"TMS Expert" with Newish Shoulder Pain

I need help identifying a suspicious shoulder pain for what will be a year next week. Its onset was a whole lot like an acute trauma, yet with aspects of it that just don’t make sense. I have a real problem with brevity when it comes to writing, so I’ll omit my lengthy history where possible. If no one here is able to get through this, I expect there to be some value just in writing it all down.

What am I trying to get out of this post?
I’m hoping to hear more stories from those dealing with shoulder pain in general. Its onset, specific characteristics and limitations, success or failure of treatment with the principles of TMS and/or more traditional options.

Current Situation

• The pain started abruptly, following athletic activity for which I was physically unprepared
• It makes no sense for it to affect both shoulders, as the activity required only my dominant shoulder (pain is worse in the other (left) shoulder)
• I had it imaged (I know, I know), and, perhaps predictably was told I have a torn rotator cuff, combined with severe tearing of nearby tendons
  • Aggressive rehabilitation may help, but surgery is more than likely the only path to complete or mostly complete recovery
• The quality is not dissimilar to the labral tear 15 years ago, where I knew I needed surgery the moment it happened. A lifelong infielder who hadn’t played in several years, threw a softball from centerfield to homeplate (a strike to the catcher btw, who dropped the &$*@% ball)
• I have no doubt been under tremendous stress this year, especially after a layoff (my 6th since I started working). However, the “injury” occurred at a summer job I took at a sleepaway camp, where I was having a wonderful, stress-free experience
• I know the brain can use a previous injury as a trigger, using it as a more effective rouse, yet this was a much more abrupt, cause-effect kind of situation

Backstory
I was fortunate enough to have been a patient of Dr. Sarno’s, who helped eliminate some debilitating back pain almost 25 years ago now. While it didn’t result in a lifelong immunity to recurrence, including a handful of episodes severe enough to require a wheelchair, it gave me the tools to identify and manage the psychological component of my pain. The “symptom imperative” hasn’t been an issue since my initial experience with TMS, when the back pain morphed into a two-year battle with panic disorder after Dr. Sarno ‘fixed’ my back pain.

Ever since, my experience with pain has existed in sort of a gray area – a chicken vs. egg scenario in which severe LBP can be rooted in enteropathic arthritis from Crohn’s Disease, or TMS. Most autoimmune disorders, especially Crohn’s Disease, can be activated by stress. That stress can be the repressed or current kind, depending on the perspective. There’s stress related to present-day physical and psychological impact of the disease (and its treatments), as well as the repressed kind coming from battling a chronic, incurable illness beginning at age 6.

There is both clinical pathology and incidents of physical trauma in the exact location of the back pain, identified as a clear correlation as opposed to generic DDD, bulging discs, etc. Spinal fusion was recommended by 4 different neurosurgeons without any direct financial or other interest in my decision. Thanks to the brilliant work of doctors David Hanscom and Howard Schubiner, who thankfully picked up Dr. Sarno’s mantle, I learned that recovery was possible without definitively solving the chicken/egg riddle.

I ultimately became somewhat of an expert in MBS - an evangelist even - adept at distinguishing between muscular pain of TMS, and the “skeletal,” arthritic kind. Sometimes there is even pain and radiating from hypersensitive nerves of nearby intestines, activated by bowel obstructions. Unlike TMS, IBD-related pain can cause tissue damage, and can even persist during clinical remission through non-inflammatory pain (arthralgias) through long term impact on pain-sensing and spinal cord neurons. Depression, anxiety, and general stress, all extremely common in Crohn’s patients, can also cause cells in the wall of the gut to function poorly, tipping the balance of bacteria and also leading to pain.

All that said, stress of all kinds can activate my underlying disease. It can also flare up in connection to lifestyle choices, diet, or no reason at all. I have suffered from and successfully treated TMS, though never in my shoulders. Like my back pain, the doctor expected exactly what he saw on my MRIs after strength/mobility testing and the reported symptomology.

