Q&A: How do I tell the difference between an injury (or overuse) and TMS?

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I understand that TMS is real, but injuries do occur. My question then, is, how can we tell when it is our damage (i.e. structural abnormality or overuse), and when it is TMS? In other words, how can we tell the difference?

Answer by John Stracks, MD

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Practitioner Johns Stracks

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This is a great--and complex--question and almost always comes up after the first week of the four-week course.

Acute injuries definitely occur and the pain that accompanies them is our body's way of telling us to slow down and rest. This is likely the primary purpose of the pain system in our bodies. Luckily, only a very small percentage of pain episodes fall into this category.

Acute injuries (like sprained ankles) almost always have a memorable instant when they occurred, and they are almost always accompanied by other bodily changes such as swelling, bruising, warmth or redness. If any of those symptoms are present, it is worth getting evaluated by a physician to make sure nothing is broken. If no fracture is present, the pain usually resolves in one to two weeks and full function returns within one to two months, even for severe injuries.

Another common source of acute pain is the soreness that accompanies strenuous exercise or activity. If this occurs, I advise patients to congratulate themselves on being able to exercise vigorously enough to create soreness; that puts them ahead of about 95% of the American population. That soreness almost always resolves in 48-72 hours; if it doesn't, then one should suspect TMS.

As for more subtle injuries, such as structural abnormalities or overuse injuries, there has never been a good study that has shown that structural abnormalities cause pain; that is, many people have abnormal MRIs with no pain, and many people with excruciating pain have normal MRIs and CT scans. Even with an identifiable structural abnormality, once pain has lasted weeks or months without any identifiable injury, TMS becomes very likely.

In short, then, pain that accompanies an injury usually has a easily identifiable onset, is accompanied by other symptoms in the body, gets better with time, and resolves quickly over days or weeks. TMS pain--which is useful psychologically but not generally physically--usually lacks those other bodily changes and tends to linger over weeks or even months, often times getting worse as time goes by rather than better.


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