Alan G. How does TMS cause tightness?

jen s · Nov 18, 2018

jen s said: ↑

I’m new here. I attribute my pain to 90% myofascial pain. When I have acupuncture or body work done, the pain is alleviated (until I do something to trigger it again). Are you saying my pain is not originally fascial/muscle tension in nature? That I get a pain from my brain and then tense in response? I feel quite in touch with my body and don’t feel an original non tension pain. Wondering if this is TMS or if I just have a lot of muscle tension?
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Alan, that answer was SO interesting! The brain is causing the pain AND causing muscle tension to happen, which is how it feels so real, as there is real tension. One thing that you said authentic indifference -- I have SUCH a hard time with this. I can't seem to be curious or indifferent about the pain. I genuinely don't want the pain at all -- I hate it , which I guess from what you are saying is feeding the pain. How do you come to this indifference? That is the hard part for me! It's like saying to be indifferent to being kicked in the shin --- that will never happen, as I'll always prefer NOT to be kicked in the shin -- every time. I have struggled for years to be the "curious observer" as I really can't find indifference. Would telling myself "I don't like it (the pain) but I accept that it's here right now and know that it's TMS and will eventually be gone"? Is that effective? So hard to be indifferent.

thmakled · Apr 23, 2019

jen s said: ↑

Alan, that answer was SO interesting! The brain is causing the pain AND causing muscle tension to happen, which is how it feels so real, as there is real tension. One thing that you said authentic indifference -- I have SUCH a hard time with this. I can't seem to be curious or indifferent about the pain. I genuinely don't want the pain at all -- I hate it , which I guess from what you are saying is feeding the pain. How do you come to this indifference? That is the hard part for me! It's like saying to be indifferent to being kicked in the shin --- that will never happen, as I'll always prefer NOT to be kicked in the shin -- every time. I have struggled for years to be the "curious observer" as I really can't find indifference. Would telling myself "I don't like it (the pain) but I accept that it's here right now and know that it's TMS and will eventually be gone"? Is that effective? So hard to be indifferent.
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I too struggle with ignoring the pain and cultivating authentic indifference because damn it, sometimes it really hurts and I'm tired of hurting! The cognitive battle can be exhausting, and ignoring tends to feel the same as challenging - the pain is so present that trying to ignore it just makes me think about it more. Yeesh.

Gojab · Sep 29, 2020

I just came across this thread and its likely no one is following it since its been so long. Nevertheless. I can add that 80% of my pain I think has been due to muscle tightness/spasm. Even before I read this thread in my mind I had reconciled that "mile oxygen deprivation" from TMS and muscle tightness were very close cousins. I could literally feel that some muscles, likely in my core, were not even there while some muscles in my back were working overtime. It even got to the point that my stomach was bulging out like crazy. I had no idea why.

I'm happy to report that I am 4 weeks out on my program, and my muscles have definitely relaxed. There is still some tightness but I am at a 1 pain level vs 7-9 that I have been for the past 2 years. My stomach is started to return back to normal.

Zuz · Apr 29, 2021

Gojab said: ↑

I just came across this thread and its likely no one is following it since its been so long. Nevertheless. I can add that 80% of my pain I think has been due to muscle tightness/spasm. Even before I read this thread in my mind I had reconciled that "mile oxygen deprivation" from TMS and muscle tightness were very close cousins. I could literally feel that some muscles, likely in my core, were not even there while some muscles in my back were working overtime. It even got to the point that my stomach was bulging out like crazy. I had no idea why.

I'm happy to report that I am 4 weeks out on my program, and my muscles have definitely relaxed. There is still some tightness but I am at a 1 pain level vs 7-9 that I have been for the past 2 years. My stomach is started to return back to normal.
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Waaaa I also have this stomach bulging sometimes up so I can hardly breath. At least for the last months I do not panic about it anymore being prettyvsure its TMS!
I am so looking into finding a therapist that can virtually help my twenty year back pain, I have so bad quality of life I am so looking forward getting better
Very enouraging to read you, thank you

Laleah Shoo Shoo · Oct 22, 2021

Alan Gordon LCSW said: ↑

Answer

This is an interesting question, and one I've thought a lot about. I recently spoke with Dr. Schechter and Dr. Schubiner about this, and I have a theory which is by no means conclusive.

There's a lot of evidence that TMS pain is a function of learned neural pathways in the brain. This is not new, TMS physicians have been talking about this for years.

So the pain is in the brain, we get that. But how does that account for the physical tension that some TMSers have - physical tension that can be so profound, other people, such as massage therapists, can even feel it? This physical tension seems to indicate that in some cases the pain is more than just an interpretation of neurons in the brain.

I believe that neural pathways in the brain can flip a switch, generating physical tension in the body. The way one responds at the onset of the pain determines whether the tension perpetuates, or whether the switch flips off.

