Tendinopathy and TMS

S

Shakermaker

Peer Supporter
I’m just looking for info regarding TMS And tendinopathy.

I’ve been diagnosed with a very mild form of tendinopathy (mild inflammation, tendons fully intact so not ruptured or even partially torn) in my shoulder and hamstring. Pain started while working out in the gym.

I know from previous readings that things like disc herniations and meniscus tears also show up in people who are pain free. I was wondering if similar studies have been done on tendinopathy? Like can people have inflamed tendons showing up on MRIs but still be pain free.

I’m just to figure out how much TMS might be playing a role in this for me, or whether this one is a purely physical problem
 
Hi @Shakermaker.

I asked perplexity ai to summarise the 'mechanism' of what can be going on when the cause is mind-body/TMS, as follows:

"When you have persistent pain in your hamstring and/or shoulder with only "mild inflammation" and no tears or ruptures present, it is easy to assume that the inflammation is the direct cause of your pain. However, modern neuroscience reveals a very different, encouraging reality: your body isn't structurally broken; your nervous system has just gotten stuck in an overprotective "false alarm" loop.

While older theories suggested this was caused by restricted blood flow or structural damage, modern science shows it is actually a nervous system glitch called Neuroplastic Pain.

More about this:
  • Mild Inflammation Can Be Completely Pain-Free: Large-scale medical studies show that a huge percentage of people without any pain have mild inflammation, small tears, or wear-and-tear in their tendons. Under normal circumstances, mild inflammation sits well below your "pain threshold" and goes entirely unnoticed while the body naturally maintains it.
  • So, What Actually Causes the Inflammation? If there is no physical tear, the mild inflammation is likely being caused by Neurogenic Inflammation—meaning it is generated by the nervous system, not by mechanical injury. When your brain stays in a chronic "fight-or-flight" state due to stress, pressure, or anxiety, it sends continuous distress signals down your nerve pathways. These overactive nerves release chemical messengers (like Substance P) directly into your shoulder and hamstring tissues. These chemicals cause local blood vessels to leak a tiny amount of fluid, creating a real, physical state of mild inflammation—but it was switched on by a stressed brain, not by a physical strain.
  • The Hyper-Sensitive Volume Knob (Central Sensitization): Because your nervous system is in this high-alert state, it turns the "volume dial" on your body's sensory inputs all the way up. Suddenly, the tiny amount of neurogenic inflammation that a calm nervous system would easily ignore is magnified by the brain into intense, debilitating pain.
  • "Inverted Healing": If you had a minor injury in the past, the tissue has done its job to repair. However, your brain memorized the pain pathway. Now, normal movements trigger that old memory, and your brain uses the presence of that minor, nerve-driven inflammation as "proof" that it needs to keep screaming at you with pain.
The Bottom Line: The mild inflammation is a real physical finding, but it is not a sign of structural failure. It is the physical footprint of a hyperactive nervous system that has forgotten how to switch off its alarm. Because this is a neurological loop rather than a structural injury, it can be retrained and reversed."

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And the following is from https://cbphysiotherapy.com.au/the-correlation-between-imaging-and-symptoms-in-tendinopathy/ (Imaging & Tendinopathy Symptoms | CB Physiotherapy)

"THE CORRELATION BETWEEN IMAGING AND SYMPTOMS IN TENDINOPATHY

Imaging results (x-ray, MRI, CT and ultrasound) in general correlate very poorly with an individual’s reported symptoms. Tendinopathy is a great example of this.

A pathological tendon found on imaging (with an MRI/US reporting tendinosis, degeneration, disorganization of fibres or intratendinous tears) is purely a RISK FACTOR for a painful tendon, rather than a definitive diagnosis. These findings will make you 3-15x more likely to have a painful tendon (or clinically a tendinopathy).

Think of it like smoking and lung cancer. Smokers are far more likely to have lung cancer than non-smokers, but it is not guaranteed. Just like people with degenerative tendons on imaging reports are simply more likely to have a tendinopathy.

We know that there is a very high prevalence of asymptomatic tendon pathology found on imaging (up to 50% in some groups). This means that almost half of people with a crappy looking MRI or ultrasound will have no pain!

We need to focus on pain and function, not on imaging reports…

Chris Bryceson B. Health Sciences (Physio), APAM CB Physiotherapy"

-----------------------------------------------------------------------------------------------------------------------------------------
 
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BloodMoon said:
Hi @Shakermaker.

I asked perplexity ai to summarise the 'mechanism' of what can be going on when the cause is mind-body/TMS, as follows:

"When you have persistent pain in your hamstring and/or shoulder with only "mild inflammation" and no tears or ruptures present, it is easy to assume that the inflammation is the direct cause of your pain. However, modern neuroscience reveals a very different, encouraging reality: your body isn't structurally broken; your nervous system has just gotten stuck in an overprotective "false alarm" loop.

While older theories suggested this was caused by restricted blood flow or structural damage, modern science shows it is actually a nervous system glitch called Neuroplastic Pain.

