Tension Mysositis Syndrome

An alternative view pioneered mainly by Dr John E. Sarno hypothesizes that repetitive strain injuries and other pain syndromes are entirely psychosomatic in nature and not caused by underlying musculoskeletal injuries. According to Sarno, emotional stress eventually manifests itself as physical pain through tensed, oxygen constricted muscles. Sarno calls this condition Tension Myositis Syndrome (TMS).  The muscle pain in TMS is similar to what athletes might feel after strenuous workouts. The difference is that for athletes pain relief usually occurs within moments of completing the workout whereas RSI sufferers have constant, lingering pain. TMS says that the brain latches onto tension to divert attention from underlying negative emotions.

By doing this, the brain manages to suppress the negative emotions deeper into the unconscious levels. This can lead to a disastrous cycle where negative emotions cause RSI pain, which end causing more stress and negative emotions and transitively more pain. Sarno boasts very high rates of treatment success (85% - 95%) with his approach, and many RSI sufferers have claimed complete recoveries from adopting this regime.

If you have had RSI lingering for longer than a few months, it is recommended that you pay attention to this section.

In the context of computer related RSI, the physiological output of TMS is reduced blood flow to the hands resulting in mild ischemia and a build-up of waste materials (the toxin output of hand muscle movements). This causes varying degrees of pain and sometimes muscle spasms. Before making a self-diagnosis of TMS, it is recommended that you consult a medical professional to rule out much more serious problems (like tumours).

Symptoms of TMS

  • No conventional treatment seems to bring lasting results, you’ve tried everything and nothing works.
  • You’re a “Type T” personality. Common personality traits include: Perfectionist, self-motivated, ambitious, neat and organized, in control, responsible, self-critical, tendency to feel guilty.
  • Pain plays a large role in your life. You think about it and/or experience it frequently.
  • You have a history of psychosomatic conditions, not necessarily clinically diagnosed. Earlier trauma or eating disorder for example.
  • The pain coincides with or started at a stressful periods of your life.

This page summarizes TMS in the following sections:

  • Unconscious fear and anger
  • Physiological changes
  • Physical symptoms
  • Psychological and social factors add to the symptoms, creating a full-blown syndrome that practically rules your life.
  • How to get better.

Unconscious fear and anger

People are capable of experiencing various negative emotions like fear, anger, guilt, anxiety and shame. During a lifetime a person will likely experience a variety of these emotions to varying degrees. People also tend to construct a self-image of themselves as intelligent, successful, independent, strong, likable, sexually attractive, patient and loyal in the context of some role like a husband or wife, father or mother. When a situation arises that threatens this self-image, the mind tends to do everything possible to divert conscious attention from this threat and avoid confronting it. Psychologically, a persons mind avoids confronting certain negative emotions by embedding them deep into the unconscious mind. This appears to be a built-in defence mechanism.

Most of the time these negative emotions are low-intensity and unimportant and the brain successfully manages repress them. When these emotions are particularly strong the brain struggles to keep them repressed and invokes physiological changes to divert attention away. These physiological tend to be some muscle tensions which over the long-term become the catalyst pain – RSI Pain in particular.

The emotions which cause this tension exist at the unconscious level and are not the same as those stressful emotions at the conscious level. The emotions experienced when receiving a bad grade or arguing with a friend tend to be consciously expressed and manifested outwardly. These emotions are not usually repressed, and are not the type contributing to TMS. Unpleasant feelings simmering below the surface – feelings of inadequacy, failure, uncertainty - are the types of emotions which cause this tension. Seemingly happy events like getting married or getting a new job can provide these types of emotions (“Do I look fat in my wedding dress?”, “Am I going to be able to handle these responsibilities?”). Over the long term, the full-blown syndrome TMS develops and can cause all sorts of physiological problems and changes.

Physiological Changes

The underlying premise of Dr. Sarno’s work is that the repressed, unconscious fear and anger described in [1] can actually induce physiological changes.

Dr. Sarno came to this conclusion as a result of dealing with patients suffering from back and joint pain. In the vast majority of his patients, Dr. Sarno noticed a history of tension-induced disorders such as heartburn, pre-ulcer symptoms, hiatus hernia, irritable bowel syndrome, colitis, spastic colon, tension headache, migraine and eczema. Whilst not all in the medical profession agree that these disorders are psychosomatically-induced, based on his consistent clinical observations and on the failure of conventional treatments,  Dr. Sarno felt confident that indeed they were.

