Yoga On & Off the Mat

Back Pain the Sarno Way

By Brooke Hewes, 9-28-07

Like millions of Americans, I’ve suffered through bouts of back pain during my adult life.

Also like millions of Americans, I’ve looked to yoga for relief. I’ve tried asanas and sequences to strengthen postural muscles along my spine; I’ve practiced poses to build core muscles; I’ve lengthened my hamstrings and opened my hips. Sometimes this helps, sometimes it doesn’t.

One method that has worked more often than it hasn’t, though, is another mindbody practice — what I call the Sarno Way.

Dr. John Sarno’s TMS Theory
Dr. John Sarno is a professor at the New York University School of Medicine and an attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine at NYU Medical Center. After many unsuccessful years of treating pain with conventional wisdom and physical therapy, Sarno landed on a theory that he shares in his books Healing Back Pain (1991) and the national bestseller The Mindbody Prescription (1998).

According to Sarno, back pain is an “epidemic” sweeping America that rests on a handful of faulty premises and diagnoses. Instead of an injury, weakness, or faulty disc, the pain comes from “a benign (though painful) physiological aberration of soft tissue (not the spine), and it is caused by an emotional process,” writes Sarno in the of Healing Back Pain.

	The Diagnosis and Treatment for Back Pain according to Dr. John E. Sarno in his book Healing Back Pain. The Diagnosis What. TMS, tension myositis syndrome, is a totally harmless, extremely painful syndrome caused by mind oxygen deprivation to certain tissue in the body. Why. To distract the mind from underlying emotional pain. The process is entirely unconscious, so even if you’d rather feel the anxiety or anger (or whatever unpleasant, un-proper emotion is lurking in your subconscious), tough luck. You’re stuck with the pain until you accept and integrate the diagnosis. How. The autonomic nervous system constricts blood flow, and therefore oxygen, to cells. Where: TMS tends to target the postural muscles of the back, neck and butt; tendons and ligaments around the elbows, knees, ankles and shoulders; and nerves, most commonly the sciatic nerve. Who. Sarno calls TMS a “cradle-to-grave disorder.” Having said that, the overwhelming majority of his patients are between the ages of 30 and 60, and are typically sensitive, perfectionists, concerned with other people’s happiness, and caregivers. When. To be tricky, the pain usually arrives with a physical incident: during a fall, with a pop, while working on a really challenging yoga move. Alternatively, it strikes some while lifting a pencil or sitting at their desk. Like a cold, it can hit during vacation or after a prolonged period of stress when your guard in down. Like stress, it sometimes arrives with relatives around the holidays. The Treatment 1. Read the book. Educate yourself on the manifestations, psychology, and physiology of TMS. “The most important factor in recovery is that the person must be made aware of what is going on; in other words, that the information provided is the ‘penicillin’ for this disorder.” (p. 71) 2. See a doctor who is trained in diagnosing TMS and rule out any structural abnormalities or serious illnesses. 3. Accept and embrace the diagnosis: blaming the pain on an injury or some physical degeneration “must be resolved in the patient’s mind or the pain will persist.” 4. Review the following daily reminders: • The pain is due to TMS, not a structural abnormality • The direct reason for the pain is mild oxygen deprivation • TMS is a harmless condition, caused by my repressed emotions • The principal emotion is my repressed any • TMS exists only to distracts my attention from the emotions • Since my back is basically normal, there is nothing to fear • Therefore, physical activity is not dangerous • And I must resume all physical activity • I will not be concerned or intimidated by the pain Some people, writes Sarno, actually need to feel the emotional pain to get over the physical pain. In fact, between 15 and 20 percent of people he works with only get better with the help of a therapist. For most, however, the pain disappears or largely dissipates by educating the conscious brain about the subconscious process (the psychology and physiology of TMS). Once the mind catches on, the subconscious gives up its strategy and the pain disappears.

Our backs ache, says Sarno, when our emotional well overflows with stress, anger, anxiety, or any unpleasant feeling. Rather than feel the emotion, our body redirects the mental pain to our physical selves by constricting blood and the oxygen it carries to muscles, nerves, tendons and ligaments. Once cells are deprived, pain kicks in.

