The Great Back Pain Myth

If you fear suffering, you are already suffering from your fear. – Michel de Montaigne

This article is adapted from a section of my book, What is a Real Life?, titled, “The Physical: Reflection, or Disguise?” That section is from the 2nd of three chapters on subjective and objective reality (you can see an outline of the book here, though it is somewhat dated). You can get the full book at this page on Amazon.

I would like for this article to focus on chronic pain and to be accessible to people regardless of what they think about the nature of reality (if anything at all), so I have cut out the pieces on subjective reality. But don’t worry: you can still find them in the book!

First, I explain what Tension Myositis Syndrome (TMS) is and how it works. Then I tell the over-dramatized story of my experience with chronic pain to drive home the points made in the first part of the article. It’s a bit drawn out, but I want to really illustrate this experience to you to help you see its validity (well, I should say, its lack thereof).

I stand by what I have written here, and also what I have read from Dr. Sarno. I’m not one to create hype, but if you’re suffering from chronic pain, what you’re about to read could change your life. I hope you’re ready, brother.

(By the way, if you find typographical errors in this, such as spelling or grammar, let me know so I can change them in the book)

What I am about to tell you is based on the work of Dr. John Sarno—specifically, on his book Healing Back Pain. Here goes.

The basic premise of Sarno’s work is that most chronic pain is symptomatic of a condition (or an equivalent thereof) known as Tension Myositis Syndrome, or TMS. In TMS the brain produces pain in a particular area of the body even though there is nothing physiologically wrong with that part of the body. Sarno has hypothesized that the brain does this to distract the mind from repressed emotions that lie underneath. These are emotions that are difficult to deal with—most often, they are emotions such as anger and anxiety.

Most often the pain of TMS occurs in the lower back, the glutes, the neck, and the shoulders. Sarno asserts that most of the structural abnormalities we believe to cause pain, such as herniated discs, spinal stenosis, bone spurs, and scoliosis do not actually do so. There are also diagnoses we make in which we believe pain is due to problems with the body, but in actuality this is not the case. Such diagnoses include pinched nerves, osteoarthritis, spina bifida, fibromyalgia, and plantar fasciitis (pain in the foot). There are even conditions unrelated to back pain which Sarno believes serves the same purpose as TMS—that is, to distract the mind from repressed emotions. Such conditions include ulcers, spastic colon, irritable bowel syndrome, hay fever, asthma, migraine headaches, eczema, acne, hives, dizziness, and ringing in the ears (perhaps this includes tinnitus).

For several years I have regarded pain to be linked to underlying emotional conflicts. However, I had always thought of the pain as an outgrowth of those conflicts—that resolving the conflicts would make the pain go away. But Sarno suggests that the pain is meant to distract from the conflict. He writes,

                For many years I was under the impression that TMS was a kind of physical expression or discharge of the repressed emotions just described… but the idea of TMS as a physical manifestation of nervous tension was somehow unsatisfactory and incomplete…

                It was a psychoanalyst colleague, Dr. Stanley Coen, who suggested… that the role of the pain syndrome was not to express the hidden emotions but to prevent them from becoming conscious. This, he explained, is what is referred to as a defense. In other words, the pain of TMS… is created in order to distract the attention of the sufferer from what is going on in the emotional sphere. It is intended to focus one’s attention on the body instead of the mind. It is a response to the need to keep those terrible, antisocial, unkind, childish, angry, selfish feelings (the prisoners) from becoming conscious. It follows from this that far from being a physical disorder in the usual sense, TMS is really part of a psychological process.


What supports Sarno’s view of the pain as a disguise rather than an outgrowth of internal conflict is the fact that the pain tends to go away when a patient is made aware that the pain does not actually represent ill health in the body and instead is, in fact, a veil which covers (yet is not caused by) psychological distress.

Sarno also has found that an understanding of the covered-up psychological conflict is not necessary. If it was, he says, his “Cure rate would be zero.” Sometimes all it takes to be liberated from pain is to acknowledge it for what it is: a distraction from repressed anger and anxiety. You just have to recognize that the emotions are there. That revelation can be, on its own, enough to alleviate months and years of suffering.

Of course, this revelation is aided by further knowledge about how TMS and similar conditions operate (the knowledge, Sarno writes, is the cure). If you have ever suffered chronic pain, you probably have found that your pain intensifies when you do certain activities. Perhaps your lower back hurts when you bend over to lift something up, rather than squat. Your knees hurt if you run too much. Maybe your butt hurts if you sit on a cushiony chair rather than a hard one.