For those who made it this far, I appreciate you. You also need more hobbies LOL

 

I didn't play because of the heat today...and I am being mindful that THAT pisses me off.

OK..throwing Balls is THEE most maligned BS injury activity in the world. I have never seen a guy need to go on the DL who wasn't under some sort of other stressor...and then there's the generation before the MRI who played 154-162 games a year with no problem.... I throw w/o warming up all the time. I am obviously not a pro, but I am nearing 60 and can still throw someone out from second (can't get the deep in the hole at short throw because of lack of skill, not aging) warming up is for accuracy and depth, not 'protection'..that is Old Wives baseball myth 101...Curve balls do not damage an arm.... Being an airconditioned spoiled brat who doesn't throw enough , who also has rad insurance so Mommy can check every ouchy, is way more dangerous than any curveball.

I am certain if me, my sons and my buddies were MRI'd they would find all sorts of crap...I have had a problem a few times and ALWAYS treated it as TMS and it has always gone away...I wouldn't let them MRI me unless I was out cold and had no choice. I don't WANT to know. my son pitches one complete game about every three weeks..He doesn't like to get 'too warm'..he approaches 90mph and sometimes throws 90% breaking pitches....and when his arm has bugged it is always after something in the GAME pissed him off. BUT I Imagine if we MRI'd him, they'd find stuff...I would bet everybody who plays regular has stuff. Like the 'degenerated spine' it is just 'there'.

I DO have anecdotal evidence to prove structural crap is just that..about ten years ago, MY gall bladder was bugging, When they looked at me they accidentally found a broken Vertebrae in my spine that had already healed. I had fallen off a ladder the year before and I assume that was when it happened, but I was so obsessed/focused on them re-attaching my thumb that was severed that I did not get checked for anything else (I fell from the second story) when it happened...nor did I have money to get checked for anything else. (blessed are the poor)

I don't know dick about Crohns, but I do know that if your one of us (you are) I would assume everything is TMS unless I had VERRRRY strong evidence otherwise. I also think the catcher dropping the ball had more to do with the symptoms then the throw...One overlooked aspect of athletic TMS is how fricking competitive we are. I want to be a nice guy....after I have WON. I will be the gracious WINNER and be a nice guy. The bad thing about baseball is you aren't supposed to show emotion..it messes with your game...but it also gives you TMS.. the ultimate head game.

good to hear from you!

 

Seems he found what he was expecting... no surprise.

Ditto Baseball: I would assume everything is TMS unless I had VERRRRY strong evidence otherwise.

Didn't catch whether you'd let it rest and so on, give it a couple of months. Then if it still hurts, more evidence of TMS.

Even the great veterans of this work get "struck down."

Best of luck in this for you.

Andy

 

Hi Andy! Great to see you

 

Great to see you too Baseball. Great work on this Forum for so many years. I always love your comments!

 

This says you are thinking physically on this. Because with all your experience, you have to know this is just another manifestation of TMS. It moves around. You say you’ve healed before. You can do it again!

 

I agree that rotator cuff injuries are over-treated and over-diagnosed...which is why I'm not running to the operating table or even considering it at this point. However when I threw that ball & tore my labrum, I knew I needed surgery that moment. Incidentally, and I know TMS has deeper roots, but it is relevant to note that it happened during a moment in time that was much much happier & stress-free than many years prior, and I was in the best shape I'd been in since college days. Before I had an MRI, before I even saw a doctor, I spent several weeks unable to lift a cereal box above my waist, and saw 0 improvement with near total rest. The pain didn't move, change, or behave like anything other than a severe injury. The surgery was rough, but clearly successful & other than some expected soreness & scarring, post-rehab I was back on the field. Like you, I lost some zip on my throw & moved from the "hot corner" to 2nd base, but my shoulder was fixed, and it never became a TMS "trigger" after that.