Sarno also noticed that heating pads, massage therapy and physical therapy seemed to provide significant pain relief to his patients, albeit temporarily. Since those therapies simply increased blood circulation to the applied areas, Sarno further conjectured that the real cause of pain was a reduction of blood supply to soft tissues in the affected areas, initiated by emotionally-induced tension. His texts go into much greater detail on how the limbic and autonomous nervous systems are able to produce such effects.

According to Sarno, TMS is pain syndrome and does not lead to permanent damage of the affected soft tissues, despite the intensity of the pain. Simply understanding that the pain is tension-induced and not a structural problem is the key to a “cure”. Sarno noticed that once his patients understood that they were suffering from such tension, they were able to resume their normal activities without pain.

It is important to emphasize that according to Sarno’s TMS theory, the cause of the pain is entirely psychosomatic in nature and not a consequence of underlying musculoskeletal abnormalities as typically diagnosed by conventional medical practitioners. The pain is not caused by muscle tears, tissue inflammation, herniation, degeneration, decrepit muscles, bad ergonomics, poor posture or bad typing techniques. None of these are the cause. The root cause is entirely a sea of repressed, unconscious, negative emotions which must be confronted. This is a tough pill to swallow for RSI sufferers who have received diagnosis of underlying musculoskeletal disorders from various doctors and who can testify that the pain they feel is indeed frighteningly real.

According to TMS, what is often diagnosed as tendonitis, bursitis, fasciitis, metatarsalgia, shin splints, tennis elbow, sciatica, carpal tunnel syndrome, deQuervain syndrome and so are simply areas of soft tissues not receiving enough oxygen. Something interesting to note is that people with real structural problems often don’t experience any pain whatsoever, and yet people with perfect structural composition might undergo excruciating pain. This pattern is common within computer-related RSI sufferers.

So how do the mind and body conspire against you in this way? How do they know what physiological modifications to make in order for these unacceptable emotions to go away? The answer to this question is remarkable. Most assuredly the sufferer will develop symptoms least likely to be attributed to the underlying negative emotions - symptoms attributable to a structural abnormality or something “mechanically wrong”. So long as the conscious mind believes that the pain is mechanical nature, believes that something wrong with their wrist or joint, then this mechanism is doing its job and the  distraction will remain in place with the true cause – the underlying negative emotions – remaining unconfronted and repressed.

Physical Symptoms

The physical symptoms of Tension Myositis Syndrome are many. In fact, throughout its incremental development, TMS symptoms began to accumulate and now range from cardiac disorders to immune system disorders. TMS says that the following disorders are fundamentally emotionally-induced – created by your own system to distract you from underlying and unacceptable negative emotions.

Class of disorder Specific disorders
Lower back pain Sciatica
Spinal stenosis
Herniated / bulging / degenerated lumbar disc
Neck/shoulder pain Osteoarthritis
Pinched nerve 
Herniated / bulging / degenerated cervical disc 
Knee pain Osteoarthritis
Elbow pain Tennis elbow,
Muscular imbalances around the elbow joint
Lower leg pain Tendonitis
Shin splints
Wrist/hand pain Carpal tunnel syndrome/repetitive stress injury
Nerve dysfunction Sciatica
Bell's palsy
Gastrointestinal Heartburn/acid reflux
Irritable bowel syndrome
Circulation Tension headache
Genitourinary Urinary tract infections
Cardiac Rapid pounding heartbeat (paroxysmal auricular tachycardia)
Immune system Allergies
Skin disorders
Psychological Depression
Other Dizziness/vertigo
 Laryngitis/spasmodic dysphonia

Full-blown syndrome

TMS symptoms develops initially as minor tensions. By keeping focus away from unacceptable emotions onto physical symptoms, TMS successfully performs its function. Adding insult to injury, the ensuing psychological and social consequences of TMS can leave the sufferer utterly devastated. Mission accomplished! So long as you’re devastated with physical symptoms, you’re not thinking about the real underlying emotional problems, and the illusion keeps chugging along.

Secondary gain: It is common for TMS sufferers to be accused of faking or prolonging their problems to weasel out of their responsibilities. It’s the same type of stereotype often applied to Chronic Fatigue Syndrome (CFS) sufferers. As any CFS sufferer can testify, their symptoms are real. Likewise, the debilitating TMS symptoms are real, frighteningly real.  If untreated, TMS can evolve into a full-blown syndrome preventing one from attending school or work, or functioning adequately within social environments.