There are all sorts of rules about proper physiological movement and functioning we have been taught. Don’t wear heels. Don’t slouch. Don’t sit too long. Don’t exercise too much. Don’t sleep on a soft mattress. Pain is the result of physical weaknesses and imbalances. And so on.

What Sarno concludes, however, is that most of these rules are bullshit (yes, bullshit is my word—not his). The real culprit at play here is not physiological issues: the pain of TMS does not represent actual problems in the body—remember? Instead, the villain of TMS is conditioning. Our bodies turn into houses of cards that can’t handle certain stimuli because we have developed a belief system that is likewise a house of cards.

When pain persists for a while we tend to think that something must be wrong with the body. If you are unaware of Sarno’s work or related work, this is a fairly logical conclusion to reach. We assume something must have messed up our bodies. So then we start looking for things that might mess up our bodies further. Because the mass of people are unaware of how TMS works there are all sorts of ideas about what people with certain types of pain should and shouldn’t do. These ideas are so persistent in current American society that we take them for granted.

Once we accept such beliefs as true, we pave the way for pain to worsen. As the pain worsens, we become further entrenched in the beliefs. By way of belief, we become restricted. We are now at the mercy of rules—rules that come from stories. When we live inside a story- and a bad one, at that- we are fragile. We are at the whims of the storybook world.

Likewise, when we believe that something is physiologically wrong with us and thus that there are physiological activities we should avoid, we also think that physiological treatment is what we need. We think that ice packs, heating pads, deep massages, biofeedback, compression sleeves, braces, chains, and whips are what we need to heal. Of course, because nothing is actually wrong with the body, these treatments do nothing. In fact, some may even create the very weaknesses which we blamed our condition on in the first place.

It may seem ridiculous to imagine that all this suffering is the result of mere thought. But recall that TMS is a primarily psychological condition: the only physical thing about it is the pain. This is a condition created by the brain. It’s all a façade. It makes perfect sense, then, that beliefs influence the course of TMS so strongly.


An Athlete’s Story of Chronic Pain

I have been a distance runner for 7 years. I ran all through junior high, high school, and my sole year of college. As such, I have been exposed to all manner of myths about pain. The most persistent myth I have been exposed to as a runner is that of the overuse injury. The term is straightforward: if you make a particular movement too often, you will hurt your body.

The first four years of my running career I basically regarded the phenomenon as true. I was never hurt too badly until I was about 3 and half years in— specifically, in Outdoor Track during my sophomore year (age 15). I had a strict rule at the time about never, ever running more than 6 days in a row. I was certain that if I didn’t take a day off every week, my body would crumble and die. Early in the Outdoor Track season, however, I was weaseled into running a whole eight days in a row. For some insane reason, on a particular Sunday, April 1st, 2012, I went for a 30 minute run (yes, I have the documentation to prove it). I cannot imagine why I would do such a thing, because that week we had three whole meets with the first being on Monday, and the last on Saturday. That meant that unless I skipped practice I would have no choice but to run all 7 days. You know what I did that was even more ungodly? I ran the day after Saturday too. That’s right—I ran on Sunday. Again. For a whole 20 minutes. I ran a jaw-dropping 8 days in a row. I cannot imagine what parasite must have been eating at my brain. Certainly not the kind that takes your writing skills away.

For some other unknown reason- perhaps God was kind to me and cancelled practice- I did not run the following Monday. Thus, I was spared from running an unimaginable 14 days in a row. Still, what happened at the end of that second week was horrifying. I also had a strict rule about never, ever doing a speed workout (i.e. running fast) the day before a meet. But for some reason, on Friday that is precisely what we did. And for what may have been the first time in my life, I did not finish that workout. My knee was bothering me at the start of practice. Halfway through that workout it was really bothering me. I was worried. I told my friends; they told me to stop. I did so reluctantly.

Before my first race the next day- the 3000 meters- the middle-aged head coach, who we will call Bill, stretched out my bad leg, and unmercifully so. Asking him to help you stretch was a death wish: it hurt more than my knee did without intervention. First I laid on my back and stuck the bad leg straight up. He pushed back on it (so that the leg moved toward me), and I had no idea how flexible I was until that moment. Then, staying on my back, I kept the leg above me but this time I bent it inward, so that my calf was squished against my thigh. Then, pushing down on my knee, he pushed the leg toward the opposite side of my body. I thought I was going to lose the leg.

