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TMS & Trigger Points

PeterO

PeterO

Peer Supporter
TMSers.

As advised in much TMS literature I am trying to increase my physical
activity levels. However each time I am set-back with excruciating & debilitating
trigger point pain in lower back. Or more specifically, the left quadratus lumborum
and glutues minimus muscles. Also there is some localised swelling, overall muscle
ache and movement restriction.

These symptoms are long term (20+years) and more often than not, leave me
bedridden.

Today is one of those days.

My problem is that I have much difficulty aligning this pain with the
TMS diagnosis given its overwhelming nature & site specific pain responses.

Unfortunately, it sidetracks me from my TMS journey.

It feels as it is impossible for me to return to good health.

Any advice?

Pete
 
My first question, Pete, is whether you have adopted a strategy of upping your activity in gradual increments, or have you adopted a boom/bust exercise cycle where you try to return full blast to strenuous activity? What I mean by increments is as little as walking 3 minutes per day, as long those 3 minutes are entirely pain free. Then, don't up it to 6-minutes per day prematurely. Stay at one level a good long while before you up the ante to the next incremental plateau.

You say that your symptoms are of 20+ years standing. You can't expect to deprogram those well-grooved pain pathways in one big push. Instead set modest goals over a long period of time - like 3 months, 6 months or even a year. Like the historians say, Rome wasn't built in a day, and you're not going to disassemble and rebuild the Forum in one big burst of frantic energy. Try to maintain an attitude of what Alan Gordon calls, "Outcome Independence", where you're not trying to monitor your rate of improvement too closely. A watched pot never boils. It will get better when it gets better. Not before.

I have to assume that over that 20+ year course, you've tried everything and been checked out for any preexisting medical conditions? Your pain condition has been reinforcing its programmed response for over 20 years, so don't expect it to go away in one fell swoop. Therefore, I'd recommend a gradualist (rather than a boom/bust) approach to returning to full strenuous physical activity. Just getting more and more mobile is bound to change your mental activity for the better in any case.
 
Bruce.

Absolutely boom & bust. I really like your term 'gradualist'.

Will look into Alan Gordon's 'Outcome Independence'.
I have located it on the TMS Wiki.

I must admit to looking for some immediate gratification.
A definite personality trait. Also I have a pattern of self-sabotage
in relation to my physical healing. Almost an underlying fear of the
work involved. At times, I am frightened, almost panicked, by
the intensity of my physical symptoms & just want someone to
fix me. I can recognise my little boy self subsconscious. On a
deeper level I still can't yet accept a TMS diagnosis. A behaviour
here is to provoke the physical symptom so that I can then
return to my medical based leanings. At least now I am
acknowledging this, even if often in retrospect. And with
assistance from my TMS Wiki friends, yourself included.

On the flip side, I am undertaking some psychology work
with Dr James Alexander (via Skype) and continuing with
my Alexander Technique training. Also slowly working through
the TMS Wiki Structured Education Program.

Another insight is my feelings of envy, long held, especially
in regard to others physical attributes & achievements.
Your recent post about Beth Rodden bought out such
feelings. I desperately want to express myself in a physical
manner & feel again the achievement of such. Also throw
in a bit of ego recognition. This has much to do with my urgent,
almost desperate, want to return to physical activity.

20+ years is a long time waiting!

Thanks for your advice here.

Pete

Pete
 
Pete,

Before I found out about TMS / MBS I was much into triggerpoints. I treated them but with limited success and reappearance of the TP's. When I asked around I concluded that TrP's are just a mechanism in TMS. Having them, to me, is a sign of TMS at work.
 
I remember that Dr Sarno said that trigger points were where the most amount of oxygen debt was concentrated.
 
BruceMC said:
My first question, Pete, is whether you have adopted a strategy of upping your activity in gradual increments, or have you adopted a boom/bust exercise cycle where you try to return full blast to strenuous activity? What I mean by increments is as little as walking 3 minutes per day, as long those 3 minutes are entirely pain free. Then, don't up it to 6-minutes per day prematurely. Stay at one level a good long while before you up the ante to the next incremental plateau.
Click to expand...

This is actually something Dr. Alexander writes about--you should definitely talk to him about it. I was greatly heartened by his explanation in his book about developing a "pacing" (rather than "boom/bust") attitude toward getting back to activities, because it's what I've been doing on my own and I felt validated seeing it in print. I feel like many TMS writers don't really explain just how to get back to physical activity, and Dr. Alexander's method seems very sensible, realistic, and easy to understand and implement.
 
