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[quote][i]Originally posted by Peg[/i]
[br]Hi all,
We recently sent an excellent question posed by Piano5, to one of our TMS experts. The original thread can be found here:  http://tmshelp.com/forum/topic.asp?TOPIC_ID=5819

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

Dr. John Stracks provided a thoughtful response:
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.

Dr. Stracks

Disclaimer: This information can not 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.

Best,
Peg

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual.      Galileo Galilei
[/quote]

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T O P I C R E V I E W
Peg	Posted - 08/03/2009 : 17:04:03 Hi all, We recently sent an excellent question posed by Piano5, to one of our TMS experts. The original thread can be found here: http://tmshelp.com/forum/topic.asp?TOPIC_ID=5819 Question: I understand that TMS is real, but injuries do occur. My question then, is, how can we tell when we have damaged ourselves (i.e. structural abnormality or overuse), and when it is TMS? In other words, how can we tell the difference? Dr. John Stracks provided a thoughtful response: 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. Dr. Stracks Disclaimer: This information can not 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. Best, Peg In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. Galileo Galilei
8 L A T E S T R E P L I E S (Newest First)
Peg	Posted - 08/05/2009 : 12:41:14 >There ain't nothin' good about TMS pain though Agreed Peg In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. Galileo Galilei
Plantweed	Posted - 08/05/2009 : 12:02:42 "No pain no gain"-style muscle pain from a workout feels MUCH different than TMS pain. It's almost like a "good" pain, sore but not searing. There ain't nothin' good about TMS pain though.
Peg	Posted - 08/05/2009 : 09:25:13 I see where you are coming from celloLWF. I always think TMS first with any physical issue (mine or someone elses). Not that that's right. My understanding is that physiological changes occur in the muscles after exertion, which resolve over time. For example with resistance training, the muscle fibers actually sustain tears. This will cause the temporary soreness that Dr. Stracks describes. It is in the rebuilding process that we increase muscle mass (building muscle). Myself, being an intermittent exerciser, can attest to temporary soreness following activity after a period of being more sedentary. >I do not believe that the next day soreness from exercise or injury is a physical response to excretion. Got a chuckle from the typo at the end of the sentence. Take care, Peg In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. Galileo Galilei
Hillbilly	Posted - 08/04/2009 : 22:13:30 quote: I do not believe that the next day soreness from exercise or injury is a physical response to excretion. Rather, this is the brain taking advantage of a trigger event. If Sarno has recently begun saying that all muscle soreness is TMS, then we definitely need to put him on an iceberg and set him adrift. But I defy you to find and post the statement you reference. I can play Sarno Says with nearly everyone here, and I haven't read or heard anything remotely akin to the language you use above. In fact, he uses nearly the same language as the doctor referenced above to differentiate "normal" metabolic breakdown of tissue and waste product as a result of exertion and the discomfort of a pain syndrome. Difference is in the time it takes to resolve. Pretty simple and straightforward. If you take issue with such universally accepted concepts, how does it help you relieve your overabundance of inner tension by making public pronouncements that cry out for rebuke? I hate quotations. Tell me what you know. Ralph Waldo Emerson
Piano5	Posted - 08/04/2009 : 13:11:31 First off, I'm flattered that Dr. Stacks took the time to address this, and thanks to Peg for coordinating this thread. I would like pose another comment and question to celloLWF: first of all, I believe that Dr. Sarno has asserted that next-day soreness is normal, and not due to TMS. The body breaks down and rebuilds itself. It is a normal function of our anatomy. I would be interested to see his words on this matter if you have them available. Here is the question: I am assuming you are a cello player. If you were to not play cello for 6 weeks, the calluses on your fingers would likely dissipate. If you were to sit down after six weeks and play cello for 6-7 hours, pain free, the skin on your fingers would be red and sore. Is this not an clear effect of the physical, anatomical body reacting to your cello? Two days from then, you would be rebuilding new calluses. Would you attribute that soreness to TMS? Suppose your friend who hasn't exercised in 2 years has a change of heart. He runs 5 miles and lifts weights at the gym. He's going to be sore in the morning, that's for darn sure. That's the body at work, not the mind. It's for this reason that I wonder about our friends and family who have had long-standing injuries and made full recoveries without TMS. (Not to mention Max Weinberg, who had 7 surgeries for RSI and still drums for Springsteen) It's not to downplay the role of emotions in our lives, simply to explore when our bodies are acting up, and when it is our minds.
Capn Spanky	Posted - 08/04/2009 : 12:50:59 Peg, Thanks to you and Dr. Stack for taking the time to provide us with this information!
celloLWF	Posted - 08/04/2009 : 10:36:06 I respectfully disagree with Dr. Stracks. I do not believe that the next day soreness from exercise or injury is a physical response to excretion. Rather, this is the brain taking advantage of a trigger event. Dr. Sarno has explained this in numerous interviews that the next day soreness is TMS. I would challenge Dr. Stracks to demonstrate the actual physical changes that he believes are present after physical activity that is quote 'strenuous.' "The fear of nothing is more powerful than anything."
SarnoFan	Posted - 08/03/2009 : 21:20:01 Good info. I assume then, that this also includes "repetitive injuries"? For example, if you strain a tight back and it spasms, it heals over time with rest and gentle movement. Then you think you strained it again when you over exert yourself the next time. Would that be TMS also? Is the expert saying that a "mechanical issue" cannot itself cause repetitive injury? I think many TMSers need this reassurance as well. Any thoughts on this?

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