Daniel L. Is this a case of TMS?

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Question

Hello all! I would like to ask if my case sounds like I could have TMS or something similar. I am on chapter 5 of the divided mind, but I wanted to ask here if my case lines up at all, before continuing with the book.

I am a 18 year old advanced tennis player, (I will be playing division 1 next fall)
This past summer, I started what has turned out to be over 8 months off my sport due to injury!! I have aspirations of being a great college player, and eventually trying some pro tournaments, so it has been very devastating.

Early June I came down with the first injury, which was Tennis elbow(Tendonitis(osis) on outside of elbow) I was not able to practice until 3 months of mostly rest. The pain was not that bad at rest, but it was just extremely slow to heal, making me think that it was tendonosis not tendonitis. For those that do not know, tendonitis is inflammation of the tendon whereas tendonosis is where there is actually degenerative healing of the tendon tissue.

Now that is pretty much behind me, unfortunately though, about 3 weeks after practicing at close to full speed I came down with bicep tendonitis(osis). The pain is all throughout my bicep tendon, so bicep, front of shoulder, and extends into my right pec. At the beginning I was told by a phys therapist I was recommended, that it was mild rotator cuff tendonosis, but after about 3.5 months into the injury I was told by a MD that it was bicep tendon, which matched up much better to the symptoms. So being mislead certainly did not help. Although I have made progress, and the initial inflammation is gone, the progress has been extremely slow, and discouraging for the better part of 5 or 6 months! I started physical therapy with a manual therapist, and that has helped further educate me, and it definitely started feeling better, but the progress is still disatisfactory. My family is not in the best financial state right now, so we are going to have to stop the phys therapy for now, but I can still do most stuff I was doing there on my own.

Right now I am practicing very lightly once a week to keep some rythm, opposed to practicing 6 days a week for several hours like before. I recognize that I might need to alter some technique on my shots, to take any added stress on my arm, and I have been working on that. I have also quit my job as a tennis instructor, to stop any unnecessary stress on my arm.

The pain pretty much goes away at rest, but will feel worse while or after I practice.I have done as much of my own research as I can, and I have learned a lot. My strategies have changed a lot over the course of the injury. I have started a new plan about a week ago, I will give information about it below. I have scapula winging, and my shoulders do not naturally sit in back of my socket, due to the nature of tennis, and not paying attention to it over the years. I can hold them there if I think about it.
For the posture aspect I am implementing
- Daily myofascial release of pec major, pec minor, lat, subscapularis, and upper trap
- multiple times per day of Pec stretch, bicep stretch, and lat stretch
-scapular squeezes with back flat on wall
-prone cobras
- Rotator cuff exercises (ex rotation, reverse fly, band pull aparts)
- thinking about it more when I am not training.

PT exercises include
-cable punch on floor to activate serratus
- light lat pulldown (focusing on pulling down sapula)
- another exercise to pull down scapula
- thoracic spine mobility exercise
- a few others

Below is what I am implementing to strengthen the tendons, and promote healing.

-Eccentric exercises-- I do an exercise that would aggravate the tendonosis, but only the eccentric portion, so that it does not bother it. supposedly this is suppose to be great for healing tendonosis once and for all, and strengthening the tendons. I just began this protocol.
-Hot tub once a day. heat is supposed to be good for the blood flow. I do not ice, because I don't think that stopping blood flow, and reducing inflamation will help me heal.

I also have a mild case of tennis elbow in my left arm, from practicing lefty in the summer. thru this time, I have gotten occasional bouts of pain in the inside of my right elbow, but more on the forearm close to the elbow, then the tendon itself. As for past injuries, I have had on and off issues with my lower body, or certain areas in my back, they kinda feel like tweaks. My worst injuries before were, probably a muscle pull in like my back or groin. However, it has never taken more than two months to heal, and about a month till I could start practicing a little again. This is the first summer and on that I have had long term issues with my upper body.

Personally, from what I know, it does not sound like I have TMS. However, I do get very frustrated, helpless at times due to the time I have been out for, I think being more positive, may help me.

Anyways, I am willing to try anything, and I would like to get others opinions on this! thanks!

