To push through the pain or not to...that is my question

Hello world - My name is John and I'm new to this site. I could use some guidance/advice from those who have 'been there, done that'. I discovered John Sarno's first two books about 13 years ago and successfully rid myself of relatively minor back pain. Then I had a major knee injury (ACL tear and reconstruction), a big move, a big change of job, a divorce, various auto accidents, and much, much more. So, here I am some 13 years and many convincing MRIs later rediscovering Sarno and many of you fine supporters, authors, and practitioners. I've decided that what the doctors have been saying and recommending just doesn't make sense. My meniscus MRI just isn't that bad (as a highly respected TMS doctor was kind enough to confirm for me via email). My back MRI ripe with 'multi level degenerative disc disease', 'grade 1 spondylothesis', and 'mild thoracolumbar scoliosis' is not nearly as scary as they made it sound. I should be fine and so I've set out to begin my re-education and re-conditioning.

I've been seeing some consistent progress in the weight room over the past few months and have been able to work through these and other pains that had popped up (shoulder, elbow, forearm).

Yesterday I decided to try something I had not tried in 13 years...to step on a basketball court and shoot around a bit for about 30 minutes. Basketball was my biggest passion and I was too fearful to go back out on the court because it didn't take much for my knee to become painful and swell up significantly after my meniscus 'injury'. I felt good and was very hopeful with how my knee was holding up.

Then towards the end of my shoot-around, I got a shooting pain in my lower back when taking a shot. My back had been feeling much better up until then. I knew this was ridiculous. I was hardly pushing myself. The pain radiated like it never had before...wrapping around my entire lower back and even around both sides of my lower torso. Then twinges of a very old familiar 'friend' of mine - patellar 'tendonitis' (tendonalgia I now know it by). I know this is TMS. Nothing else really makes sense.

I was hoping the back pain would lessen but it's even worse today. So, my million dollar question is - do I look this pain in the eye and say FU and get right back out on the basketball court...and keep doing so until it finally relents no matter how bad it gets... or do I wait until it's not as bad again before trying again?

 

in my personal experience, i'd yes and no...
start slow, because you dont want to overwhelm the nervous system because after all, pain is a danger signal. Then again, some people would say there's no harm in overwhelming the nervous system because you're not damaged. It really depends on whether you believe in the more medical side of "central sensitive sensitization" or emotional side of TMS. The book "The great pain deception" by Steve Ozanich really inspired me.
In my personal experience, I got back into my favorite sport, mountain biking, after being absolutely floored by a pelvic nerve disorder called pudendal neuralgia. If you asked any pelvic specialist, they'd tell you to NEVER sit on a bike again. heck, many doctors tell you not to SIT at all! Most of my doctors dont know i bike, and I wouldnt tell them. After all, some cases of PN arise from cycling.
I had quit cycling when i got PN (it developed after a medical procedure, but i was a cyclist beforehand) because every time i tried to get back on a bike, i got horrific flares. however, quitting cycling only led to depression, and my pain didnt go away even if all i did was lay around.
So i got a special saddle, and cautiously got back into cycling. At this point, i hadnt heard of TMS yet, and i felt as though i was being stupid and selfish by risking nerve damage by cycling, but i was so addicted to it, that i allowed myself 2-5 miles, once a week. Of course after every ride, i'd freak out, pop a bunch of pills, sit on ice, take baths, and cross my fingers. Like clock work, my pain would start around mile five and i'd have to plan my rides so i could escape around the 5th mile (or around 1 hour) and like i said, i'd get flares.

