Tension myositis syndrome

Tension myositis syndrome

Tension Myositis Syndrome (TMS), also known as Tension Myoneural Syndrome, is a condition originally described by John E. Sarno, MD, a retired professor of Clinical Rehabilitation Medicine at New York University School of Medicine 1. Sarno is a vocal critic of conventional medicine with regard to diagnosis and treatment of back pain, which is often treated by rest, physical therapy, exercise and/or surgery. Tension myositis syndrome is a condition that causes real physical symptoms, such as chronic pain, gastrointenstinal issues, and fibromyalgia, that are not due to pathological or structural abnormalities and are not explained by diagnostic tests. In tension myositis syndrome, pain symptoms are caused by mild oxygen deprivation via the autonomic nervous system, as a result of repressed emotions and psycho-social stress.

The tension myositis syndrome diagnosis and treatment protocol are not accepted by the mainstream medical community.

Tension myositis syndrome causes

According to Sarno, tension myositis syndrome is a condition in which unconscious emotional issues (primarily rage) initiate a process that causes physical pain and other symptoms. His theory suggests that the unconscious mind uses the autonomic nervous system to decrease blood flow to muscles, nerves or tendons, resulting in oxygen deprivation (temporary micro-ischemia) and metabolite accumulation, experienced as pain in the affected tissues. Sarno theorizes that because patients often report that back pain seems to move around, up and down the spine, or from side to side, that this implies the pain may not be caused by a physical deformity or injury.

Sarno states that the underlying cause of the pain is the mind’s defense mechanism against unconscious mental stress and emotions such as anger, anxiety and narcissistic rage. The conscious mind is distracted by the physical pain, as the psychological repression process keeps the anger/rage contained in the unconscious and thereby prevented from entering conscious awareness. Sarno believes that when patients recognize that the symptoms are only a distraction, the symptoms then serve no purpose, and they go away. tension myositis syndrome can be considered a psychosomatic condition and has been referred to as a “distraction pain syndrome”.

Tension myositis syndrome symptoms

Back pain is frequently mentioned as a tension myositis syndrome symptom, but Sarno defines tension myositis syndrome symptoms much more broadly than that:

  • Symptom type: tension myositis syndrome symptoms include pain, stiffness, weakness, tingling, numbness, muscle contractures, cramps and other negative sensations, according to Sarno.
  • Symptom location: In addition to the back, Sarno states that tension myositis syndrome symptoms can occur in the neck, knee, arms, wrists, and other parts of the body. Schechter states that the symptoms have a tendency to move to other parts of the body. He considers symptom movement an important indicator that the pain is from tension myositis syndrome 2.

Tension myositis syndrome diagnosis

Below is a list of criteria for diagnosing tension myositis syndrome, according to Schechter 2 and Sarno 1:

  • Lack of known physical cause: Schechter and Sarno state that a physical examination, tests and imaging studies is needed to rule out serious conditions, such as tumors. Sarno considers spinal disc herniations to generally be harmless, because he says the symptom location does not even correlate to the herniation location 1.
  • Tender points: While medical doctors use eleven of eighteen tender points as a diagnostic criteria for fibromyalgia, Sarno states that he uses six main tender points to diagnose tension myositis syndrome: two tender points in the upper trapezius muscles, two in the lumbar paraspinal muscles and two in the lateral upper buttocks. He states that these are found in 99% of tension myositis syndrome patients 3.
  • History of other psychosomatic disorders: Schechter and Sarno consider a prior history of other psychosomatic disorders an indication that the patient may have tension myositis syndrome. They list irritable bowel syndrome and tension headache as examples of psychosomatic disorders 3.

Schechter and Sarno state that if a patient is unable to visit a medical doctor who is trained in tension myositis syndrome, then the patient should see a traditional medical doctor to rule out serious disorders, such as fractures, tumors and infections 4.

Tension myositis syndrome treatment

The treatment protocol for tension myositis syndrome includes education, writing about emotional issues and resumption of a normal lifestyle. For patients who do not recover quickly, the protocol also includes support groups and/or psychotherapy 5.


Education may take the form of office visits, lectures and written and audio materials. The content of the education includes the psychological and physiological aspects of tension myositis syndrome 2. According to Schechter, the education allows the patients to “learn that their physical condition is actually benign and that any disability they have is a function of pain-related fear and deconditioning, not the actual risk of further ‘re-injury” 2.

Writing about emotional issues

Sarno states that each patient should set aside time daily to think and write about issues that could have led to the patient’s repressed emotions. He recommends the following two writing tasks:

  • Writing a list of issues. Dr. Sarno states that each patient should try to list out all issues that might contribute to the patient’s repressed emotions. He suggests looking in the following areas:
    • (a) certain 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,
    • (c) current life stresses and pressures,
    • (d) aging and mortality and
    • (e) situations in which the patient experiences conscious but unexpressed anger.
  • Writing essays. Dr. Sarno recommends that the patient write an essay for each item on the above list. He prefers longer essays because they force the patient to examine the emotional issues in depth 6.

Schechter developed a 30-day daily journal called “The MindBody Workbook” to assist the patient in recording emotionally significant events and making correlations between those events and their physical symptoms. According to Sarno and Schechter, daily repetition of the psychological process over time defeats the repression through conscious awareness 7.

Resumption of a normal lifestyle

To return to a normal lifestyle, patients are told to take the following actions:

  • Discontinuation of physical treatments – Sarno advises patients to stop using spinal manipulation, physical therapy and other physical treatments because “they tend to reinforce erroneously a structural causation for the chronic pain” 5.
  • Resumption of normal physical activity – Schechter states that patients are encouraged to “gradually be more active, and begin to resume a normal life” 2. In addition, patients are encouraged “to discontinue the safety behaviours aimed at protecting their ‘damaged’ backs” 4.

Support meetings

Sarno uses support meetings for patients who do not make a prompt recovery. Sarno states that the support meetings (a) allow the patients to explore emotional issues that may be causing their symptoms and (b) review concepts covered during the earlier education 5.


Sarno says that about 20% of his patients need psychotherapy. He states that he uses “short-term, dynamic, analytically oriented psychotherapy” 5. Schechter says that he uses psychotherapy for about 30% of his patients, and that six to ten sessions are needed per patient 2.

  1. Sarno, John E. (1991). Healing Back Pain: The Mind-Body Connection. Warner Books. ISBN 0-446-39230-8
  2. Schechter D, Smith AP, Beck J, Roach J, Karim R, Azen S. Outcomes of a mind-body treatment program for chronic back pain with no distinct structural pathology–a case series of patients diagnosed and treated as tension myositis syndrome. Altern Ther Health Med. 2007;13(5):26–35.
  3. Sarno, John E. (1998). The Mindbody Prescription: Healing the Body, Healing the Pain. Warner Books. ISBN 0-446-52076-4
  4. Schechter, D., Smith, A. Back Pain as a Distraction Pain Syndrome. Evid-Based-Integrative-Med 2, 3–8 (2005).
  5. Rashbaum IG, Sarno JE. Psychosomatic concepts in chronic pain. Arch Phys Med Rehabil. 2003;84(3 Suppl 1):S76–S82. doi:10.1053/apmr.2003.50144
  6. Sarno, John E. (2006). The Divided Mind: The Epidemic of Mindbody Disorders. HarperCollins. ISBN 0-06-085178-3
  7. Schechter D. The MindBody Workbook. Los Angeles: MindBody Medicine Publications, 1999, ISBN 1-929997-05-1.
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