 

Answer

Thanks for writing. It sounds like you’re extremely frustrated about your healing process. It also sounds like you’ve spent a fair amount of time thinking about whether or not this is TMS.

I’ll be honest with you. I’m not sure if what you’re experiencing is TMS. I think that there’s a decent chance, but you need to find out for sure. If you live in an area with a TMS doctor, then go see them immediately! If not, then you’ll have to do some work on your own to figure out if this is TMS.

From your post, I can tell that you’re a person that puts a lot of pressure on yourself. A lot. Start by relieving some of that pressure by recognizing when you tell yourself that you should or shouldn’t do something. If you hear the words should or shouldn’t quite often throughout your day, then you’re doing it wrong. Take that pressure off!

Wanting to be a great college player is great, but make sure you’re not using that as a reason to be stressed out and make it so that you feel like you have to getter better or else you’ll never be able to make it in college. No one can thrive under that amount of pressure.

Because you don’t think you have TMS, then I’d encourage to do what you can to eliminate that possibility entirely. The anxiety about a particular diagnosis can be really debilitating, and it’s important that you can feel a sense of ease about your diagnosis.

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Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

 

I'm a tennis player and have been playing for about 15 years with a "bad" hip. I play almost everyday and will be practicing in about an hour (dubs, can't run). NO ONE CAN DX YOU OVER A MESSAGE BOARD! But, according to TMS dictum real muscular injuries like tears healing in a few weeks. Like Mr. Lyman said go see a TMS doc to get an unbiased mindbody DX, there's a list in the sidebar of this site. I quit reading all the things physically you are doing, you wouldn't have found this site if you hadn't tried everything by now and your PT's haven't fixed you either. With your usual sports injuries 12 PT sessions does it.

Since you haven't finished a TMS book yet, you have't gotten to the crux of the TMS matter yet. If you have TMS, which we can't for sure DX you with because no one here wan't to be sued if something goes south, read the books, see a TMS doc and make up your own mind.

Instead of writing about the "physical" you need to explore the "emotional" things going on in your life. See the RAHE-HOLMES list of stressful life events that cause psychosomatic dis-ease--there's your TMS science. What events were going on in your life the year your tennis elbow hit?

BTW, Dr. Sarno played tennis. Thomas Muster practiced while sitting on a wood crate after he got squished between the bumpers of a car while unloading his bag at a tournament.

Hope this helps, can't comment on your technique, but if you're teaching it can't be too bad. Let me go out on a limb, you may have TMS and hope you do. Do you have a OHBH or a two? Who do you strive to play like, Fed or Rafa? Pete or Andre?

G'luck!
tt

 

Bobo, I agree with Tennis Tom that you need to spend more time learning about TMS, but also get a thorough checkup
to learn if there is some physical problem. It does sound like you're putting a great deal of pressure on yourself, to become a
very good tennis player and also to heal the pain. Read more about TMS and start the Structural Education Program that
will help you understand TMS better.

 

The more I read about TMS, the more I am convinced that I most likely have it. I am not so sure that the original tennis elbow was from TMS, but the amount of stress, frustration, and anger the duration and timing of these injuries put on me, lead me to believe that it is a large part of why I continue to deal with upper bicep/shoulder tendonosis. There are also other things that have caused me to suppress rage most likely, but I'd rather not state here.

I have been reading the mind body prescription, and I can certainly take pieces, and paint a picture of myself. I certainly have a need to be liked, and am not one that likes confrontation, rather I kinda ignore it. Over the last months, everyday has been about my injuries. The moment I wake up I am trying to gauge whether it feels a little better or a little worse, thinking in my mind that I have to get better soon. I have read countless books, done research, and watched videos, about injury prevention, rehab, movement mechanix, stretches etc. almost becoming paranoid about everything from my nutrition, rehab exercises, posture etc. I find myself constantly wondering if I am on the right path, or not. this experience has definately created a very fearful attitude that I have, like my body is extremely fragile, and one poor move, could cause a long term injury.

