Young guy at start of journey- can you help?

[Matthew-31]

Hello all,

Really grateful for any thoughts on my case even though I know it's not a place for diagnosis. I've learnt a lot from the Curable app in past days.

I've been suffering with significant knee, foot and back pain which I attribute to a small accident (jump down onto a wooden floor) six months ago. Felt some foot/knee pain soon at the time in one leg, then fine for 24hours at which point I did a yoga class and felt more knee and foot pain and legs "didn't feel right". Quickly got into a panic (prone to health anxiety), sleepless etc that it wouldn't get better and within weeks I was (clinically, not first time) depressed and struggling to work/ function. Burning pain then in both knees and within a month my already temperamental back had started causing me substantial pain-lower and upper. Tried manual therapy, massage, swim daily but limited relief.

Currently still away from successful professional career and trying to build back my life- moved to a small town now with less pressure and stress. I'm 31 so want to work to get away from "life is over" type thinking.

I definitely do have many of the personality traits including perfectionism, anxiety, some coming out trauma.

Normal spine MRI apart from minor scoliosis and facet joints not all moving properly- so some brief relief from osteopathy. Sent to neurologist due to hyperactive reflexes and clonus/tremor (latter probably due to depression medication) but not yet conclusive. Psychiatrist also suggested "somatic element likely" but at least at time i felt "who is he to decide that? my legs are damaged."

Over past two months I've had some lower pain days, but with the smallest incident/ overexersion eg a small trip over, walking up stairs too much or getting up awkwardly I can feel "back to square one" and weeks of pain that seems to gradually recede before next flare up.

I'm just confused whether there is likely to be a TMS element or just coincidence that I have these (fairly common?) personality attributes.

I know I would need to believe it's TMS 100% if any chance of improving but I'm conflicted as there does seem to be a physical element? The thought of doing all activities with my weak and painful legs seems overwhelming/ unlikely
to work well. So much talk of 'pacing' in the pain literature which I'm probably following too much.

Thanks so much for any advice or observations! Wishing you all the best too with your journeys. A great resource here.

 

[MindBodyPT]

Hi Matthew,

Welcome to the TMS forums, and glad to hear you got some relief from Curable! You are definitely right, you need to have full confidence in your TMS diagnosis in order to move forward. Have you read any of Dr. Sarno's books, or other TMS doctors like Dr. Schubiner? I healed from my TMS before Curable so not sure how much overlap there is, but the books definitely go into more depth.

It sounds like your issues are probably TMS (though obviously I can't diagnose you). Any muscle strain you had from a fall 6 months ago has surely cleared up. Remember that people heal from surgeries and traumatic accidents in a matter of a few months, for the most part. And you're right, a psychiatrist does not have training to diagnose your issues...and if the doctor isn't versed in TMS theory they won't be too helpful in your situation. You even have some imaging to tell you that your back is normal (though many people, including me, have much more "pathology" on their imaging that is actually benign and not pain-producing).

In terms of getting back to activity- remember that TMS pain is just as real as pain from a physical injury. Know this to be true and work on thinking psychologically, and work on gradual return to activity. Most of us here did not just start running again when our TMS pain was still in full force...it took time. Conditioning plays a strong role in the TMS pain. Getting over the fear of activity and thinking of your body as normal and healthy will do wonders.

 

[Free of Fear]

I know I would need to believe it's TMS 100% if any chance of improving but I'm conflicted as there does seem to be a physical element? The thought of doing all activities with my weak and painful legs seems overwhelming/ unlikely to work well. So much talk of 'pacing' in the pain literature which I'm probably following too much.

Hey there Matthew. Just a few thoughts from someone in a very similar situation (and someone who is recovering). I hope some of this is helpful for you.

Everyone has their own recovery strategy - some do it 'boot camp' style, all at once, while others pace slowly, and everyone else somewhere in between. Personally, I've paced, going from only 2 minutes of walking a month ago to today hiking for an hour-and-a-half. For me, pacing hasn't meant only being active when the pain is low, but choosing a realistic goal and sticking to it regardless of increases in symptoms (see 'Back Sense' by Siegel for this strategy laid out). In my case, I've increased my walks by 5 minutes every two days. I think of it like battling for territory - I'm expanding my functioning bit by bit, day by day. Even those days when it hurts more, I still go to sleep knowing that I made gains in functioning, and this alone increases my confidence in my body. So, for me, pacing has involved quite a bit of courage. Sometimes it has felt reckless, but I think it has felt that way because I'm challenging my old beliefs that pain=damage.