Sarno calls the condition TMS, short for tension myositis syndrome, and says that the entire process happens subconsciously through our autonomic nervous system (the one responsible for involuntary functions like breathing and circulation). Even if we’d rather feel the emotions with our mind, our subconscious has already decided that it’s better that we feel the pain in our bodies. And though the oxygen constriction is temporary, leaves no trace and doesn’t cause physical harm, it hurts like hell. This intensity, of course, is why the mind’s strategy is so effective: we are totally taken by the pain and totally distracted from our emotions.

When I first heard this theory five years ago I thought it was wacky. Nothing short of impossible. Everything every doctor I had seen for pain said that something was wrong with my body. My muscles were weak, tendons loose, gate off, pelvis tilted, you name it. Something was physically wrong, they said. However, despite exercises, manipulation and other remedies offered, the pain persisted.

Before the book, the idea that my back hurt because of emotional stress never occurred to me. Yet once it did, thanks to a local doc who treats many patients with the Sarno Way, it resonated. Plus, if nothing was wrong with me, I could stop living according to an ever-growing list of restrictions. I could bend, twist, run, and practice yoga. In fact, says Sarno, diving into activity and living life as a healthy, strong and capable person is the only way for the pain to go away. (See sidebar about diagnosis and treatment.)

So I did. And within days, the pain went away! As did a “sprained ankle” a year or so later and several small bouts of back pain since. As pain would creep up, I would think psychological not physical, even talk to or chuckle at my brain’s attempts to distract me, and it would melt away.

Of course, like any tool, the Sarno Way isn’t always appropriate and doesn’t always work (like, for instance, with my current bout of lower-back discomfort). And, to be very clear, saying that pain is due to TMS is not the same as saying that the pain is all in your head. On the contrary, the pain is very much in your body and excruciating. Rather, TMS is an intriguing alternative, especially when nothing else seems to help. Besides, considering just the number of people that I know who are physically strong and healthy and still in pain, I have to wonder: why do 60 to 80 percent of North Americans suffer from back pain at some point during their lives?

As Sarno poses in his book: “After a few million years of evolution, has the American back suddenly become incompetent?” Alternatively, as one recent article suggests, have we evolved with a weak back?

Or could the doctor from New York be right? Could our collective disorder stem from the combined effect of:

• Economics: Some $31 million is spent on office visits to physicians for back pain each year. In Healing Back Pain, Sarno refers to a 1986 Forbes article reporting that $56 billion was spent annually “to deal with the consequences of this ubiquitous disorder.” Basically, a lot of people make a lot of money from back pain related research, medication and therapy; puncturing a hole in the back-pain paradigm that supports this spending, suggests Sarno, would affect our economy.
• Modern medicine’s “love affair with the laboratory,” which doesn’t easily lend itself to the study of emotions. (Healing Back Pain, p.2)
• Fear: “… this pervasive concept of the vulnerability of the back, of ease of injury, is nothing less than a medical catastrophe for the American public, which now has an army of semi-disabled men and women whose lives are significantly restricted by the fear of doing further damage or bring on the dreaded pain again.” (Healing Back Pain, p.1)
• Physicians discomfort dealing with problems “related to the emotions.” (Healing Back Pain, p.3)
• Stressful lifestyles: “…88 percent of the people [I saw] had histories of such things as tension or migraine headaches, heartburn, hiatus hernia, stomach ulcer, colitis, spastic colon, irritable bowel syndrome…..and a variety of other disorders, al of which were strongly suspected of being related to tension.” (Healing Back Pain, p.ix)

What does Yoga say about Sarno’s Mindbody Pain? Whatever you think about Sarno’s theory, the connection between yoga and TMS is strong. To even consider TMS as a diagnosis requires disengaging oneself from the dominant paradigm. The treatment of jumping back into full physical activity also requires that we un-attach ourselves from what others say or think about our own bodies and mind. In other words, we must explore ourselves for and by ourselves. When we practice yoga, as we follow our breath through our body and mind, what do we feel about their connection? How do we feel about a dichotomy between the two?