Unfortunately, these death stretches were not enough to keep me from struggling during that race and the other I ran that day. Compared to past performances I ran quite slow, clocking in at 11:26 in the 3000 and at 2:46 in the 4x800 meter relay. As I would find throughout the season, no other amount of stretching did much to help me, either, though I believed it would.

Eventually I discovered that there was a knot, or muscle cramp, right behind my knee. I went nuts went I felt it. I knew that must be the culprit. I now formed a new belief—that knots behind the knee caused pain at the front of the knee. With advisement from my athletic trainer, I conjured up another treatment protocol in addition to stretching: applying heat to the back of the knee before exercise. It did not take away all the pain, but in my mind it was necessary to staying safe.

For about two weeks after the struggle-racing and death stretching, I was restricted. At meets I was limited to competing only in the 4x800, and at practice I was forced to suffer running very little, while watching everyone else happily go about the actual workout. This was the first time I ever had to sit out. I was devastated.

Before my one and only race at a meet one day, the second-in-command coach, who we will call Panda, pulled out a curious container from the first aid kit (more fondly known as the “med kit”). It was filled with a strange blue goop labelled Biofreeze. He told me to apply some to the back of my knee, so I did. But that wasn’t enough, so I put on more. A magical thing happened: I ran my race without pain! It was amazing! Of course, after the race pain very slowly and gradually returned to my body, and I was advised to use ice on the knee. I was not and am still not a fan of ice, but I did as I was told and entered, for 20 minutes, a realm of cold. That day, another rule was picked up: Biofreeze is my savior. For some reason, however, I would consult Biofreeze only several other times over the next few years. I preferred to tough things out if I could. Or maybe I was just masochistic (mmm, pain).

The pain remained with me until there were about two weeks left in the season. I have no idea why it let up. But of course, this would not be the end of my battles with long-term pain.

So, when did I begin to question the credibility of the overuse injury? Well, the next bout of chronic pain came to me at the end of that Summer, which marked the beginning of my junior year of high school as well as my fifth cross country season. This time pain struck in the left foot, near the toes. This pain, though not as quickly-debilitating, was much nastier: it remained with me for 8 months—that is, the whole schoolyear.

Certainly the pain was worse at some times than others over those 8 months. It steadily got worse throughout the cross country season until the very end. Then it let up for a while, and the old knee pain returned to me early in Indoor Track and took over. Then, in the middle of the Indoor season, the foot pain reached a critical mass after a race. I was certain that I was next to fall victim to a stress fracture, just as many of my friends had. Up to that point, I had always worn shoes with spikes screwed into the bottom during races. It wasn’t as necessary on the track as on a muddy cross country course, but I liked to imagine it gave me an extra edge. But I decided the edge was worth it no longer. I picked up another rule that day: no more racing in spikes. Only once would I attempt to wear spikes again after that day. It went over just as badly.

My rules about shoes didn’t stop there, however. I made radical changes. I decided that I was no longer going to wear shoes that had elevated heels by any measure. Then, I gave up shoes that were too narrow. At that point, all I had to wear to school were my sneakers. Then, I gave those up too.

Through the Internet I discovered that I could buy racing shoes that had nowhere to insert spikes. These shoes are called racing flats. They look just like spiked shoes, except that the spike-holes were closed up. It seemed perfect: the shoes were light and wide. The material they were made of was flexible, so I had plenty of room to wiggle my toes. There are rules in interscholastic running communities about how it is dangerous to wear racing flats when you aren’t racing—let alone, to train in them and walk around school in them all day. But I defied their rule by making up my own rule. The rule was this: from now on, I only run in racing flats—and, as much as possible, I avoid all other shoes. To this day I have never again slipped into a pair of sneakers.

In fact, the rule really was, Avoid all shoes as much as possible. On one cold March day, just prior to the start of Outdoor Track, I decided to go for a three mile run around my neighborhood—in nothing but socks. When I got home, the socks were destroyed, and my feet were giant. I couldn’t pop the blisters because they were filled with blood. That was the day before America’s Greatest Heart Run and Walk. I missed the Heart Run that year.