This one is just more suspicious because it has that "this has been worsening over time" and a dubious connection to any specific trauma. It also doesn't make any sense that it'd affect both shoulders at once, or that it's worse on my left arm (I'm a righty). I don't put much stock in the MRI. The cortisone shot helped a lot, as does Prednisone. My assertion that it could be connected to my general arthritis from the CD (which I probably over-explained definitely exists on its own independent of TMS & I'll never be convinced otherwise for a number of reasons, and I don't buy the whole repressed stress developed in the womb from my mother).

I don't disagree with that approach, especially with my history & personality type. I mean, my profile was referenced on every page of "Healing Back Pain".. I felt like freakin patient 0 at that time. I've spent far too much time overanalyzing the relationship between TMS and physical pathology/underlying illness, & connecting the former to specific types of stress and incidents of emotional trauma. Until I found Dr. Hanscom's work, which convinced me that solving the chicken/egg riddle 100% wasn't essential for defeating the TMS.

Oh no, that was just kidding...I mean, it's true, and it would have been an ESPN-highlight type of play, and I don't like to lose, but we're talking about a coed pickup game; not even a regular team.

[BEGIN TANGENTIAL RANTING]
The whole thing is made A LOT tougher with my IBD being about as angry as it's ever been, with the oft-associated depression even worse - following the COVID-damage everyone had to shake off, I lost my job (6th layoff overall, but who's counting) in a very career-ending sort of way, looking down the barrel of moving in with my parents, giving up the lifestyle I've enjoyed for 25+ years, any semblance of privacy, and in many ways, my independence, & living in a bad episode of Curb). All while my peers are looking toward retirement & empty nests, I'm left ruminating over all of the bad decisions that got me here, the brutal self-criticism, shielding myself best I can from the unhealthy focus on financial success as a barometer of a happy life I grew up around.

That misguided focus took every ounce of my limited energy for so long, leading me to pursue the hot career at the moment instead of personal fulfillment. I started out with a blindingly bright professional future ahead of me, & was even pretty OK with gobs of money replacing that fulfilling job. I never could have guessed that after all that fancy education (if anyone wants to buy my MS & take over the $40k student loan still hanging around my neck, I'll sell it to you for 10 cents on the dollar), work/shit-eating for thankless employers, general sacrifice to my health, I wound up without the relationship/family, too broke (& often too sick) to pursue a relationship or those passions. I couldn't even accomplish the one career goal I had - not to need to rely on anyone else for my livelihood. My young nephew recently said to another family member how I was the smartest one in our extended family full of wealthy (but wonderful) people, and couldn't understand why I wasn't rich too.

Now I can't get a whiff of an interview for jobs I don't really want, can no longer muster the wherewithal, stamina, or ambition for a sole-proprietorship or startup, and may not even be physically capable of maintaining a full-time job. Now my "job" is battling the insurance company, IRS, unemployment system, & figuring out how to get by without accumulating more debt. etc.

Now I have to find a way to accept that unless Doc Brown lands in my yard with a DeLorean, my career options are between a dead-end job with a salary comparable to what I earned in 2009, but with 2x the responsibility, a part-time unskilled job for little more than minimum wage, & living in my parents' basement watching TV.

I suppose I should be grateful for that 3rd option, and I try to be, but also worry about its impact on my mental health. You can take away all of the illness & pain, and anyone would be dealing with depression when you tally it all up. I've even started ketamine infusions, and recently finished a complete "wellness" program that emphasized mind-body connections & chronic pain. I was practically able to teach the group sessions. I was frustrated by all of the unnecessary suffering, unnecessary life-altering spinal surgery, and the clear, sad reality that all of them will continue suffering. They won't ever be people to accept that the white coats have been so tragically wrong.
[/END TANGENTIAL RANTING]

So yeah, I have a few reasons for some extra TMS these days. I want nothing more than to build endurance & get back to athletics. Yet I still don't make nearly enough of an effort to make the lifestyle changes necessary to make progress down that path. I'm just weary of hitting the "reset button" when I get sick, and have descended into an "all or nothing" mentality that's left me with horrendous ADD and a routine of flagellation that is as damaging as any injury could ever be.

