Q&A: Fearful of getting really hurt
Answer by Howard Schubiner, MD
Your question is an excellent one and most people with back pain face these questions: how can I be sure that I have TMS and that my back is really normal? How much exercise can I do and is there a risk of injury if I do too much? If you can't answer these questions clearly, your recovery may be delayed or derailed. If you think your back is damaged or delicate, you're going to avoid using it normally and you won't be cured.
There are often several components that perpetuate the pain of TMS. One component is of course, the emotions and stressors that started the TMS pain in the first place, so you definitely want to identify and work on those. A second component to recognize is that there is learned pain caused by the brain and nervous system developing nerve connections which cause pain. These nerve connections are easily activated by triggers, which typically have also been learned. These triggers are best understood by the analogy of Pavlov's dogs, who learned to salivate when they heard a bell. Most people with back pain due to TMS have learned to have pain when they do certain activities (not to mention when they experience certain emotions or stressful situations), such as bending, lifting, driving, walking or sitting. In other words, it is likely that you have TMS which is the cause of your pain and the bulge in L4-L5 is not the cause of your pain, but a finding on MRI which is seen in many people who have no pain. If your neurological examination is normal, i.e. you have normal muscle strength, normal deep tendon reflexes, and normal sensation in your legs, then you should be cleared to treat your back normally. If your doctor clears you to do physical therapy, then he/she is clearing you to exercise and strengthen your back. My advice to my patients whom I have diagnosed with TMS and whom have a normal neurological examination is this: treat your back normally; strengthen it and gradually resume all activities; talk to it and tell it that you know it is normal and healthy and that you are not going to tolerate pain any more. If it hurts, don't worry; it is part of the process of overcoming TMS. If you want to be cured, you need to be free of pain, be able to use your back normally, and to be free of fear of injury or movement.
The first step in beating back pain is to get the diagnosis right. If your neurological examination is normal (and I suggest that you check with your physician on this) and your doctor has cleared you to exercise, you can be sure that you are in no danger if you exercise. If you are sure that you have TMS, then do the emotional work and the physical work to overcome the triggered responses that are perpetuating your pain. If you are not sure if you have TMS, please seek the care of an experienced TMS physician. Once you are sure you have TMS, you can pursue your cure with vigor and certainty.
It is important to recognize that no information on this wiki can be considered a specific medical diagnosis, medical treatment, or medical advice. Reading information here does not create a doctor/patient or other professional relationship between you and the answering professional. As always, you should consult with your physicians and counselors regarding new symptoms and any changes that you might make in medications or activities.
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