It is only from this place of union, of yoga, that we can really consider the possibility of emotional pain flowing and finding its way in and out of our physical selves.

[End of article]

I just found these two interviews with Dr. Sarno online: http://www.tms-mindbodymedicine.com/medscape1.htm and http://www.tms-mindbodymedicine.com/medscape2.htm.

There are also numerous websites dedicated to TMS, which include personal accounts of TMS success stories. One example:http://www.tarpityoga.com/olive.html

Hi:
I have read the book, and strongly believe in the book, but I am still having lots of discomfort in my lower back. How do I get an appointment with Dr. Sarno?
Please help me out.

Hey there,

You must live in the New York area (I think CT and maybe NK count, too) to meet with Sarno. He doesn't take patients from outside the NYC area. There are other doctors, however, trained by Sarno who live around the country. Check out this link for doctors: http://www.tarpityoga.com/directory.html. I am sure that there are many more who use his method without being trained by him directly; I am not, however, sure how to find them…

In my experience, there are many ways to relate to the pain. Most recently, I have abandoned the "argue" method, as resistance tends to cause more mental/emotional tension and mental tension begets physical tension. As such, I have adopted a more mindful approach and, actually, can settle into a place with my breath and body (and pain) much like I do in my yoga practice. Just as I return to my breath and Awareness as anxiety/worries/thoughts rise and swirl, I return to a bigger-than-the-pain Self when the pain arises. I return to the present. The pain can exist if it wants to in the background; in the foreground, there is only breath, the present moment, and confidence that I am OK. When I allow the pain to fill the foreground –when I become mentally and physically consumed by it –this indulgence only serves to send me into fear, panic and more pain. Instead, confident in the diagnosis and the fact that it is TMS and not an injury, I can actually smile at the pain and even relax into it. Some days this is easy, other days it is near impossible. Still, it is a practice and a softer way of being.

Having said all this, I have also benefited immensely from the basic tenets of Sarno’s book and from a local doctor who uses the book.

I wish you luck.

Best,
Brooke

I read Dr. Sarno's Healing Back Pain book many years ago and, although it took awhile for the concepts to sink in, it worked for me! It literally changed my life because it taught me how strong a mind-body connection there is and to not always accept pain for what it is.

Give this book and the concepts a chance, give it time to "sink" into your subconscious mind, and you will probably feel better!

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Hi Brooke,

I can totally relate to what you wrote about Dr. Sarno's ideas seeming wacky at first. I was also skeptical at first, but eventually, his ideas cured me of over 10 years of chronic pain, so it is pretty hard to be skeptical now. ;-)

I also wanted to complement you on your wonderful description of using mindfulness with chronic pain: "The pain can exist if it wants to in the background; in the foreground, there is only breath, the present moment, and confidence that I am OK." I'm fairly new to meditation, but even to me, that seems spot on.

I thought that your readers may wish to know about a wiki that is starting up around Dr. Sarno's ideas:
http://tmswiki.wetpaint.com/
It is called the TMS Wiki, after the name (TMS) that Dr. Sarno gave the condition, and it aims to essentially be the Wikipedia of TMS. Like other wikis, it is free, so people who don't yet have one of Dr. Sarno's books can read it to figure out if they want to invest in one of the books.

The wiki has a special page for people who are just learning about "the Sarno way," and who think that they may have what he describes:
http://tmswiki.wetpaint.com/page/So+You+Think+You+Might+Have+TMS
I thought that it might be particularly helpful to your readers.

Regards,
Forest

Hi Michaella,

I don't know if you were referring to the original article or to the wiki, but if the latter, thanks! We've got a new feature where you can ask questions of doctors who understand TMS and have them answer your questions for free. Also, the forums are getting much more active, and we're always happy to see new people join our community. We're quite friendly.

F

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the only way to get cured from tms is to stick to john sarnos principles period. It has nothing to do with yoga. That just distracts away from the purity of the healing. Do you ever see John Sarno talk about yoga in his books. Never. Follow his approaches simple and straight from his books and if it won't fully stop the problem that means your repressed emotional issues are at a deeper level will counseling assistance from a tms trained pychologist, not the yoga master.