I was generally in a similar case before. I have never had a steady private coach, or fitness trainor do to financial reasons, but when I was about 15 (18 now) I fully decided to commit myself to being the best player I could be. Putting it on myself to schedule several practice sessions a day with other players, research what to do for my strength and conditioning, etc. I would get somewhat paranoid if I wasn't sure if I was practicing enough, playing with the right equipment, training the right way, stuff like that. always questioning.

When I think of what was going on right before my tennis elbow(that is now healed came on) one big thing popped out. sure there may have been some other things, but one thing thing that was more pressure I'd say. I hadn't had a great winter before this past summer, but from about late February to june I was playing really well. Had new equipment, great training schedule etc. I had a few solid schools that were interested in me, but no very top schools. I had just had a great result in may at a tough tournament. I new this was the perfect summer, to get some attention from top schools, as I felt like I was at the top of my game. At the time I really wanted to go to as high level of program as I could go. It was a few days before a really big tournament when I pulled a hamstring, it wasnt too bad, but I was worried, as the biggest tournament of the summer was 2 weeks after that one. I layed through my first two matches and it hurt, but I was able to win. the next day I had a better opponent. I new if I could win against the two oppenents that day, I would have a ton of attention from top div 1 schools, and I felt like I could the way I was playing, but needless to say was worried about the hamstring. The next morning when warming up I hit serves and my elbow was excruciatingly painful. I thought I just wasnt warmed up well enough, as I had never felt anything like it. I went to the match, and unfortunately it didnt go away. my hamstring was hurting as well, more than the day before. I lost the match, and devastated, I want to default the next match due to the injuries. being honest my mom pressured me to finish the next match, the elbow didnt feel any better but I managed to win. My hamstring got better in less than a week, but my elbow took over three months. My mom wanted me to play the big tournament in two weeks, and so I did. I did okay, but I couldn't hit a serve at even 50% of my normal speed. I was certainly dissapointed, and angry at the way the summer had played out.

From there I was even more angered every week that went by only feeling marginally better. Once I FINALLY got better, my coach was able to talk to a college coach at a big time school that he had ties with. He put in a good word, and the coach wanted to see me play. at that point I was simply waiting to get back to 100%. Finally when almost at 100% after a few weeks of playing, I felt a weird feeling in the front of my shoulder after a shot. Turned out it didn't get any better, only worse the next few days.
eventually I was told by a phys therapist that it was rotator cuff tendonitis. I did exactly what he said, and more for 2 months. he said it should take 2-6 weeks. Each week, or month that would go by, I would get more and more frustrated and disheartened. I decided to sign with a solid D1 school, that really wanted me. But I havent really felt the pressure go down from there. I really feel it is my responsibility to get better asap, as my future coaches, did not anticipate it would take this long.

Finally I took things into my own hands doing all sorts of research. fast forward to 3.5 or 4 months into the injury I went to see a sports MD, who said its bicep tendinitis, which made more sense with the location. I then proceeded with about 10 sessions of manual therapy, as well as a ton of stuff on my own which I saw some improvements, but a lot of it had to do with them taking some stress off the area that hurts, by getting me to use other areas. However I still found myself going back to them, and when they would ask "How does the shoulder/bicep feel, any improvements?" I would have to kinda guage, but I always found myself not really being sure, usually saying something like "I think a little bit".

So now I am here, I'm trying to get rid of some of the fear that I am a fragile human being that is destined to be injured. I am working on my arm, trying to heal with movement, and positivity.

I have to say, I'm not sure if it's in my head(no pun intended) but my arm has been feeling better from starting to read the book, saying some affirmations, focusing on detail, and my mind when I start to feel pain etc, rather then panicking about my body. I played, yesterday for the longest amount of time since I first got the bicep tendonitis. Of course, I was going less than fifty% with my upper body, and I feel a little of the aftermath today, but It is really not to bad, and again, maybe I am just expecting pain, it doesn't really feel too bad today. Also a long term pain I have had in my left elbow since summer, has reduced. I am trying hard to trust that my arm will be okay, and that I don't have to be so fearful of using it.

