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.

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