You go Peter! TMS has nothing to do with Yoga, or sound nutrition as have read elsewhere, or meditation. Get your facts straight folks! You can be a couch potato watching I Love Lucy reruns 24 hours a day and STILL get over the pain with TMS training. And...what is all of this about "pain in the background" on some days. If you still experience regular pain you need some help here: re-read the book! I have HAD back pain for over 30 years, diagnosis: herniated disc, had horrible sciatica etc etc...I am into 6 weeks of TMS training -i read different parts of Dr. Sarno's book daily -I have pain free days now. When i get a twinge -i go back to the book immediately. I have thrown out my orthotics that i had been using daily for 15 years, I walk everyday and use an aerobics tape i gave up on years ago due to all the after pain. I get a twinge of pain -or more than a twinge -I READ THE BOOK! It is sinking in to my subconscious! I have also had amazing horrible phantom pain -what to call it?
Enjoy yoga for yoga's sake -otherwise you are missing the point of TMS healing.

I am going to add a little more of what I know as well. Per having read Sarnos original book healing back pain 9 years ago, reading his newer book divided mind, seeing other conditions within myself go away from using his approaches, it has become apparent to at least me that he has touched upon only the tip of iceberg in terms of what tms really is.

I initially caught onto this because several years ago after stopping back pain, I started to have symptom imperative shifts to other types of problems, gastric reflux and strangly the disapearance of attention deficit disorder just as if I took a ritalin when I didn't. Then the problems would return with regular attention deficit disorder and then a shift to something new for symptoms like gastric reflux or lower foot pain. It shifted all over It became real obvious that tms cuases alot more then just back pain. The hypathalamus/ego will go after any form of distraction based symptom to keep you from thinking out bad emotional thoughts. The trick is to not only follow sarnos book for back pain, but to also figure out the anatomy based reaction of other conditions and you will get relief in those problems too.

For instance I figured out through research and professional experience in the educational/medical field that add is caused by oxygen deprivation to the muscles/tendions in your inner ear, that this cause disruption to an inner organ called the cochlea, which controls visual perceptions, auditory processing, equilimbrium/balance, fine motor coordiation (think about it add equates to lack of coordination, being impaired/distractable, most often auditory perception problems (missing little bits and pieces of what's going on). To put it simple its an attempt by the hypathalamus to distract you at an ultimate level. It also means that add has nothing to do with structural difference in the brain. Its just a distraction based condition caused by inner ear disruptions and the meds do nothing more then to over ride the problem by hyping up the focus capacities of your conscious mind.

TMS is more then likely the underpinnings of so many conditions that are not being treated correctly.

I think the trick is to learn sarnos book but then to go beyond it with other conditions and see if you break them with the same approach through an expanded understanding of the anatomy based underpinnings to soften things up.

P. Richmond

I am paying attention to all you say -and have already been wondering how far i can go with tms diagnosis, and am ready to take om my asthma, among other physical issues, mostly made up in my mind for total distraction.
I found that writing really opened the door for me. I was terrified of putting pen to paper, but as i did i found that i would be able to work through anger issues so quickly this way, I'd forget what was bugging me by the next day and could move onto the next lingering issue!
i don't know enough about all that add entails- but I think i will look this up -i do know i feel extremely focused since my mind is off any chronic back problem - I have spent many years not quite following through on various projects- but i may be mistaken about calling this add -feel free to correct me.
I have also just faced a death in my immediate family, but refused to hold back my pain, as i normally would, taking care of those around me first and foremost, and as horrible as it has been, i have been able to let the sadness & anger out and have had no back issues.
Don't tell my subconscious. I'm going to re-read your blob now.

dora email me directly with your email.. i have info for you but don't want to over monopilize the block... P. Richmond,

I think some of you are missing the point. Getting over TMS requires no yoga. Yes, of course. However, yoga is a philosophy imbued with practices to informs us of connection--connection to self, to others, between mind and body. It is about union, self awareness and non attachment among others; it is far deeper and broader than physical postures, though they are one way yogis drop in and connect to something larger than individual consciousness. The connection this article makes is on those levels, and uses the principles of this incredible tradition to articulate that which Dr. Sarno discusses. The words are different, the concepts the same. In no way does this advocate a different route that Sarno suggests: it merely points out the similarities between mindful awareness (yoga is the cessation of the turnings of the mind) and a way of being that helps people overcome tension-induced symptoms.

