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weatherman
USA
184 Posts |
 Posted - 10/25/2006 : 10:16:48
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After nearly 3 years of fairly successful TMS thinking regarding an achilles "tendonitis" issue I have been forced to a crossroads. About 3 weeks ago I was mountain biking up a good hill - which I'd been doing all summer - and near the top felt a subtle, dull kind of pull around the achilles/soleus. Nothing dramatic, in fact I went out hiking the following weekend and didn't particularly notice it. Since then it has progressed to a mostly constant discomfort - no screaming pain but a nagging kind of thing you feel with every step even during normal walking. This, in spite of reducing my activity level the last couple of weeks. Interestingly, I had tweaked my patellar tendon a bit a couple of weeks before that during a sudden slip and stop - once the achilles started grabbing my attention the patellar thing pretty much disappeared entirely.
Since the TMS part of me often sees the glass half-empty I am unsure how to proceed. I could rest it, ice it etc. - but aside from making me and those I live with crazy it would be like giving in, and just perpetuate the cycle. Or I could try to push through, but then have the worry that I'm really injuring something. (If you want to get really depressed, search the web for achilles tendonitis and read the dire warnings about the possible consequences of not "taking care" of it. On the other hand, maybe these warnings have the same validity as those you constantly hear about back care).
Maybe a compromise position would be to rest it for a month, and then if it still hurts conclude that it must be TMS. The only catch to that approach is the rest part. It goes without saying that any doc around here (Montana) would give the conventional advice. I checked out the web site for the new TMS doc in Seattle - he also does acupuncture, so I don't know if he's exactly a purist, but he did study under Sarno.
Would anybody out there like to trade a sore back for a sore achilles? I actually had a bad spell of back issues about 10 years ago, and there was a period where it seemed like it would never get better. Now I use my back with reckless abandon, and when I do occasionally throw it out think nothing of it and it's fine in a few days.
The TMS theory reminds of the old Star Trek episode "Shootout at the OK Corral", where Spock advises the crew that Wyatt Earp's bullets can hurt them only if they believe they can.
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Fox
USA
496 Posts |
Posted - 10/25/2006 : 14:49:56
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| I would continue physical activity - but only light activity for a while - and, during this period, search for the emotional connection...What about walking as far as possible each day (through the pain) and then progress to more strenous activity? I had a bad spell of achilles tendon pain several years ago but kept walking (although I did avoid the steepest of hills until the pain level diminished) and it went away in 6 weeks. I did no icing or other PT stuff. |
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Dave
USA
1864 Posts |
Posted - 10/25/2006 : 15:15:38
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You could talk to Cliff Floyd of the New York Mets, who despite several surgeries and trips to the DL is still plagued by TMS in his achilles.
It's a bit of a catch-22. If you worry it may be an injury, TMS will sieze that opportunity to perpetuate ths symptom. If you totally ignore it and resume physical activity, TMS will sieze that opportunity to make the symptoms worse in an attempt to make you worry that it may be an injury. It can be a vicious cycle, only interrupted by firm belief that it is TMS, even if you treat the symptoms. |
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art
1903 Posts |
Posted - 10/25/2006 : 15:28:40
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quote:
If you totally ignore...TMS will sieze that opportunity to make the symptoms worse in an attempt to make you worry that it may be an injury
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THis is generally not true for me thankfully...The mere allowance that it's probably TMS, in combination with continued working out, has worked fine in my case....I would however hesitate to make any grand generalizations based on my own experience....
I will however risk generalizing about low level "nagging" pain, which is that I think that's most often TMS...It certainly has been with me...Your minor patellar pain mysteriously disappearing in favor of your current minor Achilles pain definitely sounds like TMS ...That's a very common pattern with me... |
Edited by - art on 10/25/2006 15:29:55 |
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Allan
USA
226 Posts |
Posted - 10/25/2006 : 16:05:25
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weatherman
Fred Amir says challenge the pain, so give “Push through” a try.
The question is will it get better after it gets worse. As Dr. Sarno mentions in his books, if it is TMS pain the brain gives up.
In my case, the brain gave up.
I had sciatica pain in both legs for several months. When I challenged the pain, it did get worse initially, but it was gone in two days.
What have you got to lose?
Allan
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weatherman
USA
184 Posts |
Posted - 10/25/2006 : 22:13:00
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I should elaborate on my description of the achilles pain - it's a minor pain when compared to an earache or a bad ankle sprain, for example. But the NATURE of the pain is incredibly nasty and persistent, it is there with every step and just ruins your whole day. One funny thing - the achilles itself has very little soreness to the touch, and looks no different from the other one - no redness, swelling etc.
