Bringing TMS theory into clinical practice

Hi all,

I wanted to put this question out there to any of you using TMS theory in your clinical or professional practice. How did you get started with this?

I've been so happy and excited to discover this world of TMS/PPD and it has been instrumental in helping me cure my own chronic back pain. As a physical therapist I am excited and eager to eventually bring it into practice to help my own clients, as I think many of them will benefit as we all have. Once you learn about this you just can't ignore it! It is clearly all around, as many of us know.

I feel a bit of a dilemma presently because I practice in a rather traditional healthcare organization that has no knowledge of TMS theory/thinks about pain in a much more conventional way. At the moment I would not be able to branch off and start using TMS theory while working for this organization.

It is a goal of mine to eventually practice in a setting (whether for another group or my own practice) that allows to work with TMS clients. I'm just in the beginning stages of thinking through all of this and would love to hear any of your stories of how you built a practice around all of this. Thanks!

 

I suggest you contact Georgie Oldfield, who is a PT in England who practices completely from a TMS perspective. She started an organization there that is quite active called SIRPA, which I believe stands for Stress Illness Rehabilitation Professionals Association. They hold conferences and provide ongoing support to professionals interested in a TMS perspective. She has also written a very good TMS book, Chronic Pain: Your Key to Recovery. Her contact information is listed in the TMS provider section of this wiki.

I'm not aware of a comparable organization in the US, but maybe you can start one

 

You might also reach out to Alicia Batson. She told me she wants to help anyone in the field expand into incorporating Dr. Sarno's work. Very supportive!
http://www.tmswiki.org/forum/threads/a-physicians-tms-story-rsi-hyperacusis-and-much-more.7658/ (A Physician's TMS story - RSI, Hyperacusis and much more.....)

Georgie's work would be a great template for you, probably! I wonder if this is the only method she uses, or a mix. I would think it would be hard to "ride two horses at once" with regards to clarity for yourself and clients... I guess many physicians kind of "feel things out" with clients before introducing Dr. Sarno's work?

The most simple way to begin, in your work, I believe, is to introduce the idea that the pain may be increased by stress. This is acceptable for most. I know Dr. Sarno mentions this as already accepted, but his work goes all the way to the root. For many clients this would be a start however, to have them direct their attention to their feelings/experiences/pain levels. Also, recall that Dr. Sarno mentions that only about 10% of the population is open to the "TMS approach." In my experience, most people do not believe pain can be caused by inner tension, and I do a lot of education/outreach for my practice.

Good luck in your work!

 

Thank you both for the suggestions! I was also thinking of Georgie Oldfield as a contact point to get started and will also contact Alicia Batson. I've been reading all the Sarno books and have started Unlearn Your Pain and some of the others to get ideas for treatment templates.

Andy, you're right on all of that, though if even 10% of my clients accepted TMS theory and were open to the education i'd be thrilled! I see an extremely wide range of people with issues varying as widely as stroke and spinal cord injury survivors who need intensive "traditional" PT services, to clients who I now know are clearly suffering from TMS pain. (Some might even need both if they have true "pathology-caused" mobility impairments but also suffer from chronic pain!)

One thought I had about "riding two horses at once" was this- for the clients open to the idea of stress causing/contributing to pain, I could introduce them to TMS theory by recommending they read Sarno. They would still benefit from a general strengthening program but it would be important for me to emphasize this is for general health and NOT to fix their pain. Emphasizing there is nothing "wrong" with the painful body part would be key too (as long as their MD has ruled out any pathology).

I have a lot to think about, reading to do and people to contact, thanks again for the suggestions!

 

Hi MindbodyPT,
I follow everything you say, and it makes perfect sense. I only went to PT for chronic pain, so I didn't get the full picture of what you all do. Good luck!

 

MindbodyPT, you could make such a difference!

At the height of my pain, I was referred to the PT, with the diagnosis of carpal tunnel syndrome. Unlike three MDs who could not see the forest for the trees of my symptoms, she quickly diagnosed me (well, unofficially, since she was just a humble PT - sarcasm!) with the Complex Regional Pain Syndrome. That was my first step to recovery - I finally knew what it was. She was awesome in each and every way within the confines of conventional PT and the time allowance provided by Kaiser: smart, nurturing and tactfully forceful. But when I brought her Sarno's Mindbody Prescription, she literally freaked out. She told me: don't you ever tell anybody that it is all in your head, they will think you are crazy! To Andy's point, she did recognize the role of stress in development of disease, but she flat out denied the psychological approach to recovery.

It has been 8 months since we parted our ways. She told me that several of her patients with CRPS got better, but none fully recovered. I am waiting to prove her wrong, but I have improved at least 50% since then. I wish she was more open minded - like you.

My two cents, speaking from experience: despite Dr. Sarno's prescription to stop PT immediately, I still use some of the exercises that my PT gave me, as a supplement to the emotional work that I am doing. I find it important, to use PT as a thoughtfully designed regiment, on top of the Sarno's approach. In my case, in addition to chronic pain, I have dystonia, which is involuntary contraction of the muscles and PT is very helpful to make all the affected muscles and tendons work.

I wish you the best of luck on your path!

 

I think it's so awesome that you were open to TMS as a Physical Therapist! Since so much of a PT's focus is on the structural and physical.

On the other hand, I imagine you may experience frustration when some patients don't improve and it may be natural to wonder about the psychological aspects of pain.

 

TG957 and Cap'n, thanks for the encouragement! TG957 thanks for sharing that story...I understand many PTs would not be open to Sarno's theories. I'm sorry yours wrote it off as "all in the head" which speaks to the stigmatization of anything that sounds even remotely psychologically caused! I might be a little more open to this stuff as I have an undergraduate background in psychology and counseling and several family members in mental health fields, which helps. (Though I don't think it should take this kind of background to be open minded enough for TMS/PPD theory!)

Regarding the dystonia- yes traditional PT is certainly helpful there and i'm glad to hear it has helped you out! My subspecialty is actually working with clients with neurological dysfunction (though I see chronic pain/orthopedic clients as well) so I definitely know how helpful that can be.

I certainly have experienced frustration (as have all PTs) when some patients' pain doesn't seem to improve despite doing all the "right" techniques. I think TMS theory really puts it all together for me! In an ideal world I think PTs would be attuned to pain caused from either/both structural or psychological causes.

Career goals! Now I have my work cut out for me...thanks for the support

 

Yes, this experience was very common for me as a client. Should pain, do PT. Whiplash, do PT. Etc. But none of it really worked... It is exciting for me too, to know that you have added this understanding of Dr. Sarno's and it "really puts it together" for you.