Alan G. Is my pain from TMS or surgery?

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Question

I had surgery for shoulder impingement syndrome 13 weeks ago. I now understand I have TMS and most likely did not need this surgery. How do I know if the pain I currently experience is from the healing of the surgery or the TMS? Also, I have read that you should not do PT when you have TMS. Am I an exception to this, since I have to recover from the surgery? Thank you for your help.

 

Answer

Hi Mathteacher,
Once when I was in 10th grade I thought I solved Fermat's Last Theorem. It turned out that I didn't. Math is hard.

I've never heard of shoulder impingement syndrome. Shoulders are tough, it's not always as clear cut as other parts of the body. Whenever it's something like shoulders or wrists or knees, I always advise to consult with a TMS physician, preferably one who specializes in orthopedics, instead of just assuming that it's TMS.

With regard to your specific situation, assuming it is in fact TMS, definitely keep doing the PT. PT after surgery has been shown to be effective with regard to recovery.

With regard to whether the pain you feel is from the surgery or if it's TMS, it doesn't matter. It's the fear of and attention to the pain that perpetuates it. If it's from the surgery itself, it will subside with time. If it's from TMS, once you stop paying so much attention to it, it will fade. Either way, there's no reason to be preoccupied with the pain.

Sometimes it can takes months for the swelling to go down post-surgery, so try to be patient with yourself.

Alan

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Thank you, mathteacher and Alan, for this question and response. This was exactly my question: I had bilateral knee replacement surgery 11 months ago and am struggling to recover. There is plenty of evidence that much if not all of my orthopedic woes are due to TMS (and the evidence continues to accumulate), but the surgery certainly mutilated muscles, tendons, nerves, etc. and I wasn't sure if I should continue with the PT exercises or just concentrate on not allowing pain to distract me from acknowledging and feeling my feelings. Now I will continue with the exercises since they are helping strengthen and stabilize my new knees and supporting structures as well as following Alan's program and the structured educational program (plus re-reading the books). Thank you again!

 

"With regard to whether the pain you feel is from the surgery or if it's TMS, it doesn't matter. It's the fear of and attention to the pain that perpetuates it. If it's from the surgery itself, it will subside with time. If it's from TMS, once you stop paying so much attention to it, it will fade. Either way, there's no reason to be preoccupied with the pain.

Sometimes it can takes months for the swelling to go down post-surgery, so try to be patient with yourself."

This is great and so timely--I was just about to ask a question to the therapists regarding my own concern with mild bladder prolapse, which I will ask here because I think it relates closely to this question.

I just saw my OB-GYN yesterday and at 7 months post-partum, she said it hadn't improved much from two months post-partum. That really scared me at first, but I realize how far I have come because I was able to think rationally and not let myself go too far down the rabbit hole of fear; which is not to say that I don't still have some, but I am using lots of great coping strategies to manage the fear thoughts when they arise.

I did ask the doctor a few questions regarding activities, since I am a very physically active person and the idea that I can't do everything I want induces great fear. She said that many women who have had babies live with a mild prolapse their entire lives, and it does not cause pain. For those who get surgery or wear a pessary, it is more about if it is annoying and interfering with their lifestyle. The condition itself does not cause pain. She did recommend that I engage my pelvic floor and not lift a 50 lb suitcase or big barbells, and to take the lighter child if we go hiking with our little ones. So, these restrictions have "scared me" somewhat, but I am realizing that it's the preoccupation with the symptoms or limitations that causes me to feel fear, sadness, frustration, and anxiety. I remind myself that the symptoms themselves are fairly benign, and I can still be very active. She said to continue doing Kegels and that I can run if I love running, just see how it impacts things. This leaves me wondering if I am now going to overly obsess and focus on this, since I have been doing so well with gaining confidence in the TMS diagnosis with my other symptoms (hip/buttock pain). Now, I do have to "be careful" with activity so it's going to be the art of managing the fear and noticing when I am getting caught up in that, and notice when I am allowing it to preoccupy my thinking. A big confidence boost for me prior to learning of my mild prolapse was to do something very physical and push myself and notice how it didn't hurt me. Now, I can't really do that to stand up againt the pain, or not as much.

Do you have any more words of wisdom for those of us who do have something happening that is "real", yet also have other physical symptoms that are TMS?

By the way, I loved the Breaking Bad clip you shared, as that has been helping me tremendously lately--realizing that the psychological burden of worrying "what if" hurts me far more than if the what ifs actually came to fruition.