I appreciate all the help, and any more is also great!
I have a two handed backhand.
Here is video of my forehand


Ps. I really can't see a doctor. (financial reasons)

 

Hi, Bobo. I'm glad your feeling less pain after learning about TMS,
but so far you haven't mentioned doing any thinking or journaling about TMS repressed emotions
or a perfectionist and goodist personality. That's where the cause of your pain come from.
The Structural Education Program will help you with that. Good luck and keep "swinging'!

 

Is there a TMS physician near you?

 

I would urge you to read Dr. Alicia Batson's Success Story linked below to answer why it's so important to consult with a TMS practitioner to get an unbiased mindbody diagnosis:

http://www.tmswiki.org/forum/thread...si-hyperacusis-and-much-more.7658/#post-42526

 

I think there are a few physicians in my area. I talked to my mom about it, and she is fairly open minded, but made it clear that she doesn't feel comfortable spending money on therapists etc. I guess ill just go through the course here, keep reading mind body prescription and see how it goes.

 

Keep reading and studying the TMS info videos and audios, there's a plethora of them here. I can understand how money could be short after the traditional medical, PT and alternative "healing" complex has cleaned out your pockets. A work-up by a TMS physician can take up to two hours and costs about $500. How much have you spent on all the rest? How much more will you be spending chasing more snake-oyls? How much is the rest of your life worth to you?

 

My daughter has played soccer, she has had tryouts for a national team. Soccer costs a lot of money, thousands of dollars a year, with camps, tournaments, tryouts, travel, etc. I am just saying this from the parents point of view. Maybe going to a TMS doctor isn't that expensive in comparison to the other costs. Just something to think about.

Other than a TMS doctor, I think studying TMS is a great decision. Following the Stuctured Education Program as Walt said, is a good start. If you believe you have TMS that is at least half of the battle.

 

Tournament travel costs has been the highest cost. I generally find academys, or other training that allows me to play for free. For example this summer if healthy I will be getting paid to play in an academy, kind of as a advertisment type thing, but I will be training not coaching.

The pain is not really noticeable when I am not doing activity, so it is not like I am in constant pain, and in need of relief at any cost.

To everyone saying I need to see a doctor. It may have been a different story about 1.5 years ago. Not to start a sob story, but my dad lost his job then and has not been able to get a consistent one since. So it is not really easy for me to just drop 500, for what I feel I can try on my own first.

My plan as of now, is to continue with about half of the physical rehab type of stuff i'm doing, as well as dive in to all the home TMS treatment. I am almost done with the mind body prescription, and will do the free program on here, and some other stuff. I know it is not advised to do the physical treatment at the same time, but as an athlete, I believe it is beneficial to do this stuff anyway, for future health, strength and longevity. It also gives me some piece of mind, that if the TMS doesn't workout, I hadn't kicked everything else to the curb the whole time. I also am going to slowly get back out on the court more, not going hard, just so I can slowly eliminate the fear, and the negative associations with pain and tennis. later on I might go see a doctor.

 

That sounds like a good plan, study, build your confidence and see what happens after that. Good luck.

If you can get a handle of some of this psychological stuff at a young age, it can be really helpful in your tennis career and in life in general.

 

Have you asked yourself how your dad's work troubles have affected you emotionally? You said,"not to start a sob story". That kind of sounds like deflecting others sympathy or concern. Maybe you have journaled about it, but if not you might explore that.

 

Yeah, to be honest, I probably have a lot of resentment. I am pretty much always angry or frustrated with him in some manner, and I don't really see eye to eye with him.

As I am writing this I am sort of having a flash back. Not too long ago my mom told me about what "really" happened with my dad about 5 or 6 years ago. I was young and my dad had to go to the hospital, I was with a neighborhood friend, and I remember my mom saying that my dad was sick, and that I should sleep at my friends house tonight. without going into detail, I was told last year that my dad came close to ending his life that day. I think it had something to do with medication, but still.

I can't remember if it was before the elbow injury or not, but I have a feeling it was before, or shortly after. I remember feeling very sick the day I found out, and having to lie down for awhile. I couldn't really look at my dad the same since, and can't help feeling very cold towards him. I definitely tried to forget about it as much as possible, but I certainly have felt more anger towards him since finding out. I am going to try and find out around when I found out, and see if I can make any connections.