More about this:
  • Mild Inflammation Can Be Completely Pain-Free: Large-scale medical studies show that a huge percentage of people without any pain have mild inflammation, small tears, or wear-and-tear in their tendons. Under normal circumstances, mild inflammation sits well below your "pain threshold" and goes entirely unnoticed while the body naturally maintains it.
  • So, What Actually Causes the Inflammation? If there is no physical tear, the mild inflammation is likely being caused by Neurogenic Inflammation—meaning it is generated by the nervous system, not by mechanical injury. When your brain stays in a chronic "fight-or-flight" state due to stress, pressure, or anxiety, it sends continuous distress signals down your nerve pathways. These overactive nerves release chemical messengers (like Substance P) directly into your shoulder and hamstring tissues. These chemicals cause local blood vessels to leak a tiny amount of fluid, creating a real, physical state of mild inflammation—but it was switched on by a stressed brain, not by a physical strain.
  • The Hyper-Sensitive Volume Knob (Central Sensitization): Because your nervous system is in this high-alert state, it turns the "volume dial" on your body's sensory inputs all the way up. Suddenly, the tiny amount of neurogenic inflammation that a calm nervous system would easily ignore is magnified by the brain into intense, debilitating pain.
  • "Inverted Healing": If you had a minor injury in the past, the tissue has done its job to repair. However, your brain memorized the pain pathway. Now, normal movements trigger that old memory, and your brain uses the presence of that minor, nerve-driven inflammation as "proof" that it needs to keep screaming at you with pain.
The Bottom Line: The mild inflammation is a real physical finding, but it is not a sign of structural failure. It is the physical footprint of a hyperactive nervous system that has forgotten how to switch off its alarm. Because this is a neurological loop rather than a structural injury, it can be retrained and reversed."

----------------------------------------------------------------------------------------------------------------------------------

And the following is from https://cbphysiotherapy.com.au/the-correlation-between-imaging-and-symptoms-in-tendinopathy/ (Imaging & Tendinopathy Symptoms | CB Physiotherapy)

"THE CORRELATION BETWEEN IMAGING AND SYMPTOMS IN TENDINOPATHY

Imaging results (x-ray, MRI, CT and ultrasound) in general correlate very poorly with an individual’s reported symptoms. Tendinopathy is a great example of this.

A pathological tendon found on imaging (with an MRI/US reporting tendinosis, degeneration, disorganization of fibres or intratendinous tears) is purely a RISK FACTOR for a painful tendon, rather than a definitive diagnosis. These findings will make you 3-15x more likely to have a painful tendon (or clinically a tendinopathy).

Think of it like smoking and lung cancer. Smokers are far more likely to have lung cancer than non-smokers, but it is not guaranteed. Just like people with degenerative tendons on imaging reports are simply more likely to have a tendinopathy.

We know that there is a very high prevalence of asymptomatic tendon pathology found on imaging (up to 50% in some groups). This means that almost half of people with a crappy looking MRI or ultrasound will have no pain!

We need to focus on pain and function, not on imaging reports…

Chris Bryceson B. Health Sciences (Physio), APAM CB Physiotherapy"

-----------------------------------------------------------------------------------------------------------------------------------------
Click to expand...
Hi @BloodMoon that’s great thank you so much
 
Tedinopathy sounds like one of those diagnoses that those of with TMS get that only explains the symptoms, not the cause. Pain in the tendons. Well, yes, I have that but why. It doesn't answer any questions.
 
@Shakermaker.
Just to say that I read that tenosynovitis is closely related to tendinopathy and I experience a major bout of the former, which turned out to be mind-body/TMS. Years ago, after a stressful - but trivial in the great scheme of life - disagreement with someone via email, I suddenly developed extremely severe pain and stiffness in my dominant hand while using my laptop (although at the time I didn't put two and two together and realise the connection). I couldn't use my hand for normal every day tasks like brushing my teeth. It was very disabling and continued for many months and was eventually thought to be De Quervain’s tenosynovitis, with surgery discussed. Once surgery became a real possibility, the symptoms all of a sudden began to improve; they gradually disappeared, and I returned to typing on the same laptop without the pain returning. (True De Quervain’s tenosynovitis can apparently get better on its own after a few months, but my De Quervain’s tenosynovitis-like symptoms had gone on for very much longer than that.) My interpretation is that my TMSing brain was terrified of the surgery and as such stopped creating the 'reason' for the surgery!
 
Last edited:
Shakermaker said:
I’m just looking for info regarding TMS And tendinopathy.

I’ve been diagnosed with a very mild form of tendinopathy (mild inflammation, tendons fully intact so not ruptured or even partially torn) in my shoulder and hamstring. Pain started while working out in the gym.

I know from previous readings that things like disc herniations and meniscus tears also show up in people who are pain free. I was wondering if similar studies have been done on tendinopathy? Like can people have inflamed tendons showing up on MRIs but still be pain free.

I’m just to figure out how much TMS might be playing a role in this for me, or whether this one is a purely physical problem
Click to expand...

It can be incidental for sure - have you attempted to treat it from a physiotherapy perspective? That can be your best friend here (I'm not necessarily recommending you do, more asking if you have), as if it hasn't responded as expected to treatment, then that's even more indicative of TMS. That's especially the case given it's a very mild form of tendinopathy, to me (I'm not a physio mind you) I'd be expecting results quite quickly and I'd imagine that such mild forms have very high success rates when it comes to physiotherapy (if physio was indeed the correct path).
 
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