Mind Body Connection - TMS

The Mind-Body Connection

Dr Kyle Christensen, 2019

Many are aware and in agreement that emotional stress and tension can literally make you sick. A tension headache or tight muscles across the shoulders are commonly considered the result of stress in our lives. We learn from scripture that God creates everything spiritual first before things are manifest physically. "And God said .... , then there was....". This pattern is also true in our lives. Things are created mentally, emotionally and spiritually before they are manifest physically. So much emphasis is placed on the correct diagnosis, yet the reality of the mind-body connection is seldom considered. I have found in my practice, particularly with many of the chronic conditions that there is almost always a degree of emotional stress intertwined with what is going on.

 

Tension Myositis Syndrome

Tension Myositis Syndrome (TMS), also known as Tension Myoneural Syndrome or Mind-Body Syndrome is a name given by Dr John E. Sarno (former head of Rehabilitation at New York University). TMS is the result of stress in your life that results in pain (muscle, nerve and tendon) that can be anywhere in the body. TMS can also cause dysfunction in the immune and hormonal systems leading to autoimmune disease. While TMS is considered psychologic in its origins, the pain and physical symptoms are very real and do have a physiologic basis.   

  

The mechanism of TMS is as follows:

Stress, anxiety or tension caused by emotional distress causes the muscles to tighten or tense up. This tension in the muscles squeezes off the blood supply to the muscle itself but also to the nerves, tendons and ligaments in specific areas of the body. These areas are often sites of previous compromise, injury or areas that may correspond to specific emotions. The decrease blood flow results in a diminished amount of oxygen to these tissues. Often only 4-5% decrease of oxygen. The result is pain. Think in terms of a muscle cramp. The pain associated with a muscle cramp is the muscle literally screaming for oxygen. The pain associated with TMS does not cause permanent or physical damage, although the pain is very real and can be debilitating. However, prolonged tension and muscle tightness can result in adhesion or scar tissue formation within the muscles that may need to be resolved.

 

Symptoms associated with TMS

TMS symptoms include pain, stiffness, weakness, tingling, numbness, muscle contractures, cramps and other negative sensations. Often these symptoms will come and go or move around for no apparent reason. You will have good days and bad days. Often the pain is worse at night.

 

TMS symptoms can occur in the back, neck, knee, arms, wrists, shoulders, and other parts of the body. The symptoms have a tendency to move to other parts of the body. The fact that symptoms often move or switch to other parts of the body is an important indicator that the pain is from TMS. This is frequently described with the diagnosis of fibromyalgia.

 

Proper Diagnosis is the Key - How do you know if you have TMS

Lack of known physical cause:  A physical examination, blood tests and imaging studies may be needed to rule out a more serious conditions, such as tumors, fractures or infections. Surprisingly, MRI's or x-rays which show spinal disc herniations or bulges and stenosis are generally found to be harmless and not the direct cause of the pain. Often the symptom location does not even correlate to the herniation location. If your condition seemed to have begun without an event that you can put your finger on - for example, "I just woke up with this" "I think I must have slept wrong", then TMS should be high on the suspicion list.

You may have Tender points or Trigger Points: 99% of those with TMS have tender points in the muscles. While the diagnosis of Fibromyalgia uses 18 points to confirm the diagnosis (at least 11 are tender for this diagnosis), 6 specific points are used to determine the diagnosis of TMS. The six main tender points to diagnose TMS are two tender points in the upper trapezius muscles (across the shoulders), two in the lower back muscles (just to the side of the spine) and two in the lateral upper buttocks.  Often people will say regarding these tender points: "That's where I hold my stress".

You may have or had other psychosomatic disorders:  A prior history of other psychosomatic disorders is an indication that the patient may have TMS. These may include: Irritable Bowel Syndrome, Multiple Sclerosis, Tension Headaches, Panic and Anxiety Disorders, Gastric Ulcers, Carpal Tunnel Syndrome, Plantar Fasciitis, Crohn's Disease, Chronic Fatigue, Hypothyroidism (Hashimoto's disease) and the list goes on and on.

Remember: Serious disorders, such as fractures, tumors and infections should be checked for and ruled out.