After adopting this new rule and embracing the new shoes the pain calmed down, though it didn’t fully go away until Spring. Of course, right around then I kicked a door angrily one night after a meet because I was locked out of the school. Then it all came crashing back.

It wasn’t until that Summer, just prior to my senior year, that I considered that the whole overuse injury thing might be a fluke. Sure, both my knee and my foot pain had caused me quite a bit of suffering the last year—there was no doubt about that. But I never stopped running. It boggled my mind to watch teammates get taken out by stress fractures in their feet while I, though afflicted with similar pain, kept going. Were they just weak? Malnourished? Was I just special? I had been waiting so long for something in my body to finally snap, and I now was skeptical that it ever would. I figured that I just had pain which, though it hurt quite badly, was, in essence, benign.

Two years later, I can tell you that my skepticism was correct. Though I would go on to again fall to the pain-facilitated illusion that something was soon due to snap inside me, it never did.

My skepticism deepened a year after I began to question overuse, when I started training for my first ultramarathon (100 kilometers, or 62.1 miles). I worked my way up to running 60 miles per week. Then I went up to 75. Then 85. The week of the race, I ran 95 miles. How could it be, I wondered, that runners are getting diagnosed with overuse injuries at 30 miles a week, while I’m all the way up here in the 90s? That Summer, I suffered no pain. All those claims of running being bad for the back and the knees—where on Earth did they come from? I assumed that part of my pain-free success was due in part to my lack of emotional distress at that time: I was incredibly confident in my ability to complete the race. I didn’t have the full picture of how chronic pain works just yet, but I was on to something. In addition to that, I still held on to some conventional rules: I also credited my success, in part, to increasing mileage slowly—that is, by 5 miles a week. Of course, that ignores the fact that after I got up to 60 miles I starting making 10-15 mile jumps from one week to the next.

Unfortunately, it was shortly after this point that I began to develop a textbook case of TMS. Before that happened, however, I was afflicted during cross country (freshman year of college now) with intense pain in my left heel. As with my previous bouts of foot pain I doubted that the heel would turn into an injury. Again, I was correct. However, I couldn’t doubt that it hurt. The rule I picked up: the heel hurts the worst after a run. It hurts a little less if I take my shoes off. So when I got to class after practice on Monday and Tuesday nights, the shoes usually came off.

The true torture began in mid-December, about a month into the Indoor Track season. This was also immediately after the end of the Fall semester, so I had a month to train on my own. I decided that within that month I was going to train for and compete in a 100 mile race in Buffalo, New York. The day after I signed up I decided that I was going for a 20 mile run—the first run longer than 12 miles since my last ultramarathon in August. But I only completed 10 that day. Just 3 miles in I started freaking out. I can’t handle being alone out here for all these hours, I thought. I need to go fast. I need to get this running thing over with. It was right around that time when pain dug its claws into my left glute—more lovingly labelled, my buttcheek.

As one might imagine, I made up even more rules. Try to stand up as much as possible. Be careful on long runs and going up hills. Don’t run on the indoor track at school—my femur might pop out!

By the start of Spring the pain had gone down substantially, though it still hurt pretty bad. It hurts worst during speed workouts. This is why I’m slow. Of course, it was also around that time that my lower back begin to hurt. I found new rules which suited both body parts: No more powerlifting—deadlifting especially. No more sleeping in bed—sleep on the floor. Avoid sitting on chairs or other furniture with cushions. Things hurt less when I don’t wear shoes (okay, that’s an old one).

See how lost in our stories we get? It might be accurate to say that my freakout indeed caused my butt pain. But such “trigger” events don’t always happen: my back pain was a bit harder to explain. Sure, I could have blamed it on running or lifting weights, but I always did those things. Really, it seemed to just start out of nowhere. Perhaps my butt hurt more because the story behind it seemed more believable. It was only at the very end of my pain days when my back started to hurt more, because I was told a believable story for that as well (regarding how different body parts were interacting with each other to create the pain I was having).

Thankfully, I believed this story for only a few days before I found Sarno’s book, in August 2015. By this point I had suffered from glute pain for 8 months and back pain for 4. I completed the book in one several hour session, and after understanding the information I immediately felt better. I went for a run very shortly after, and I was already running far faster than usual. I felt awesome. Since then I have been sleeping in my bed, running, lifting heavy objects, and wearing shoes with no problems. The pain does still arise at least once per day, but once I recall that nothing is actually wrong with my body, and that the pain is just masking repressed emotions, it usually goes away.