Fast forward to when i learned about TMS, so i started pushing the envelope a bit. I had to really change my attitude. Instead of getting scared every time the 5th mile approached, i would pretend i didnt have this condition, and i would approach rides like it was the olden days, and i'd get EXCITED for a ride, rather than get scared. Keep in mind, this was hard! Expecting pain was so ingrained in my brain that it took a long time to drop that habit. Slowly over time, i was able to increase my mileage. Over a year, i went from 5 miles to 20+ miles. The next hurdle, was being able to ride more than once a week. I still struggle with this, but now i can generally ride 2-3 times a week, but multiple days i a row is still a struggle. I think one day i will get there. Habits are hard to break, but these days i rarely get a bad flare from a ride. If anything, i get mild flares at most. I still have daily "default" pain, but exercise (biking) usually doesnt increase it. If i listened to the oldschool doctor's advice, i should be horrifically damaged from biking, but i'm not.

In short, start slow and build up, but more importantly, it's the attitude. Do your best to pretend you dont have the pain, and pretend it's like the old days before the pain struck. get excited to play. dont approach it with hesitation, approach it with joy! if i can bike agian with pudendal pain which is historically the worst thing you can do, then i think you can do anything.

 

I actually had this very same dilema this morning. My TMS flared up pretty good yesterday and as I got up today for my morning workout that I never missed, I contimplated what I should do as my back was definitely bothering me. I didn't do my normal workout of lifting weights on account of a separate injury to my elbow but actually thought about "taking it easy". Instead, I sucked it up and went for a 3.5-4 mile run with my fiance. I'm not going to lie, the pain was defintely there (more prevelant at times than other) but I mentally pushed myself through it.

My TMS is in full force today, but I know it's all in my head and that this will pass like the rest of my episodes have. You better believe I'll be up and at 'em again tomorrow morning, mentally pushing myself through the pain.

 

I'm struggling with this exact issue myself. Slowly starting to find the balance, but still... there really isn't a roadmap. When I first discovered that TMS was the source of my pain, I was really motivated to get back on a spinning bike (which had triggered my worst round of symptoms), just to prove to myself that I wasn't really injured. It went better than I expected, but I also can't say I was completely comfortable with it. After a couple of sessions, I decided to give it a rest and go back to swimming. I'm trying to practice listening to, and trusting, my body more. I've been slowly increasing the amount I walk each day; I generally find that the more I do, the better I feel, but the psychological piece is just tricky. I know that worrying about the pain is what causes the pain, but still, it's hard not to default to the worry. At any rate, today I tried going for a run for the first time in about 18 months. I was ready to try it, and again, I was fine. But I might back off a little for the next few days at least. This whole thing is a process of learning not to push so hard all the time, or maybe about learning when it's worth it to push hard and when it's worth it to back off a little.

 

Thank you for the replies and for sharing your experiences. It's so difficult to strike that balance between overcoming/not reinforcing old conditioning/triggers (e.g. for me, sleeping on a soft mattress (back), playing basketball (knee), lifting weights a certain way (shoulder/elbow/back)) and not letting placating your pain by modifying your behaviors.

That to me has been THE MOST difficult aspect of the healing process thus far.

For example, without getting into boring, unnecessary details which have nothing to do with my back or TMS - I recently decided to temporarily to sleep on a softer mattress in the house which I always hated because it triggered my back pain. And so, it did again. On the heels of having already stirred up this pain from the Basketball, it just really sucks. I wake up with the severe stiffness/pain...it dissipates significantly by evening, I go to sleep - Groundhog Day.

Do I reinforce this 'trigger' by going back to the firmer mattress?

Do I keep pushing through it until I, hopefully, rid myself of the belief...all the while possibly reinforcing the negative association?

And either way...God, it's painfully obvious how much I'm still preoccupied with my physical body and pain.

I am healing and getting better but figuring this out is more complicated than Calculus.

