Tension Myositis Syndrome VS Physical Therapy - are they compatible?
It is very uncommon to encounter someone with chronic pain or Tension Myositis Syndrome who hasn’t tried or isn’t still doing some kind of physical therapy. The benefits of physical therapy in the cases of injuries and other physical conditions are undeniable: you get to improve range of motion, strengthen your muscles and ligaments and condition your body for everyday use.
So why do they say that tension myositis syndrome and physical therapy cannot go together? Why did Sarno stop recommending physical therapy to his chronic pain patients, and what should you do if you’re reluctant to let go of it?
Physical Therapy for Chronic Pain - the acute vs chronic pain distinction
There is nothing like physical therapy to get you back on track after an acute injury. I’ve witnessed the benefits of it first hand on my close ones, and I encouraged them and supported them fully in their recovery. But unfortunately, I failed to experience the benefits of physical therapy myself, when I had chronic TMS pain and did not know it.
Of course, this is because both me and the therapist had a very bad idea of the true ‘cause’ behind my pain. We thought that it was ‘acute’ pain, stemming from a shoulder injury. But in reality, after weeks of therapy and lots of frustration, it should have been clear that this was a chronic pain condition, not necessarily or wholly caused by tissue damage. To understand this better, I encourage you to read my article on acute vs chronic pain.
Several months down the line, I started to get extreme sciatica, calf and thigh pain. Once again, I blamed it on a cycling injury and headed straight to the pain doctor, who recommended a physical therapist. This therapist was ‘excellent’ at his job. By excellent, I mean that he had great knowledge on how to strengthen every part of the body, and this gave me confidence. In fact, I remember I walked out of his clinic with barely any pain left at all, even though he’d just given my leg muscles quite a workout! A combination of the placebo effect and the increased circulation from the physical exercises helped alleviate my TMS sciatica pain and I felt positive and motivated.
And yet, the pain gradually returned, and I found myself wondering; he had blamed my pain on muscle weakness as well as on a flat foot, and he believed that by strengthening my limbs, this could help me get rid of pain. If this was so, then why were there so many unfit, overweight people out there, who had NO pain at all, while I, a slim 28-year old who had probably had my flat foot for all of my life anyway, and who tried to keep active and healthy, was suddenly experiencing such intense pain? Why had my flat foot suddenly ‘decided’ to cause pain? I posed these very questions to the physical therapist, and got that disturbing answer: “I don’t know how to answer you”.
Physical Therapy and the Nocebo effect
Of course, anyone who knows about Tension Myositis Syndrome knows what the answer is. The fact is, my flat foot and my ‘weak’ muscles had NOTHING to do with my chronic pain. And this is exactly why physical therapy was not for me. By hearing my therapist cite these diagnosis as the causes of my pain, I was feeding my brain more false information: basically, I was telling my mind and body that I was physically weak and ‘imperfect’, and that I had to work hard to ‘undo’ or compensate for this ‘damage’. This is the Nocebo effect at play, which is the very opposite of the placebo: physical therapy had me think that something was terribly wrong on a physical level. And the more I practised the exercises, the more I was ‘feeding’ and repeating this wrong information to my brain.
Luckily, I stumbled upon TMS later and was convinced by it to such an extent that my new beliefs replaced those false, old ones. I did visit my therapist again and told him about it. He didn’t sound convinced, but he did admit that when I had been seeing him, I had looked depressed and heavy, and told me how much happier and brighter I looked now. He did concede that mood and positivity has a lot to do with recovery. A few months later, I sent my husband to this same therapist following a severe cycling injury (a real, acute injury). He got him back to normal in a few weeks and we’ve still got his number saved somewhere.
So should I stop physical therapy?
If you are convinced that you’ve got TMS but you’re still taking physical therapy, there are two things you can do. You can either 1) Stop altogether, OR 2) continue with the exercises and treat them simply as a workout to get fitter. But if you go for the second option, you have to be very careful of the information that you’re feeding your brain.
TMSers who are still doubting the TMS diagnosis and who still partly believe that there is a structural imperfection or damage causing their pain had better not go down the road of physical therapy, unless the therapist himself is familiar with the mindbody syndrome and TMS. If your therapist is constantly feeding you the idea that there is something terribly wrong with your body, you should definitely stop seeing him or her.
Another thing to be fully alert to is your own ‘desire and need’ to see the therapist. Some patients end up in a cycle of ‘addiction’ to seeing their favourite therapist or doctor, due to the temporary relief they experience after a session and the practitioner’s kind and encouraging approach. This comes from our innermost need to feel cared for and supported. Of course, it will be more likely for pain to manifest again once a person feeds on this need, as a way of getting him or her to have a good excuse to return to this therapist.
In my case, I had continued with the exercises as a way to gain some strength. My therapist had even sent me to the gym, and since I couldn’t yet go rock climbing (which is by far my preferred form of exercise), I signed up for two months at the gym to get a good workout a couple of times a week. But I was 100% convinced and firm in the belief that I had TMS, and that what I was doing at the gym was simply a workout, and not ‘therapy’ as such. Once I started to climb again (because the pain went away completely, never to return), I quite the PT exercises and gym altogether.
In the end, our beliefs are what shape our reality. Adopt the wrong beliefs, and you may just end up creating a not-so-desirable reality. Discover the truth and adopt the correct beliefs, and you’ll be well on your way to positive change.