Yes, Gail, Dr Alexander is actually the first person I've read who actually detailed an approach to getting back to full physical activity that made sense to me, so I repeated it here. I know that when I had my TMS relapse in 2007 I tried to "kill it" with big road bike rides at maximum speed and all it did was play into my perfectionist TMS personality traits and make my symptoms worse. What I should have done was ride for about 15 minutes on the flat spinning every day for two weeks before moving up to 30 minutes etc etc etc. But at the time I didn't really have a clue and just attacked the problem head on like Steve O did with his 1000 golf balls at the driving range and running hard every day. Slow learners! Fast learners!
 
Pete,
Bruce is right on, from my humble perspective. I know Dr. Sarno wrote in "Healing Back Pain" to vigorously return to your workout but also found out the hard way that is not the optimal path. I've been a body builder for years and taking gradual, incremental steps with positive results of progress...literally adding 5 pounds to resistance training exercises every week. In my case, nerves and muscles are reattaching and gaining additional oxygen & blood flow and this takes time after shutting it all down for 2 years. Stretch, tone, build is my mantra similar to crawl, walk, run --I just moved into the "tone" phase but confident I will one day be back to building. But, hey, you need to crawl before you can walk and ultimately run. It takes patience (and humility) and staying focused on your goals. My pain shifts all around which has convinced me it's TMS and I now feel I am in control (okay, wish I was quite that confident but getting there!) But I've documented great progress, as I hope you will too, and when you do make incremental progress don't forget to CELEBRATE. Each small victory is a step in the right direction. We are all so hard on ourselves -be gentle and supportive and relish the fact that you are doing any activity at this stage.
On the days when I finish a workout without a flare-up, I ask myself, "If I had physical symptoms, how could I possibly have just completed that workout? How could I just have done my routine without major pain? I couldn't!!" When you realistically convince yourself that it's a psychological disorder causing physical symptoms, then the FEAR diminishes and you are on your way. Once the good days outweigh the bad days as you very slowly, gradually return to your workout, the only logical conclusion is TMS. I wage war in my head too but guarded optimism starts to take hold with each positive step. Just go slow and celebrate all the small wins...Rome (my fav city) was indeed not built in a day and 20 years of pain will take time and perseverance to overcome so hang in there.
 
The gradualist approach makes a lot of sense to me, as well. I think that one's internal level of tension is crucial in TMS. We need to think about, what increases our tension vs. what decreases it? If we are approaching our pain in an aggressive and inflexible manner, that just adds fuel to the fire. It increases tension rather than diffusing it.

It is also vitally important how you THINK about the activity. If you are building up internal tension as you approach it, "you're doing it wrong:"
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Instead, I think that one of the key things in TMS healing is to be aware of your tension and slowly learn, over time, how to diffuse it. In terms of resuming activities, it's vital to accept the diagnosis completely (keep reading your Sarno, Alexander, Ozanich, Hueftle, Schubiner or whoever helps you get it) until you you just aren't afraid. Then resume activities because you want to, because your life is better if you do. The pain means nothing, then, and the strategy that your brain is using to distract you is broken. The more and more I read about it, the more I think that just as the TMS syndrome starts in your mind (with emotions), it has to end in your mind as well - by soothing the tension that bedevils you every day.

So how do we beat that tension? Well, the first thing we need to do is watch where our tension comes from. In ALL of our activities. What gets us going and what cools us down?

Well, that's a bigger subject and I don't want to sidetrack the thread. But it's pretty clear that "boom and bust" will only get us going, and not just because of the constant fluctuations in pain, but also because of the tense way we are thinking about the pain. "Gradualist" is much more likely to cool us down.
 
Trypp makes a great point about your approach towards engaging in a workout. If your mental attitude and inner dialogue is saying, "man, here comes the pain any second now", you will find that pain since you have not fully bought into TMS and still have fear (I had a couple episodes that played out exactly like that). But if you take a very gradual, incremental approach -all the while reminding yourself you had success the other day - you slowly start to build on that baseline and it establishes a foundation. When I returned to an exercise 48 hours ago, I reminded myself I successfully did this then without flare up, so I know there is no logical physical symptom I should now feel if I do the same weight. Once I establish that on the first couple sets, I ramp it up 5 more pounds all the while being very mindful and aware of my pain, telling myself there is absolutely nothing wrong with me. It works, and I now added another building block which serves as my new baseline. These are all very baby steps but undeniably progress where 3 weeks into it I am now doing 15-20 pounds more on most exercises than when I started (my Grandma could still outlift me at this stage, but that's not the point). I know if I tried the level I am now 3 weeks ago, I would've flared up bigtime and really had my confidence shaken up in the process. Keep winning the small battles in your head and you will ultimately win the war!
 
Trypp,
Your point about how you think about the activity is critical. I just wrote a post about how some forms of exercise may make it easier to not build up the kind of tension you describe.
 
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