What Is Tension Myositis Syndrome? [2021]

If you’ve done any research online for chronic pain, you’ve stumbled across the term tension myositis syndrome (TMS). Maybe you’ve found this by reading Dr John Sarno’s works or browsing the TMS wiki page.

The topic of tension myositis syndrome is wormhole. You’ve got questions and we’ve got answers.

By the end of this introductory article you’ll be up to speed on all things TMS for 2021. We’ll also leave you with some self diagnostic questions and tips on how to start your recovery today.

Let’s get started right now.

The History Of Tension Myositis Syndrome

It also starts with one doctor who was bewildered by back pain.

You’ve guessed it. It was the late Dr John E. Sarno.

Dr Sarno was a physician at the New York Medical Centre. Tasked with patient rehabilitation from injuries such as chronic back and neck pain he was exposed to many sufferers of long term pain. This was pain that persisted well after the initial acute injury had healed. 

Dr John E Sarno who developed and popularized tension myositis syndrome.
John E. Sarno, MD. Source: johnesarnomd.com

He observed that any progress towards recovery was slow and haphazard. Dr Sarno witnessed many patients who had spinal surgery that was altogether unnecessary. This surgery did not necessarily improve patient outcomes. Some chronic pain sufferers had clear x-rays with no observable structural damage. 

Making matters worse, any improvement in a given patient was seemingly at random and not repeatable in other patients. 

On the flip side, he had seen the spinal x-rays of many healthy patients who had an obvious “injury”, but this was not manifest as pain. After all; bulging, herniated discs or scoliosis was just a normal part of the aging process that didn’t cause pain for many people. 

There is almost no correlation to what shows up on x-rays and pain experienced.

Tissue health is no clear indication of pain.

This conclusion has been supported by studies such here and here, and is detailed in more recent work by Dr Howard Schubiner in “Unlearn Your Pain”.

So What The Heck Was Going On?

As a keen observationalist, Dr Sarno noticed that patients who persisted in pain had distinguishable personality traits. Namely they were anxious, perfectionists, and had a tendency to put others’ needs above their own. They were driven, high-achievers, with unrelenting high expectations.

If x-ray’s aren’t a key indicator of pain, maybe another trait is?

Remember that pain is an experience. It’s not something we can see like a coronavirus cell or treat directly with medication. Side note: this is a good time to jump back into some simple definitions of chronic pain to make sure we are all on the same track.

Sarno was highly familiar with the work of pioneering neurologist Jean-Martin Carchot and the founding fathers of modern psychology such as Sigmund Freud (unconscious thoughts and feelings) and Alfred Adler (the man behind inferiority complex). They reported case study after case study of patients who suffered a wide range of symptoms brought on by their poor emotional flexibility and adaptability in the face of uncertainties. 

Sarno credited people like Jean-Martin Carchot for shaping his understanding of pain.
A Clinical Lesson at the Salpêtrière, featuring Jean-Martin Carchot and a female patient suffering hysteria

Poor emotional regulation or an emotional excess was said to be the culprit behind hysteria and neuroses – since outdated terms.

There is no question that unchecked emotions can cause physical symptoms and bodily sensations.

In years one by hysteria was known to cause a wide range of bodily disorders, just like TMS.
Illustration of a woman suffering from hysteria. We’ve known for centuries that emotions can cause physical distress.

If the majority of our mental processing is unconscious, maybe unconscious emotions are the cause of our physical pain? Bottled up emotions and stress are no good for the body.

Dr. Sarno suggested that the primary emotion is rage and anger. 

But how does that add up if I am not an angry person?

The Idea That Suppressed Anger Causes Pain Is Stupid

That’s what I first thought, until I did a bit more digging.

You see emotions like anger are very natural given the “long” human ancestry of some 300,000 years for homosapiens. But they have no place in modern day civilised society.

I mean, who could stand a coworker, neighbor, or family member who flies into a fit of rage at the drop of a hat? We have conformed to societal norms by suppressing our negative emotions. Society teaches us to be numb to them, that they are inherently bad, or that we must be evil for getting angry. 

Yet this doesn’t mean that they just magically disappear. We’re still human after all.

Instead of disappearing they are pushed aside, or banished to the subconscious mind in the same way that a naughty child is sent to their room without dinner. The problem is just swept under the rug out of site. But what does the child do while he is in his room? You guessed it – get into even more mischief! Anything to get our attention.

Sweeping things under the rug is never good.
Sweeping unresolved emotions under the rug only sends the problem elsewhere.

We see the unconscious anger conflict all the time. Caring for children or elderly parents who we love dearly, but drain our energy and resources. The monotony of having to work for income when we could be outdoors having fun. More anger.

This is particularly true for people who strive for perfectionism and conscientiousness. This may even be you. Someone who worries what other people might think of them or puts the needs and desires of others ahead of yours without question. This makes our primitive mind angry! How dare they!

Expressing any sense of anger would be totally out of line in public, but that doesn’t mean it will disappear.

So where does it go?

Sarno reasons that the unspent anger is manifest as a bodily sensation. Emotions seek outward expression.