Also, I don't think you have to instantly believe 100% that it's TMS - that is a great way to pressure yourself even more! Some people believe instantly, others need proof through achievement to strengthen the belief. See the Claire Weekes audio in my signature for a nice talk on this (she speaks of anxiety, though it's totally transferable to TMS). Her work has been integral for my recovery; I often listen to her talks while walking and expanding my functioning. I've had a lot of obsession that my back was structurally damaged and that activity would injure me further, and she speaks to this perfectly (for me, at least).

As to there being a structural component, I couldn't identify it from what you wrote. To my knowledge, no physical injury would take six months to heal. It's a general rule that anything after the normal healing period is emotionally-psychologically driven (TMS) or a result of sensitization (see Moseley).

My two cents: it seems like it could be worth you trying out the TMS recovery strategies, especially the focus on anxiety (given you mentioning being prone to health anxiety). When I began, I was on the fence, and it was a bit of a leap of faith, but I saw progress almost instantly so it was a no-brainer.

Feel free to respond with any questions. All I have to share is my own experience with recovery.

 

[Matthew-31]

Thanks very much to both of you - I appreciate it and your thoughts are helpful. I am about to read the Dr Sarno main book so I should educate myself well with that. My pattern is quite strange as I so far have had some days/weeks with lower pain and significant activity / positivity, but then typically a small over-exertion or stumble comes along and it's back to full force. But due to physical reason as it seems to me, or TMS?

My main questions at the moment are, from your experience / understanding:
- at what point to stop investigating physically (I'm in Europe so maybe not the completeness of American system) For example, I haven't had scans of knees or feet or any nerve conduction tests, just medical exams including from neurologist that don't outwardly suggest inflammation, reduced motion or reduced sensations (if anything, everything is oversensitive) I know more tests are likely to be inconclusive / fuel my concern and frustration, but also struggle to know whether I know enough yet to start assuming there isn't structural damage there. My experience has been that more activity > more pain, hence the nervousness, but this is probably central to TMS for those who have it..!

- I could definitely put my back pain down to TMS and am believing more and more that actually it's not weak/in poor shape (and even just accepting it being a source of pain sometimes rather than fearing it), but wondering whether less likely that nerve-like pain I get in my knees and feet (burning sensation sitting/standing and sometimes at rest) is also TMS-related.

If nothing else, the education about how to relax through pain and to stop catastrophising (my greatest skill) should reduce my suffering a little, but it would be amazing if I could take it beyond that.

 

[Free of Fear]

Hi again,

Your situation is NOT strange in that your symptoms are variable - this is not uncommon. It's also more reason to engage with it as if it were TMS, as it points to other factors driving your symptoms than structural ones. Also, it may be that small bumps cause flare-ups because your body is so sensitized and your anxiety is so over-active. (Recall the story of the guy taken to the hospital in agony with a nail through his shoe, only to find it that it went between his toes, and his pain vanished. Anxiety and expectation -> pain).

I know more tests are likely to be inconclusive / fuel my concern and frustration, but also struggle to know whether I know enough yet to start assuming there isn't structural damage there.

This is a deeply personal choice. Re-reading your first post, though, and given that the initial incident was just a small fall, and you're a spry 31, I'm wondering what you're realistically looking for in doing more tests. You've had a lot of medical attention already and nothing showed up. You could keep getting tests, but like you said, they'll likely be inconclusive. *And*, even if something structural *did* show up, you still wouldn't know if that's what's causing your pain - but then you'd have doctors showing you images of your body and explaining to you how it's damaged, you need to be careful, etc. It's a recipe for anxiety and lowered confidence in your body. So, for what it's worth, as someone who has been in a similar spot, I see a lot of risk and little reward in doing more tests. But again, it is a personal choice.

I'll say this: TMS work can be really hard, but even at its hardest (for me), it's infinitely easier than retreating from the world in fear of damaging my body. It was scary to start walking again in spite of the pain, so I really get where you're coming from. At the beginning, it feels about as crazy as sticking your hand into a bonfire. But if you stick to it, and find the courage to keep going, and let yourself believe in your body again, and refuse to let the pain rule you anymore, you have a really good chance of making major gains. This is what it means to heal, and it's something that no doctor can give you.

I think you're asking all the right questions, and like you said, you're already believing more and more that you have a good back. This is great. So keep reading and thinking and talking it through. You're on the right track.