain, I'm finding this a lot harder to move on from. However I live in the UK and I've got a call booked with Georgie Oldfield who helped me through back pain, she has a background in physio so I'll discuss all my fears with her and see what she says! I do think 'trying too hard' is not the best way forward, it's about getting a balance and taking the pressure off yourself to get immediate results. Good luck, I do understand!

 

Yes, I was diagnosed with achilles tendinitis as well, by several doctors actually. At one point, I did have some pain in that area too. It's a very tempting diagnosis. In my case, yes, you're right, the spinning/ankle pain made no sense, and I was kind of flummoxed by it when it happened. That's the sort of exercise people are *supposed* to do when they have tendinitis.

@plum, thanks for mentioning yoga. I did do classes regularly a while back, but then I got busy and just stopped going. My gym does offer classes, and there's another studio (Iyengar) I really like not too far from me. At some level, I'm nervous about just walking into a regular class and trying to do everything, even though I know they'll be totally accommodating if I can't. But pushing past that is going to be part of the healing process too.

 

@Mothy and @em1981,

I suffered from chronic Achilles tendinitis for years. I used to be a dancer who incurred an injury there but who pushed on regardless. I carried on dancing for over a year thinking it was no big deal and that it would be ok. Towards the end of my time dancing I experienced an awful betrayal at the hands of a brilliant dancer. I admired her greatly, loved her even more and considered her a friend. I was crushed by her casual brutality and stopped dancing within weeks.

My Achilles pain at this point was so bad I couldn't walk. Getting out of bed each morning was an agony of hell. I even ended up in hospital one day, such was the pain.

Over the years it eased but always returned with vengeance upon use. Then I discovered Sarno and thought "A ha", this must be the cause. At the time my main TMS issue was trigeminal neuralgia so I focused on that but popped my achilles (which now afflicted both ankles) into the pot.

Sadly the Achilles pain endured at a low level and I kinda forgot about it. Then I started to do Yin Yoga and this brought me relief and healing. How much of this is a gorgeous combination of somatic tracking and cognitive soothing (a' la Alan Gordon) and how much placebo I cannot say. Nor do I care. The relief is glorious.

I practice at home in my pyjamas which I find much more relaxing than a class. I follow along with classes on YouTube and then bounce into the kitchen to make a nice cup of tea

Plum x