Thanks for letting me put my journal entry here & blather on for this long. Maybe it'll help just to write it all down again even if no one can possibly read this much personal information about a complete stranger.

 

@eightball776
Though you are a complete stranger, I really feel for your rant. I have many of the same circumstances (slightly altered), resulting in the same feelings of hopelessness. It’s really hard to be older, have TMS, be diminished as a person, have fewer options, feeling like a failure, regretting choices… all of the above. And having some circumstances that can’t be changed but cause rage is one of the most overwhelmingly aspects to this.

[PEP TALK for BOTH of us] What choice do we have but to hang in there? We know the medical route isn’t going to work. We know we have TMS (that’s an important first step). As far as our future’s go, that’s all perspective. Everything has at least a 50% chance of going either way: we could die. We could get better. We could be old and broke. We could win the lottery. We could somehow get healed. We could get enough strength to build successful post-retirement businesses. Or we could end up finding that perfect retirement job that brings a peaceful lifestyle of simplicity.

I might find a higher path. A Zen place to rest my soul. I might rise above. You might too.

We just have to hold on one more day. Not give up. And follow the path that others here have trod and done to get better here on the wiki. (They are literally like a beacon to me. And at times, I’ll admit, the beacon flickers pretty dim. )

I don’t know what other choice we have but to live to fight another day. Wrestle our minds and our will. Lean into the positive. One day at a time. That’s where I am today. I honestly hope we both get better.

 

Ha! @JanAtheCPA, you always make me feel like I’m doing great! Thank you for that. Because honestly, this is the hardest thing I’ve ever been through, and sometimes I try so hard to convince myself it’s all just a bad dream. I have no idea how I’ll make it through this. But on my good days, in my best moments—I believe there is a way forward. Thanks to you guys here!

 

@eightball776 I read all of your post too, and like @JanAtheCPA, I initially wasn't sure what to say...but now I have stuff! @Diana-M inspired a lot of it.

Hanging on and not giving up is key. The first year or so that I was struggling with tinnitus and the anxiety it provoked in me, I wasn't at all sure I could do that. I love to read, though, and one of the old-school classics, "Learned Optimism" by Martin Seligman really lit the fire in me to keep fighting, especially after reminding me of the only alternative - continuing down a path of pessimism and ever-declining health that comes with it.

Another one I've been reading recently is "Eyes Wide Open" by Isaac Lidsky. I thought of this when you described your career options. Lidsky's book is about how we go through our lives making all kinds of assumptions that are wrong without even being aware that we make them, and how those assumptions result in needless conflict and missed opportunities *because* we don't see those assumptions, much less see them for what they are. Lidsky's been blind since age 25 due to a progressive vision loss disorder, and yet he's managed to live a fairly successful life of the kind most people strive for, which makes what he has to say about assumptions all the more credible to me. What assumptions might you be making that could be holding you back? Haha, I'm not assuming that you are; I just think it's a good question for any of us to be asking ourselves given that most, if not all, of us seem to make them quite a bit. Perhaps looking at that a bit might open up some new avenues of possibility for you.

On a final note...shoulder pain is something I've had recurring bouts of as well, sometimes for up to a year in duration. The last time I got it (a few years back), I was about two weeks in when I decided to do a little digging on Reddit, focusing on the physical even though I knew better. I found a discussion in which one guy claimed to have eliminated long-standing shoulder pain simply by hanging from a pullup bar a few times each day for like 30 seconds or a minute. I thought, "Why not, can't hurt!" and did it. In two days, pain was gone and didn't return for years. My guess is that either that worked because my shoulder really did have some issue that stretching out solved, or it worked because by doing so, I was refusing to fear the pain and going about my normal activities - key Sarno tenets - without even thinking about it. Ok, hanging from a bar is not a normal thing for me, but it's not unusual like skydiving would be unusual, so you get the idea, I'm sure.