 

Treatment protocol

The treatment protocol for TMS includes education, writing about emotional issues and resumption of a normal lifestyle. For patients who do not recover quickly, the protocol may also includes support groups and/or psychotherapy. Many experience relief from their pain within days or a couple of weeks. Some take 6 months or so for complete or near complete resolution of their pain.

 

1 - Education

I have long found in my practice that the better the patient understands what is going on, the more sure the recovery. It is vital that you understand thoroughly that while your pain has mental and emotional origins, the pain (due to lack of oxygen to the tissue) is very real and has been scientifically observed and documented. I strongly recommend reading one of Dr Sarno's books. All of which describe the Mind Body Connection and the painful condition of TMS. Each of us must thoroughly understand the psychological and physiological aspects of TMS. As you grasp these concepts you will learn that your physical condition is not permanent and that any disability you have is a function of pain-related fear and repressed emotions. 

Understand, we are not attempting to marginalize your pain and brush you off saying it is all in your head. What we are saying is that, like the rest of us, past emotionally traumatic experiences where you did not have the support, experience, or ability to deal with at the time are stuffed down into the subconscious as a self protective and survival measurement. Feelings buried or repressed don't go away but can fester and build. In an effort to keep these emotions away from bubbling up into the conscious memory, the subconscious can create a diversion or distraction to draw your attention away from dealing with painful and uncomfortable memories and emotions. That diversion can be muscle or nerve pain, digestion issues, autoimmune problems, etc. 

And the honest truth is that we all are so damaged. It is not just soldiers or the victims of abuse suffering from PTSD.  It is each and every one of us to some degree. And so what if you actually do have a significant injury - meaning you know when, where and how you got hurt. It is quite probable and even very likely that you can have a physical injury that is accompanied with the psychological overlays of TMS. Just because you have a real injury does not mean that you are immune to the stress, tension and consequences that may have caused or is associated with your problem. If your injury doesn't heal right up in a very timely manner, then TMS can come into play. At any rate, dealing with underlying emotions can be extremely helpful in resolving much of the pain you are experiencing.

 

I recommend that each day you read in one of Dr Sarno's books the chapter on The Psychology of TMS or the Physiology of TMS. Highlight the important concepts in these chapters and become VERY familiar with them. Study and understand TMS - really know it inside and out. When the knowledge is anchored in your heart and soul, the changes (no more pain) that you desire will begin to unfold - often within two weeks. Daily repetition of the psychological process over time defeats the repression through conscious awareness.

 

2 - Writing about emotional issues

Understand, our objective is not to simply make the pain go away, but to heal your life - Body, Mind and Spirit. Writing and journaling can be transformative in achieving this healing. Each person should set aside time daily to think and write about issues that could have led to the repressed emotions. Many will purchase an inexpensive notebook - you don't need anything fancy.

 

We recommend the following four writing tasks to consider:  

1) Writing a list of issues.  Each of us should try to list out all issues that might contribute to the repressed emotions. Look to the following areas:

(a) Childhood experiences, such as abuse or lack of love

(b) Personality traits such as perfectionism, conscientiousness and a strong need to be liked, approved or validated by everyone - The need to be seen by others as good (not a sinner - or at least look how good or righteous I am now) is a big one among the church goers.

(c) Current life stresses and pressures - marriage, children, job, whatever is going on in your life

(d) Aging and mortality - your health, weight, physical appearance, genetic issues, etc.

(e) Situations in which the person experiences conscious but unexpressed anger

 

2) Writing essays.  Write an essay for each item on the above list. The longer the essays the more you will be forced to examine the emotional issues in depth. An important purpose of writing an essay is that you will be able to discover or have revealed to you the meaning behind the suffering. Suffering shapes and forms who we are. For example: The one who is abused often becomes more compassionate and empathetic towards others. By writing you can more effectively get it all out. We recommend writing longhand rather than typing on the computer. There is something deeply more therapeutic writing by hand.