Sometimes I find it useful to acknowledge what it is that I am angry or anxious about. First, I’ll go over a list of the basic situations. It’ll be something like, Work, My running performance, This person, That person, and so on. Then I might start to think more specifically about the anger and anxiety-inducing aspects of those situations. Now that I’m not held back by pain anymore, how fast can I get? Should I start entering races? Short races? Long races? Should I compete on a team again? I should note that the feelings aren’t particularly intense—I’m not sweating or crying or shaking during this. But they are present. If I deny that, then I shall remain in pain.

This isn’t always necessary, but sometimes the pain does not go away until I do this. Just the other day the knee pain I suffered in high school (which, if you recall, I had tried to resolve through heating and death-stretching) was with me when I woke up in the morning. Since I read Sarno’s book the pain has been moving around in my body rather quickly: when one area “heals” the brain often tries to afflict others. Even just as I mentally did battle with the pain for several minutes I felt it move from the back of my knee, to my calf, to my ankle, and back up again. I struggled a bit with rules of mine about how my knee probably hurt from laying in bed too long (though I don’t advocate such activity/lack thereof anyhow), and my ankle might be hurting from not doing the usual ankle-strengthening exercises (I have decided to stop doing those to test whether I really need them to avoid pain). A few times I felt the pain ease up for a moment, and that’s how I knew it couldn’t be a real injury. But even then I kept struggling.

After a few more minutes I felt what I had to do was to dive right into the emotionally-distressing situation. Not only did I have to acknowledge what it was—I had to mull over every emotionally-charged piece of information. This regarded a particularly emotional relationship I have with another person, which I recently made a few mistakes in. I imagined myself, from a first-person perspective (meaning I was “in” the visualization—not just observing it) saying all the things to her I need to say. After our “conversation” ended, the pain was gone.

Overall, you have to take your pain on a case-by-case basis. Don’t make presumptions: be present to your current concerns, needs, and desires. There may be more to you than you imagine.

In the end, all it may take is to stop thinking and simply be. Thought is the source of all worry.




So, how can you be sure of whether you have TMS? Well, the best thing to do would probably be to visit Sarno, but that isn’t viable for everybody. Instead, you can simply apply your knowledge about the condition and see whether it produces change in you. I imagine I have provided a minimally sufficient amount of information here, though you will learn much more from Sarno’s book Healing Back Pain. I do not, of course, intend to portray myself as a doctor here—I simply wish to distribute useful information.

Suspend your beliefs about the proper ways to lift, sit, and exercise. Suspend your beliefs about all the problems in your body that might be causing pain. Nothing in your body is causing this pain, except for your brain. Even if you’re presently unaware of emotional conflicts, simply acknowledge that you may indeed have one lying around in your subconscious, and your pain is trying to distract you from this.

Don’t get discouraged if it doesn’t work right away. Remember that sometimes you do indeed have to become aware of specifically what your conflicts are, and even less commonly, to begin working through them. Sarno reports that about 5% of his patients need the help of psychotherapy to overcome their condition. Usually these are the patients with the most intense physiological conditions, such as fibromyalgia, and thus the most intense psychological conflicts as well.

Also remember that the brain likes to be tricky: it may move the pain to another part of the body. It also will recreate the pain even after you initial realization. However, as long as you can continually remind yourself of the truth about your pain, you can fend it off.

If you are without success for at least several weeks it may be in your interest to visit a doctor, to make sure that the pain isn’t coming from an actual pain-inducing condition such as cancer. Additionally, Sarno’s thoughts on autoimmune disease are uncertain (as are mine). Be wary of what the doctor tells you, however: it may be that you do have an abnormality in the body such as scoliosis or a bone spur, but remember that these conditions do not cause pain.

Please note that suspending your beliefs about the rules discussed here does not encompass all rules regarding physical health. Provided you believe this, there is no substitute for physical activity and a healthy diet. I will not elaborate on these things here, but if you are sedentary and dependent on junk food, don’t be surprised if you become dependent on the healthcare system as well.

It is your duty to form accurate beliefs and to become the expert of yourself. No one can live in your body or in your mind except you. “Expert” opinions can be insightful, but they are not always correct. Sometimes they’re in the dark just as much as you are—if not, even more so. They just give the impression that they aren’t. At the end of the day, make sure to listen to yourself after you’ve listened to everyone else.