Strange, I know. 

There is no hiding the fact that for some this mindbody connection is at the fringes of modern medicine.

Let’s flesh this out some more.

It’s been shown that emotions in our mind shape our physical body via a psychosomatic (mindbody) connection. Consider the positive influence of mindfulness. In this case redirecting our emotions and thoughts can change the physical structure of the brain.

The mind can literally shape our body!

The Mechanism Of Tension Myositis Syndrome

Tension myositis syndrome (also called tension myoneural syndrome or tensionalgia) is a harmless condition behind a whole range of tension related disorders.

It’s real and it hurts! 

The mechanism of TMS starts with the autonomic nervous system (ANS). The ANS is responsible for bodily functions like our heart rate, digestion, and breathing. It’s also got your back with involuntary actions like swallowing, coughing or sneezing. These functions happen without our awareness or control – and for good reason!

The autonomic nervous system plays a role in responding to emotions and triggers the fight or flight response. Any guesses on where we are heading with this?

TMS itself is understood to be a caused by unconscious emotions that trigger the ANS to decrease blood flow to specific nerves, muscles, and tendons. The effect is pain like sensations such a burning, aching, or tingling. Fortunately, this mild oxygen deprivation is harmless and completely reversible.

Remember how the mind has suppressed this primitive rage and anger in situations it would be inappropriate to cut loose on a rampage? This TMS pain is a form of distraction, to focus us back on our physical body. This distraction means that we don’t have to deal with those pesky emotions floating around in the back of our brain.

Who has the energy to focus on complex emotions if we are in pain? Not me.

Unresolved and unconscious anger is at the heart of TMS.
Unresolved emotions like anger and rage bubble below consciousness, only to surface as neck pain or other TMS symptoms.

TMS is also a defence mechanism. Our brain doesn’t know that these hurtful emotions can’t actually cause us physical harm. The oxygen deprivation and associated pain is our brain’s way of protecting us from the damage that our mind thinks these emotions can cause. 

In the short term, it’s pretty clever. In the long term, it’s devastating.

Why not take a moment now to thank TMS for protecting you so faithfully these past weeks, months, or years?

It could look something like this:

“Thank you for doing your job. But I don’t need you any more. I have the knowledge and skill set to embrace these feelings. Thank you TMS, but it’s time to leave. I am not in any physical danger”.

Other TMS Conditions

Unconscious anger doesn’t just stop with some back pain.

There are a whole range of conditions that have no apparent organic cause. Dr. Sarno listed an arsenal of stress/tension related conditions that have their genesis in anger. Other experts such as Dr Howard Schubiner (the author of “Unlearn Your Pain”) details many conditions that he has seen in his personal experience.

Tension myositis (TMS) can cause neck pain, back pain, and other symptoms.
Sufferers of tension myositis syndrome report a wide range of symptoms with no organic cause.

These include:

  • Tension headaches/migraines
  • Back pain
  • Neck pain
  • Thoracic outlet syndrome
  • Repetitive strain injury (RSI)
  • Irritable bowel syndrome (IBS)
  • Irritable bladder syndrome
  • Fibromyalgia
  • Polymyalgia
  • Complex regional pain syndrome CRPS
  • Chronic fatigue
  • Whiplash
  • Tinnitus
  • Temporomandibular joint syndrome
  • Sciatic pain
  • Chronic fatigue syndrome
  • Anxiety
  • Depression

Ok, I know what you are thinking. This is bat-s*** crazy. What does neck pain have to do with IBS?

Let’s follow the same reasoning by Dr. Sarno’s years of observations. Instead of focusing on what is different, let’s focus on what they have in common.

Let’s imagine that the dividing walls are transparent.

Many of the above symptoms occur seemingly at random, or worse, when something critical is required. For instance being hit with a migraine at the worst possible time. Getting stomach cramps or diarrhea before a deadline is due. These conditions may not have a related structural issue which would occur during acute pain.

Take notice of when your symptoms occur. Why now? What are they telling you?

Sarno and others have identified that people who are afflicted by the above conditions often are highly intelligent, educated, type-A personality types who are highly anxious or perfectionists (that one hurt me!). These people can fall into pessimistic cycles with the slightest uncomfortable bodily sensation. A minor twinge in the neck can make our blood run cold!

Side note: It’s worth taking pause here to remember that some author’s pin TMS or another mindbody disorder on just about any physical ailment possible from cancer to the common cold. Be careful. Make sure to discuss any concerns with your treating physician.

Chronic pain physicians such as Dr. Sarno and Dr. Schubiner stress that this condition is only when there is no a clear organic pathology.

How Do I Know If I Have Tension Myositis Syndrome?

If you’ve visited this site before, you know by now that there is no substitute for speaking with your doctor or family physician first. This is vital to rule out any life threatening issues or other medical complications.

Are we clear on this? Good.

But what happens when the pain persists that has no real cause (i.e. no organic pathology)? Chronic pain is a common result of TMS. It’s a burning, aching, or zapping sensation quiet unlike acute pain from say a sprain or bruise.