Put aside all the earthy talk and expain one thing to me if yoga is part of the tms healing process then explain why John Sarno does follow it as a solution in any way through his 3 books. In particular the newest one split mind where he tells therapists exactly how to cure people of tms and what psychological approaches to follow theres not mention of yoga. NOt one single time does he integrate or even talk about yoga being part of the process. Without yoga he has cured tens of thousands of people of the last 35 years, he has files and files upon all of them and not one one them used yoga as part of the process. People just stick with what works and only listen to John Sarno and do yourself a favor by ignoring all these other people.

Again, I think you are missing the point. In no way does he prescribe yoga; I am just merely making a comparison from the standpoint of having a practice and feeling the philosophical similarities. Really, no need to get defensive or aggressive. It's all good, and certain ways of thinking resonate with some and not others. I wish you the best.

I believe I feel peter's pain -in my opinion peter is not being the least bit aggressive but attempting to be crystal clear by making a solid point: yoga has no more to do with Sarno's tms cure than say, a sunny day at the beach.

Since John Sarno after 30 years of solid research put together a series of 3 books with all you need to know to stop tms, other people have jumped on the bandwagon and now integrated their own approaches or ideas with his, where the addoners ideas had no part of the 30 years of research that was done to prove anything. More then likely for business related decisions then medical ones. Its kind a psychological bartering to say well I've used my approaches for many years and of course even though I know now that John Sarnos approaches work, I'm not going to let go of what I've followed and built up, I'll just do a combination. The bottom line is that this man created 3 books, he research proved them with specific approaches written into his books, they spell out to therapists what to do and it don't include yoga or transmental medatation or the copy cat rehashes in other peoples books giving tms a different name (which unfortuntely has occurred via certain entrapunewers who wrote their own book). He discovered it all first and the recipee needs to be left alone because it works alone just the way its written.

what number do i call to make an appointment with dr.sarno?

Hi Adolfo -have you read the dr. Sarno books yet? Funny looking back at this thread- i last wrote in April- having been following the tms sarno method for only 4 months -and here it is 8 months later- i am so pain free after over 30 years of chronic back pain, sciatic, spasms, that i have more or less let sarno become part of my subconscious. I have given the Healing Back pain book to several friends over the past year-but not one embraced the sarno philosophy. i have come to the conclusion that if your pain is not truly chronic- daily pain- nightly sleeplessness -than you are more likely to completely forget about it until the next incident. and i don't know how to contact the dr. but there is an awesome website- and it you scroll back up this page you will find the founder and visionary for the tms site:ForestForTrees- here is the guy with the answers- including helping you find a dr. I wish you the best -i am off to buy myself a bike- a sport i have not been able to indulge in in 30 years- at an after christmas sale!

Hi aldolfo - I'm not too sure how many new patients Sarno sees, but his info is on the tmswiki's practitioner list at http://tmswiki.org/page/Find+a+TMS+Doctor+or+Therapist#US-NY . The one great thing about this list is that it has over 100 practitioners, so if you don't live near NYC there are a couple of other really good practitioners in other parts of the country you may be able to see.

@dorelle - thanks for the compliment. It is so great to hear that you were able to have such a miraculous recovery. Have you ever thought of writing up a success story?

Howard Schubiner runs a wonderful online program for TMS, which he calls MBS (mindbody syndrome). He's written a book that accompanies the program--it's more of a workbook than a text. He is an insightful, compassionate man and doctor who has worked with thousands of TMS patients. The website is unlearnyourpain.com. I highly recommend checking it out. The structure helps those of us who would otherwise get lost in the doubt that so often accompanies isolation. He is very responsive and generous with his time. The online chat room alone is worth the investment (course costs $250), and you have access to it indefinitely. If you do enroll, I'd love to hear your response--and, hopefully, success!