Shoulder Impingement / RSI / Thoracic Outlet Syndrome /

[Cellist123]

Hello,

I'm a professional cellist age 29. I feel confused about if RSI and TOS and impingements can actually happen from overuse? Or is it always TMS? Surely it makes sense one can get injured if you have to play cello for hours every day?

I have been pretty much off work for 6 months due to pain; Dec 2026 I got pretty constant tingling pins / needles and some tugging pain and occasional numbness in left hand pinkie and 4th finger. It had been a hectic term. I was told nerve irritation by physio, and to keep playing and strengthen. 3 weeks on no change in hand, and I woke up and my shoulder felt like in spasm like a false movement, couldn't shrug or change gear in car or move it much at all. Tried ice and heat and ibuprofen gel. Thought would go away but it's now June and still bad. Had clear Xray, on waiting list for Mri / nerve conduction / EMG. Seen a bunch of people - all conflicting advice.

I played through January as advised due to important concerts, rested in Feb. Tried to go back to work in March, couldn't due to pain. Hand symptoms mostly settled in April or May. I'm struggling through bits of work but still shoulder is super bad - and movement is often severely limited due to pain, shrugging up and down is the worst. Pain goes up neck and in front of shoulder too and around collarbone and hurts like AGH! if I'm startled. Severely depressed cello is my life and I can't function.

Some people have told me my upper spine is blocked and irritating nerve roots, some said tightness generally and strengthen, some say IDK, latest guy said shoulder impingement and expect slow recovery. One said it was all blocked and he released it and to play as normal - indeed I had way better movement post manipulation - but within 2 days pain and limited mvmt was back worse than ever. Spoke to a mindbody person (online for 30 mins) who said I was never injured and to get on with life and rsi isn't structural. I've really tried but it feels so structural and gets worse when I play more - though still hurts at rest too so hard to tell what helps.

Context - I know tms is real, and I healed from years of severe cfs/m.e. aged 14 - 21 during which I was housebound for a few years and in constant pain + weird symptoms e.g. food sensitivities where one eye would react. I also had two 'rsis' age 22 and 23 each lasting a year and not getting better as expected, and EMG/nerve conduction studies were clear, eventually going away when I treated it as TMS. But I never had any movement restriction due to pain as I do now before e.g. can't shrug.

Thanks for thoughts. Lost at what to pursue. My younger sibling has TOS too which has gone on for a decade, and feel like complicated pain stuff is just everywhere - I don't care if I need a year out I just want a clear answer and explanation and path forwards. I've read all of Howard's books - and adjacent stuff, curable, etc, feel like I could write a book on that all. Just idk how to treat what I currently have, I think I'm confused about are RSI injuries / MSK injuries POSSIBLE though overuse like should I treat this as mind body or not - I know about ruling out/ruling in yet am still lost as this feels murky and if it's structural how did this even happen to me!?

 

[rob89]

Overuse injuries are real and so not everything can be attributed to TMS.

I too have had similar issues skeletal wise. You said you have been off work, but have you rested as you would ‘rest’ as injury? Have you done the right rehab? This is assuming there is a physical overuse injury going on. If something persist beyond the expected then look into the ‘unexpected’….and by that I mean…not the physical.

Your injury has come on, then moved and impacted other areas, specifically at a time of great stress…and you have a history of TMS. All those things considered it sounds like TMS.

I just posted today about TMS coming back for me after a number of years. I can’t offer medical advice, but you have explored physical options, with a potential wait for further diagnostics…so treat as TMS now, but do it properly and with everything you have. I’m confident you’ll come out the other side and realise it’s another manifestation of things you have experienced before.

 

[Adam Coloretti (coach)]

Hi! Whilst not every case will be TMS, if the evidence in your specific case is there then that's all that matters.

The big pieces of evidence that it is TMS are:

- They haven't found anything wrong and nothing else has worked. This is central. I'm keen to see what the future tests say - having said that, they will need to be taken with a grain of salt and just because something is potentially found, doesn't mean that it isn't TMS (we need to rely on other evidence).

- You've had TMS before. Don't underestimate this - once someone has already had a TMS symptom, from what I've seen the chances that further symptoms are TMS skyrocket (it still could be structural though, so it's always important to get it checked nonetheless).

- "Cello is my life" - now that's not necessarily a problem per se, but it makes a lot of sense when it comes to TMS as to why the fear is high here (fear fuels TMS). In line with TMS theory too, if the brain really wanted to get your attention/protect you from danger, targeting your hands/wrist is a pretty good strategy (no point targeting your legs for example). Not only for protection/attention purposes, but also it's the best place to send it to ensure you blame it on something physical (as there's the perfect explanation as to why it's caused by your playing). That might sound a little out there, but I've seen it too often.

- Your younger sibling has it (I struggle to see this as purely coincidence). This could have a massive impact in terms of not only you being more fearful of it (as your sibling is proof that TOS is a supposedly long-term condition, which is only going to freak you out more), but there could also be a suggestive element to it. Medical students, for example, often complain of the symptoms that they are clinically observing at the time (and in some cases even show biological markers for it when it wasn't contagious). Even I sometimes pick up the symptoms of the people I work with temporarily (I would consider it ridiculous if I hadn't have experienced it myself). It's real, and it definitely could be playing a part, given TMS is all about fear and mindset.

In terms of what is evidence against that, it's hard to say as you haven't had the tests yet. Whilst some people would just say to commit to TMS without them, it sounds as if you would benefit from them either way. Like I said, just because they find something doesn't mean it isn't TMS, and it's good that you know about TMS as this can reduce the possibility of you reading too much into a scan result.

Rob is correct to bring up rehab. If they find nothing, then I'd go for TMS. If they find something, then I would get really clear with whomever the specialist is about what rehab entails. You should see improvements in a certain number of weeks - if you don't, then that's even more evidence of TMS. Don't let someone give you a rubbish answer about how rehab has to take forever, they probably only said that to cover their liability as they in truth have no idea what is going on. That rehab will give you peace of mind when it comes to TMS. That is, if you feel you need it, this all depends on how you feel and how confident you are. Without it being advice, I'm simply saying what I would do in your position

 

[JanAtheCPA]

And let's be clear about the fact that EVEN in cases of obvious injury, like a broken bone, or even obvious illness - like all illness - there IS NO CLEAR DELINEATION between TMS and "not-TMS". The TMS brain mechanism is always influencing your ability to recover. Its goal is to keep you hidden safely away from whatever is stressing you out, because it believes that the source of your stress is literally life-threatening.

In today's world, most of us are lucky enough that we aren't in actual physical danger of imminent death - but our primitive brains don't know that.

If you've previously "treated" your TMS with knowledge alone, it might be time to work on the underlying emotional aspects and internal pressures you live with.

 

[Volcano1963]

it might be time to work on the underlying emotional aspects and internal pressures you live with.

…and that can be the hardest part of all.