  

3) Morning Pages - as taught by Julia Cameron in her book The Artist's Way

Morning Pages are three pages of longhand, stream of consciousness writing, ideally done first thing in the morning. There is no wrong way to do Morning Pages - it is not beautifully constructed prose or poetry. These pages aren't even "writing." They are about anything and everything that crosses your mind- and they are for your eyes only. Morning Pages provoke, clarify, comfort, cajole, prioritize and synchronize the day at hand. Do not over-think Morning Pages: just put three pages of anything on the page...and then do three more pages tomorrow.

  

4) Cast your Burdens to the Lord - Read and follow the instructions in Dr Christensen's handout Casting Your Burdens to the Lord. You must follow the instructions in the exercise closely. You've got to physically write down all the issues, people and problems in your life that you are stressed, fearful or anxious about. You've got to say the prayer outlined in the handout - either out loud or whispered. AND you've got to destroy the paper - burn it, blend it up, whatever feels right. The physicality of this exercise is important!

 

The ancient philosopher Socrates stated: "The Unexamined Life is not worth living" - now this may seem harsh, but the truth is that we need to look at our lives. Deep introspection and self discovery is important. Past traumas can reveal that it really is not your fault. The adversity we experience will ultimately shape you into the person God wants you to become. Wounded hearts can be healed. Past experiences no matter the depth of difficulty can sanctify and purify your soul. Emotional burdens and baggage that are the cause of pain can be lifted. We are all injured, wounded and burdened. Begin where you are. Do the work. Gain the understanding.

3 - Resumption of a normal lifestyle

It is important that you return to a normal lifestyle. The underlying cause of TMS is psychological, not physical. This means that you are not going to hurt yourself further by living your life in a normal fashion. This will be a tremendous leap of faith for many, however, it is important to gradually resume normal activities. As you begin to feel better you can take courage and hope and become more and more physically active. Gradually be more active, until you are back to a normal life. In addition, we encourage you "to discontinue the safety behaviours aimed at protecting their 'damaged' backs."

 

If you are engaged in ongoing treatments for your pain, consider discontinuing them, especially if you are not experiencing steady progress and improvement. Ongoing treatments can reinforce the idea that your pain and problem is structural. Emphasis of treatments should be to let go of repressed emotions and traumatic difficulties.

 

Daily Reminders - An Overview

• The pain is due to Tension Myositis Syndrome (TMS), not to a structural abnormality
• The direct reason for the pain is mild oxygen deprivation
• TMS is a harmless condition, caused by repressed emotions, the principle emotion is usually anger or rage
• TMS exists only to distract my attention from the emotions
• Since my back, neck, shoulder, etc. are basically normal, there is nothing to fear further injury
• Therefore, physical activity is not dangerous and I can resume normal physical activities
• I will not be concerned or intimidated by the pain
• I will shift my attention from the pain to emotional issues. Experiencing the pain will be my reminder to focus on the emotions. This can be as easy as acknowledging the pain as a cover up to the emotions. Talk to the pain - "I know you! You're just trying to cover up my emotions.
• I intend to be in control - not my subconscious mind. Repetitive acknowledgement of the emotional roots causing the pain will slowly bring the emotions to the conscious mind so that the cover up of pain will no longer be necessary.
• I must think psychological at all times, not physical

 

Support

Support meetings may be important for those who do not make a prompt recovery. Occasionally, one-on-one counselling may be necessary

 

Conclusion

Our goal is not simply the resolution of our pain, but to be healed body, mind and spirit. This article is an introduction into the mental, emotional and physical aspects of pain syndromes. We will discuss later the spiritual implications in pain syndromes. Complete healing cannot be achieved with the cleansing and renewal of the spirit. Ferreting out the darkness and opening to the light. The Gospel of Christ invites us not to simply be better people, but to be transformed - to become new creatures. We need our souls and lives ignited. For those with the courage and determination to uncover painful emotional and spiritual stones and stare them in the eye - this conscious effort will be healing and transformative. The best, strongest and most capable of us suffer as well as the broken down weakened and abused. As you put these practices into play, you can heal. You can forgive (let go) and change. Of course, it isn't easy. Of course, you will need support. But you can do it.

 

God bless us all in our efforts to heal and to come more fully unto Him.

 

Dr Kyle Christensen 2019