I've wondered if the "injury" event I described at the top was essentially meaningless, and equivalent to the kinds of back pain triggers Sarno discusses. I know how those can work, usually when I've thrown out my back it's been reaching in the dishwasher or some trivial thing. It's sometimes hard to accept that pain intensity and injury severity don't always correlate. But I think one thing making this one hard to resolve is the association with a triggering event - although the discomfort in the first few days following the event was quite minor.
I've read theories that "overuse" injuries occur when a muscle, tendon etc. is broken down by activity faster than it can build back up in between activities. While it's true that no human can be the Terminator, it makes no sense that during most times I'm able to do death-march type hikes virtually pain-free, while at other times a 3-mile level walk will seemingly worsen symptoms. Shouldn't a person's ability to recover from physical activity be more or less constant? It's kind of a dilemma, in that the pain seems so real but logically it makes no sense.
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Fox
USA
496 Posts |
Posted - 10/26/2006 : 08:13:39
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| Weatherman - I think you are right that your capacity to recover from activity should remain relatively constant. Also, the fact that the pain was minor for several days after the event should be a strong factor supporting a TMS diagnosis...I said I didn't do any PT to recover but now I remember that I did lots of calf/toe raises (many reps of raising up on the ball of the feet then rolling back on the heel while lifting up the ball of the foot) while getting over the achilles tendon pain. As I remember, this only generated minor pain. I can't remember what I was thinking when I did these exercises, but if I were to do them during a bout of Achilles tendon pain now, I would tell my brain that I wasn't doing the raises to strengthen or stretch the area but I was doing them to prove to myself that I had good range of motion and couldn't have a significant (if any) structural problem or I wouldn't be able to do these exercises. |
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weatherman
USA
184 Posts |
Posted - 11/21/2006 : 15:28:45
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This achilles business is a real pain, I would SO happily trade it for a sore back. (I'm sure the people struggling with back pain would happily trade with me as well).
I'm hoping someone with a bit more medical savvy than me sees this post. I did have it looked at by a local orthopod with a good rep, the exam was limited to x-rays and physical examination. Of course he diagnosed "tendinitis", more on the basis of my description of symptoms than anything he could see or feel. In fact, I asked whether he could see any differences between the 2 achilles, and he just said something vague like "maybe the hurting side is just slightly thicker" - almost like he felt that he needed to find something since I asked. He gave me some exercises, and basically said to let the pain level be my guide - which is a totally unacceptable long-term solution. I broached the subject of a psychosomatic origin and he looked at me like I was from Mars - obviously not a Sarno trainee.
Like before, the tendon is not visibly red, swollen or sore to the touch, but the discomfort in that area - not really pain - is enough to make you consider applying a tourniquet above the ankle to get rid of it. I have resumed pushing it physically for a few weeks, with no real improvement or worsening of symptoms. Given how minor the triggering event was, it makes no sense physically that it's causing me this kind of grief 6 weeks later.
I seem to keep coming back to the same issue, which is how to confirm that nothing physical is really going on. Would an MRI offer additional confirmation, or was the orthopod's exam sufficient? Is that something a TMS doc would typically do in this situation to rule out anything physical?
There is certainly all kinds of stress in my life now, much of it concerning looming job changes and the need to make a living. This achilles business is ratcheting the stress level up by a factor of 10 - not that I needed any more.
Weatherman |
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kevin t
USA
72 Posts |
Posted - 11/21/2006 : 16:43:56
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| Ill trade what I have for an achilles issue anyday. Ill even get up with that achilles pain every morning and thanks every God that ever existed. DEAL?? |
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weatherman
USA
184 Posts |
Posted - 11/22/2006 : 13:30:12
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First a question to Dave on the following:
quote:
It's a bit of a catch-22. If you worry it may be an injury, TMS will sieze that opportunity to perpetuate ths symptom. If you totally ignore it and resume physical activity, TMS will sieze that opportunity to make the symptoms worse in an attempt to make you worry that it may be an injury. It can be a vicious cycle, only interrupted by firm belief that it is TMS, even if you treat the symptoms.
Are you saying that a firm belief that it is TMS can coexist with actions to treat symptoms? Ibuprofen, icing for example? Maybe this is in the same realm as taking painkillers for an acute back episode.
Also, the following from kevin t gave me a great idea:
quote:
Ill trade what I have for an achilles issue anyday. Ill even get up with that achilles pain every morning and thanks every God that ever existed. DEAL??
I'm wondering if we could set up an exchange where people trade TMS symptoms. E.g. I'll trade you a sore achilles for a sore back, etc.? Though I must admit, I did have one acute back episode for a night many years ago where a trade for an achilles would have been tempting.
Just goes to show that a problem is only a problem if it's a problem.
Weatherman |
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Achilles - raining on my parade
