trouble with ankle long after injury

[armchairlinguist]

I recovered successfully from RSI with Dr. Sarno's work in 2006 (after three years of RSI). I then had a few years of therapy which helped with the other equivalents (depression mainly and some anxiety).

Then I sprained my ankle in summer 2012 and was a long time recovering. It was initially mis-treated as milder, but even after getting properly treated my recovery took longer than my podiatrist predicted. After about 9 months and some physical therapy I was doing much better, but had a relapse of significant swelling and pain in May just before I was supposed to go on a trip. No tissue damage was found and an MRI concluded that I had fluid in my ankle joint (gee thanks, I hadn't noticed!). More PT ensued but I was still having trouble with inflammation and pain after about a year despite it, although by that point I could get around town OK.

After about a year I started to wonder if I had TMS again. I started to treat it more as if I did, and felt better almost immediately, recovering full functionality (modulo a bit of stiffness) in Sept 2013. Then in June 2014 I injured my ankle again in a different way (same ankle). I was recovering normally for about 3 months and got PT starting around 4-6 weeks after, and things seemed fine. Then I had a regression similar to the one in May 2013. Again no tissue damage was discerned although I didn't have an MRI and the swelling was moderated more quickly (after about a week). I went back to PT and "graduated" from it around Oct - Nov. I've been semi-OK since then but it was hard to turn up my activity as I still started getting more pain and heat quickly. In December I started looking at treating it as TMS again and again it was helpful, but I've had the worst time believing there's nothing wrong whenever I get a twinge!

I didn't have such a hard time with RSI because there was never any macro-trauma, damage or injury. With my ankle, I definitely did have trauma and it didn't work right for a while, but the healing was never what it "should have been", even after tissue damage was abated, and TMS thought process often seems to work, so that's highly confirmatory. But in terms of habits, being "injured" for over a year and again for three months has really set the wrong kind of habits in motion as far as how I think about and treat my ankle. I'd been doing quite well - ramped up activity in December to where I wasn't planning or limiting my walking, just wasn't very ambitious. I've been traveling though and walking on a lot of uneven surfaces and it seems like I irritated something again. But did I or am I just stressed by being away from home? After developing bad habits with walking do I need treatment or do I need to forget about it and go back to normal activity? How do I stop worrying about irritating it or even respraining it (which is something that obviously can happen since it did).

Has anyone had a situation like this? What helped you?

 

[Andy Bayliss]

Dear Linguist,

My experience is not like yours, but I will share some thoughts:

--You have used Dr. Sarno's work in the past with success.

--Dr. Sarno's work counters the mind-body's "natural" way to distract through pain. This propensity to dwell on pain, think of physical causes, monitor whether symptoms are reducing or growing, fearing more pain or injury----all this is the "natural inner world." It is no wonder to me that these mind-body patterns are here in you. Dr. Sarno's work takes some regular practice, and doubts and fears are part of what needs to be worked with.

--Having injuries in themselves was recognized as a form of TMS by Dr. Sarno. It gives the TMS process some fuel. It distracts from the inner life.

My hope is that regardless of doubts/fears, you continue your TMS practices, and don't focus too much on physical reasons for symptoms. The body will heal itself.

Hope any of this might help. Good luck in sorting through this.

Andy B.

 

[armchairlinguist]

Hey Andy, thanks for your thoughts. I think your observations about real injuries is pretty apt. I was actually thinking about that on my way home today - that the initial injury happened at a time when I was dealing with a lot of stuff. Since then I have had the impression that I could be "prone" to injure that part of the body again (which I mentioned in my post - which did happen once as well, also at time when a lot was going on).

Other than paying too much attention to twinges this is probably the biggest way I'm still distracted. So it is useful to realize that this is potentially another part of the TMS complex as well, the idea that I can be prone, and paying a lot of attention to not "letting it happen". (Easy to do when you are on cobblestones...) I was thinking of this as a separate part of the problem "OK, now that I am thinking the pain is TMS, how do I approach this additional fear" and it is probably better to see it all as a piece.

I haven't had an easy time distracting myself from that fear. I think there probably is a lot more going on emotionally than I am aware and I am still resisting whatever that is.