 

One thing I've found helpful is to slowly acclimate myself to situations that have traditionally served as triggers. For example, I avoided sleeping on my back for a long period because the pressure from the mattress (semi-firm, in case you're wondering!) would "irritate" the nerves on the backs of my legs and heels. To break the pattern, I practiced lying on my back for just a few minutes at a time initially, and I found it very helpful to actually read one of Dr. Sarno's or Steve Ozanich's books while I was doing this in order to reinforce that the problem was coming from my mind rather than my body. I also made sure to breathe very deeply and consciously. Gradually, I was able to build up to lying on my back for longer periods, and now I can pretty much sleep that way if I want. If the pain starts to recur, I just go back to reading, breathing, or reminding myself that the pain is just a result of my brain's former "programming," and there's no reason for anything to hurt. It was really uncomfortable initially, and I did need to push through, but really, the trick was to focus on distracting myself from the pain so the pain couldn't function as a distraction.

It was Steve Ozanich who compared healing from TMS to doing an all-black puzzle without any edges. I think that pretty much sums it up, at least in the beginning. But the more I've work with myself like this, the more I've started to figured things out.

 

Thanks - that's good advice. That one was tripping me up a bit with trying to figure out how to set incremental goals for myself that were geared towards doing things I enjoy (working out, playing sports, etc.) rather than not having pain. Your idea of increasing time of being able to read in bed (or watch tv, etc.) is a great way to tackle that one.

Thank you very much!

 

Glad to be of help! Now I'm trying to figure out how to increase physical activity without triggering pain, given that I can't exactly read a book while running Although come to think of it, I might be able to manage that on the elliptical or a spinning bike... Not sure I'd want to, though. Probably better to just focus on breathing. In all seriousness, though, I'm now at the point where I can do manage activity and be more or less ok as long as everything else goes right, but if there are any real physical issues in the areas I've had problems with, no matter how minor (e.g., athletic shoe chafing), my mind wants to seize on them and start TMS-ing. Even though I know what's going on, it's sometimes still a challenge to actually calm my mind down when the physical/mental line gets blurred like that. Or even to believe 100% that I can eliminate the pain just by thinking. I'm starting to get a handle on it, but wow, the mental gymnastics.

 

Hi, I have exactly the same problems as you guys. With reference to the ‘reading a book while running’ , could you try listening to an audio of positive affirmations while you run? That might be useful. Or maybe your absolute favourite song which you can tell your brain it is your safe song/s. Might help , but it’s good to know it’s not just me that struggles sometimes. Keep going and we will get there.

 

another thing i did, was to mostly ditch my special sitting cushion. Most people with pudendal pain walk around addicted to ergonomic donut cushions because they're convinced they cant sit on anything else. i still use it for work because it props me up and i feel like it's more ergonomically correct in general. even if my pain was gone tomorrow, i might still use it for the same reason it makes sense to have a cut-out on a bike seat. However, i used to carry it EVERYWHERE like restaurants, movie theaters, friend's houses, etc. I stopped that. After a short while, my body acclimated and i realized i didnt need it!
Another important detail is that with PN, the most common symptom is pain while sitting. However, when i was first suspected to have it, i never avoided sitting to begin with. i thought to avoid sitting would be too annoying. As a result, my brain never made the associating that "sitting = bad" and for the first few months, i didnt really have sitting pain. Then when i went to a doctor and my diagnosis was official, the next day i had sitting pain for the first time (and rectal pain, i never had that before). That's how powerful the brain was. Still, i had better sitting tolerance than most PN patients because i never avoided sitting per the advice of other people and doctors. Very rarely would i use my standing desk, or stand instead of sitting due to my PN pain. i didnt want to get into the habit of telling my brain/body that sitting was dangerous.

 

I think that would only work if that is the specific activity you want to do otherwise. Meaning, you're not listening to the audio book while running as a 'treatment'

Thought I'd share another mini-success story here. I just did it and my back is now fine. I just told myself that this is ridiculous...that it makes no sense that sleeping on a soft mattress should cause me to wake up in more pain than squatting or dead lifting hundreds of pounds. I had conditioned myself to believe it would and I had to undo that conditioning. It took about 2 or 3 nights but the pain dissipated by about 95% - no different than my favored firmer mattress. It's now been about a couple of weeks and I'm sleeping great.