Effective distractions: To avoid focus on unacceptable emotions, the brain needs to find an effective distraction. The brain tends to choose a physical pain which is least likely to be associated with the underlying emotional tension. For example, it might choose to “create pain” at the site of an old injury because chances are that you will associate that pain with the original injury, not with the emotional tension. In the context of computer-related RSI, the brain chooses to create pain in the hands because most assuredly you will associate that pain with your typing. It is important to state that when we say “creates pain” we mean that the source of the pain is psychological through physical tension. The pain arises from restricted oxygen flow at the tense areas. According to Sarno, it is common for TMS sufferers to have their pain shifted from one of the conditions in step 3 to another.

Pain “epidemics”: Over the past 50 years, the incidence of back and joint pain has skyrocketed. The orthodox medical approach has led the general populace to believe that these pains are physical in nature, cause by injuries to the very delicate and easily damageable musculoskeletal system. The legitimization of the “structural explanation” has allowed back/joint pains and RSI’s to be effective smoke-screens to hide emotional distress. Excellent hiding places to bury emotions which are preferred not to be confronted.

The cycle:  TMS leads to a Pavlovian cycle of itself. For example, if you believe that typing is the cause of your RSI then you believe typing causes you pain. Because of this, you become afraid of typing and generate negative emotions associated with typing. But since typing generates you income, generates the bread for you and your family, you continue typing which just generates more pain and more devastating emotions of inadequacy and panic. Before you know it you’re locked in a vicious cycle of fear, pain, more fear and more pain. This explains why people only feel RSI when performing a specific activity, not necessarily a similar activity. For example, typing causes pain but playing the piano causes no pain. To accommodate this vicious cycle, a TMS sufferer begins to change his activities more and more but this seems to transfer the pain and problems to another site. Doesn’t matter what you do, it seems the stranglehold of TMS never leaves.

How to cure TMS

Conventional treatments such as pain relievers and ultrasound therapies may provide temporary relief from physical symptoms, but they won’t treat the underlying psychological cause – the root cause. If you understand and believe in TMS, there is good news – you can cure your pain, and you can do it without damaging your wallet. Since TMS is designed to distract you from underlying emotional pain through physical pain, understanding and believing TMS is half the cure. The other half requires the identification and confrontation of the repressed emotions which threaten your self-image. Acknowledging these emotions evaporates them and renders the smoke-screen physical symptoms unnecessary. In some people this can occur quite dramatically. They might be emotionally volatile for a few days, then suddenly no more pain and no more negativity, almost miraculously.

Identifying and confronting these emotions is the hardest aspect of the cure since these unconscious emotions may not be apparent. The following suggestions help in this process:

  • Completely believe and accept TMS as the source of your symptoms. If you believe that a structural problem is still a contributing cause, then you are allowing TMS some breathing space. You must accept that these symptoms are emotionally induced.
  • Think about the case of your symptoms in the “emotional context”. Whilst the actual pain comes from mild oxygen deprivation to afflicted areas, the root cause is emotional. You must think about the pain in the emotional context, not in the “structural problem” context. It can be difficult to adjust your way of thinking in this manner, but it is crucial.
  • Write down a list of expectations you have of yourself, identify which ones you think are being threatened or which ones you are failing to accomplish. Think about why you believe you are failing and reason your way out of this way of thinking.
  • Start to get your body in the best physical shape you can. This step is extremely important because it helps clear the mind and relieve stress. Jogging, Yoga, Tai-Chi / Chi-Gong and meditation all allow you to do this.
  • Practice these steps several times a day.
  • Don’t rush, go slow. Resume your activities gradually as your health returns. Jumping straight into the old activities can cause a relapse.

Many people have claimed to have cured TMS by simply reading some of Sarno’s books. If you find yourself not making progress, it may be worthwhile to check out some of his books. If you still aren’t finding relief, meeting up with a TMS professional or standard psychotherapist may be helpful. Empirically, 10-15% of TMS sufferers require some form of psychotherapy to aid them. It is important to be patient and persistent, and to be easy on yourself.  Poking around in your unconscious mind can be difficult. Several suffers have described being very emotionally volatile for weeks during this process.

The most important thing is to not throw in the towel if relief doesn’t come immediately. Many thousands can vouch for Dr Sarno’s methods, they work.

Dr. Sarno’s books:

  • The Mindbody Prescription (1999): Sarno’s most recent book, on the NY Times best seller list.
  • Healing Back Pain: The Mindbody Connection (1991): More in-depth than The Mindbody Prescription but doesn’t cover RSIs specifically. The difference between the two is significant, and both worth reading.
  • Mind Over Back Pain (1970s): The corner-stone of TMS theory. Good for a historical perspective but unnecessary for understanding/treating TMS. The first two are more relevant.
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