 

[armchairlinguist]

I am still in a mystery state about my emotions. I had another small "relapse" this week - more intense pain that felt right in the injury. Unsure of why as there is nothing particularly abnormal going on - most things are running smoothly since I got back from my travels. I was terribly panicked. My boyfriend sensibly was very supportive yet said "You'll be much better tomorrow." Lo and behold I was despite my own skepticism. So it is clear that this is not reinjury - it is just a level of irritation (emotional > physical, or just physical...?). It keeps happening and I keep being terrified, so the fear cycle persists. I can unhook on the daily stuff now (usually), but not when this happens (at least not immediately).

I did make a list of all the things that have gone on since I was last in therapy for long (6 years ago now), and I journal from time to time, but honestly, most of this stuff just doesn't seem all that important when my conscious mind is operating. Is it just an accumulation? Or I'm not aware? Sometimes I think it is just the daily pressures of goodism/perfectionism, plus a chunk of life stage angst (have bought a house, am looking at making final choices about the possibility of kids, etc). If it's that I don't see that journaling will help a lot, but maybe I'm wrong and just need to try it without any expectations of major releases?

I have thought about going back to therapy, but my work schedule is more demanding than previously, and I have had some ineffective therapists - that they were helpful with some concrete issues, but were not able to get past my emotional outerwear of being a person who is getting along and excelling. (Some obvious goodism there, I realize.) I knew I should be letting them, but it's difficult.

 

[Andy Bayliss]

Hi Armchairlinguist,

I was thinking of this as a separate part of the problem "OK, now that I am thinking the pain is TMS, how do I approach this additional fear" and it is probably better to see it all as a piece.

I think this shows effective thinking about the injury and worry, and pain. They are all part of the same syndrome, and the more you treat the whole complex by witnessing and disengaging from fear, the better...

Is it just an accumulation? Or I'm not aware? Sometimes I think it is just the daily pressures of goodism/perfectionism, plus a chunk of life stage angst (have bought a house, am looking at making final choices about the possibility of kids, etc). If it's that I don't see that journaling will help a lot, but maybe I'm wrong and just need to try it without any expectations of major releases?

This is a good inquiry in my opinion. Your life decisions are perhaps creating larger pressure than you are aware of. Journaling, and being with your emerging feelings may add some release, and some information about why you are in pain. Your goodism and perfectionism can probably be seen moment to moment and cause huge inner pressures and conflicts.

In my experience, the inner conflicts between "what I think I should be feeling" and "what I am actually feeling" fuel symptoms. There is inner pressure, and super ego activity. The more you are in touch with what you are really feeling about things, and the more you defend your right to have these feelings (from the inner critic), the more clarity and functionality (less conflict) you can enjoy.

Andy B.

 

[Lizzy]

Hello, I had some confususion about healing TMS pain after an injury. Last March I broke a heel spur and when the break healed my foot continued to hurt. The foot was useless for more than 6 months. I worried about breaking it again because I don't know how I broke it. So, was it walking? Going up and down the stairs? I know of nothing that I did that I don't do everyday. This was added to all the other worry that comes with the TMS package. For me the fear just gradually abated as I did more and more. Running up and down a set of steep narrow treaded stairs took me the longest. I just started being able to do that in last couple weeks.. I come down on my foot right where the bone is, but I am not afraid anymore. Just what we are learning here, and time. I hope this helps.

 

[armchairlinguist]

@Lizzy Thank you, it is good to hear from another person with foot issues. I'm glad you're doing so well!

@Andy B You continue to be a fount of wisdom. I gained some clarity this week when I needed some medical followup based on test results. Very unlikely to be serious, but it raises that specter. The life stage angst is very present and that brought it out (I had both anger and anxiety dreams, and woke up with a sore jaw from clenching). I think there is a lot of the moment to moment. I will have to try to see how I feel inside, versus how I feel I need to act. This might be a useful question for journaling. Although I experienced the intense anger in my dream (which reminded me how it feels, and why it is so terrifying to allow it out in real life - in the dream I was crushing a car with my bare hands) I am not having luck trying to find major emotions by journaling about events I think were a problem. So more of that awareness all the time, for 'minor' things, may help.