As you can see, I have brevity issues too Hope something in all that was helpful.

 

@Scanh,
Thanks for this great post! Just what I needed to hear! Assumptions seem to be everything. They create so much distress when you feel you haven’t lived up to your assumptions and/ir when you limit yourself due to assumptions.

I was thinking just yesterday how I could benefit from learn from folks who have been disabled for life. What have they learned that I need to learn? Maybe this knowledge is key. Many of them break down assumptions against them.

Thanks for the book recommendations. I’m going to look them up.

Regarding the hanging upside down: my husband once was literally bent over in back pain and we heard about this hanging thing where you strap your feet in then tilt yourself upside down. (It’s called Teeter Hangups.) He hung twice a day for 6 months and his back pain went away. Later, When we learned about Sarno, we thought it was probably a placebo. But it worked. Another time when his back pain returned, He walked four miles one day when he could barely put one foot in front of the other, and his back pain vanished. He talked to his TMS brain and said he wasn’t having it.

I wish any of these methods would work for me right now. But I’m on my own journey. It will take what it takes. I just can’t give up. And I have to keep the hope alive. Are you better now? What’s your story? Thanks again for this.

 

I'm glad you found that helpful! I am better now, from quite a few things. My big two were chronic testicular pain that had me unable to walk across a room without crippling pain for a couple of years (I'm 17 years pain free on that one; that's how I discovered Sarno), and then several years ago I had a case of tinnitus that was very traumatic for me. Sarno's ideas alone weren't enough to fix that, so I had to look elsewhere, accept the fact that whatever I did, the tinnitus may be here to stay, be ok with that (outcome independence in a nutshell), and find other things to focus on. Tinnitus is still with me today, but I've habituated to a point that I literally don't hear it 95% of the time - unless I think about it or have discussions like these (and I'm ok with that because it will fade off as soon as I focus on anything else). That habituation is something some people with tinnitus seem to develop almost automatically, but for me, it wouldn't have happened if I had continued to focus on the noise and the havoc it was causing.

I'll put up more detailed versions of both stories at some point. Priorities, though..

 

Well this is good! But hopefully you will conquer this when the time is right. I think some rounds of symptoms are hard to shake.

 

Well, what's great is that I don't need to conquer it. I've really gotten to the point where I don't give shit whether it stays or goes; either way, I win. If it stays, it serves as an occasional reminder of where I'm coming from and how far I've come. It reminds me that I'm *alive*. If it disappears, that's fantastic too...I probably won't notice if it does for weeks anyway. That smells like victory me!

 

Yes! Absolutely!

 

I struggle with the line between self-motivation and self-criticism. If I know I'm not doing everything I can to improve my situation, the depression becomes all-consuming. I also try to ignore the fact that it is harder for me to muster that motivation due to some factors that are beyond my control ... The depression makes that harder, thus back in the hamster wheel. The difference now is feeling like the last 10 years went poof, and now so many of the things leading to the depression are now much, much more difficult to solve, if possible at all. All my life, the moment I felt better, I'd forget about the doctor's visits, slack on my medication, and pretend like I was healthy...until I wasn't. I never stopped to really accept that I had any limitations, so throw in some monumentally bad luck & a few bad decisions, and that all or nothing mentality turned out to be nothing. More of the pain is psychological these days - makes me almost miss the back pain.

 

Gosh, @eightball776! You are describing my life! It is all so overwhelming. I guess the journey that most of the TMS programs teach— learning to love ourselves and be patient with ourselves—is one of our challenges. Motivation is really hard when I focus on my failures. I get super sluggish. All hope goes out the window. But when I get in that magic zone of enjoying the present moment with no judgement, I get peace. It’s such a relief to feel it, even briefly. All things are possible. We have to believe it. Nurture the hope.