Here are some questions to ask yourself:

  • Is there a clearly defined medical disorder that explains your chronic illness? Cancer would be ab obvious one here. Be mindful of normal structural changes in bones and muscles as they age (this is rarely a cause of pain).
  • Have other TMS disorders occurred throughout your life? Migraines, IBS, etc.
  • What is my personality like? Would friends and family describe me as a perfectionist, highly strung, or anxious personality? Am I judgmental and rigid when it comes to others, or am I more open and compassionate?
  • What is my attitude to pain like? Could stressors in my life be making things worse? Have I spoken with my doctor about it?
  • What about non-pain related stressors like? Work, family, social life, fitness etc?
  • Does the pain move or track from location to location? For instance, does it shift from my neck to my lower back, or from my left arm to my right arm?
  • Does it increase in magnitude during stressful times? Or decrease on weekends, holidays, or after work?

If you are highly stressed, anxious, and tend towards perfectionism or high-achieving (a type-A personality), this can certainly be the foundations for TMS. The suppression of rage and anger. If you’ve been cleared by a physician and found to have no serious or organic pathology, this could well be TMS.

Currently as of 2021, the term psychophysiologic disorders (PPD) is becoming an increasingly popular descriptor for mindbody syndrome and TMS. I have a full explainer which details these terms.

Proof That The TMS Approach Works

I know what you’re thinking: show me the proof that the TMS approach works!

Because the TMS approach does not use drugs or surgery this can be hard to quantify ones psychological state. Just because the results can be hard to quantify doesn’t make the theory or the process any less valid.

Sarno himself claimed to have helped some 10,000 chronic pain patients and with a 90% success rate (20/20 interview). Since Dr. Sarno’s death in 2017, a website thankyoudrsarno.com is active with almost 200 personal testimonies of people who have healed.

Why not read some of them yourself?

More formally he conducted a study on 85 patients during 1999 (The Divided Mind pg 179-183). When followed up after Sarno’s TMS educational program 44% had no pain. 26% reported they they were 80 to 100% improved. 15% were 40 to 80% improved and only 15% reported no change to 40% improved. 

Other studies conducted by Howard Schubiner have indicated significant effect of the TMS approach. Patients who accept the mindbody approach to pain have clearly benefitted.

Howard Schubiner's (Unlearn Your Pain) study on TMS.
Research detailed in this paper and the text “Unlearn Your Pain” by Dr Howard Schubiner illustrates the success of the tension myositis approach.

Beyond Sarno, the neuroscience field is charging ahead full steam. Remember that mindfulness can actually physically change and rewire parts of your brain! Just another example of how our thought process can cause physical changes in our body.

For those who want more a deep dive into the literature Jeffery Axelbank has published a fantastic annotated list of 48 peer-reviewed studies on tension myositis syndrome.

How Do You Treat Tension Myositis Syndrome?

This is what you are here for! The good stuff!

John Sarno prescribed 12 daily reminders for those living with tension myositis syndrome. While they are expanded upon in his works Healing Back Pain and The Divided Mind few patients have immediate relief.

Regular, consistent work is needed to heal. But you already suspected that, right?

I have reviewed numerous free programs, books, and video resources. In essence they are distilled down to:

  • Learn more about topics like TMS, mindbody syndrome and psychophysiologic disorders. Education alone has been proven to help sufferers.
  • Recognize that all those x-rays, MRI’s, and blood tests have shown nothing obvious, dangerous, or fatal. Congrats! While it can be disheartening to not have an obvious organic pathology, it is reassuring that it can be TMS.
  • Have a realistic look at where you are currently at emotionally. Reflective writing or working with a psychologist can help uncover blind spots. I find I need to write at least 5 pages before I get real with myself. What are you feeling? What are you angry at? Why? Could this stress and anxiety be contributing to your pain? Involve your doctor in this process. Ask them if they think emotions and stress could be playing a part in your suffering.
  • Thank the TMS for protecting you from these harmful emotions. Thank TMS for the distraction it had formed by forcing you to think about your physical body instead of your psychological thoughts.
  • Take steps to heal. Push yourself a bit when it comes to exercise (Sarno himself wanted people to resume a normal, active lifestyle immediately.). Replace one or two takeout meals with healthier homecooked alternatives. Turn your phone on silent 1 hour before going to sleep.
  • Ask yourself how life you be different without pain. Do you need to set some goals and expectations?

Q: How small should I start?

A: Start with the smallest step that you can achieve daily.

Conclusion: What Is Tension Myositis Syndrome?

It’s real pain produced by a harmless and reversible mild oxygen deprivation to the nervous system.

Unexpressed emotions, anger, and the pressures of life help sustain TMS.

There is hope to recover from chronic pain.

P.S. Knowing what to do next is super confusing. We all know that a blog post isn’t the best way to get immediate information. That’s why I send out regular emails with my best tips (only for those who want to recover).

Your subscription could not be saved. Please try again.
Congrats on taking a big step to recover from pain. Check your inbox for final confirmation.

Leave a Reply

Your email address will not be published. Required fields are marked *