This is where the idea of outcome independence comes in.

If you buy in to the pain and generate fear, it sends signals to the brain and the switch stays flipped. You're in a fight or flight state, the tension and pain remain, as their psychological purpose is being fulfilled.

If on the other hand, you don't buy in to the fear, the switch eventually flips off. The pain and tension subside, as their psychological purpose (fear, preoccupation) is not being served.

An example: One of the many manifestations of TMS I had was heel pain. It came on one day out of nowhere. I don't remember banging it or anything, but even the slightest pressure was enormously painful. It felt like what it feels like when you have a bruise. There was clearly a lot of physical tension in that area.

For two days I limped, trying to figure out whether it was TMS or an actual injury. Then, I got a magical piece of evidence that changed everything. I woke up at 4 AM and had to go to the bathroom. Groggily, (is that a word?) I walked to the bathroom and back to bed. I was so out of it that I forgot to limp. But I didn't have any pain!

That was all I needed to know that for sure, definitively, it was TMS. The next day I forced myself to walk without a limp, reaffirming my evidence, standing up to the fear, and not caring whether or not it hurt. My goal was not to get rid of the pain, rather it was to hone a level of authentic indifference about whether or not I had pain.

It was hard. All those websites that I looked up days before saying you can develop long-term heel pain if you don't rest a bruise flashed through my mind. But I kept on repeating the evidence:

"It didn't hurt at all when I mindlessly walked on it barefoot at 4 AM."

Of course my fear brain would counter:

"What if it hurt but you were just too groggy to realize it?"

Me: That doesn't make any sense.

Fear brain: What if it didn't hurt because you'd been sleeping beforehand and it was rested a little?

Me: No, Schubiner said if it was a real bruise, it'd hurt even more after inactivity, not less...

I knew it was TMS.

By the end of the day, the pain and the physical tension were gone. I'm sure that if I had bought in to the fear and continued treating it like a structural injury, the pain and tension would have persisted. I believe that by interrupting the fear cycle, the neural pathways that were sending signals to generate tension in my heel were effectively switched off.

The muscular tension is real, but the source of the tension is the brain, and the way to ultimately relieve it is not through a physical intervention, but a psychological one.

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

Click to expand...

Laleah Shoo Shoo · Oct 22, 2021

Alan Gordon LCSW said: ↑

Answer

This is an interesting question, and one I've thought a lot about. I recently spoke with Dr. Schechter and Dr. Schubiner about this, and I have a theory which is by no means conclusive.

There's a lot of evidence that TMS pain is a function of learned neural pathways in the brain. This is not new, TMS physicians have been talking about this for years.

So the pain is in the brain, we get that. But how does that account for the physical tension that some TMSers have - physical tension that can be so profound, other people, such as massage therapists, can even feel it? This physical tension seems to indicate that in some cases the pain is more than just an interpretation of neurons in the brain.

I believe that neural pathways in the brain can flip a switch, generating physical tension in the body. The way one responds at the onset of the pain determines whether the tension perpetuates, or whether the switch flips off.

This is where the idea of outcome independence comes in.

If you buy in to the pain and generate fear, it sends signals to the brain and the switch stays flipped. You're in a fight or flight state, the tension and pain remain, as their psychological purpose is being fulfilled.

If on the other hand, you don't buy in to the fear, the switch eventually flips off. The pain and tension subside, as their psychological purpose (fear, preoccupation) is not being served.

An example: One of the many manifestations of TMS I had was heel pain. It came on one day out of nowhere. I don't remember banging it or anything, but even the slightest pressure was enormously painful. It felt like what it feels like when you have a bruise. There was clearly a lot of physical tension in that area.

For two days I limped, trying to figure out whether it was TMS or an actual injury. Then, I got a magical piece of evidence that changed everything. I woke up at 4 AM and had to go to the bathroom. Groggily, (is that a word?) I walked to the bathroom and back to bed. I was so out of it that I forgot to limp. But I didn't have any pain!

That was all I needed to know that for sure, definitively, it was TMS. The next day I forced myself to walk without a limp, reaffirming my evidence, standing up to the fear, and not caring whether or not it hurt. My goal was not to get rid of the pain, rather it was to hone a level of authentic indifference about whether or not I had pain.

It was hard. All those websites that I looked up days before saying you can develop long-term heel pain if you don't rest a bruise flashed through my mind. But I kept on repeating the evidence:

"It didn't hurt at all when I mindlessly walked on it barefoot at 4 AM."

Of course my fear brain would counter:

"What if it hurt but you were just too groggy to realize it?"

Me: That doesn't make any sense.

Fear brain: What if it didn't hurt because you'd been sleeping beforehand and it was rested a little?

Me: No, Schubiner said if it was a real bruise, it'd hurt even more after inactivity, not less...

I knew it was TMS.

By the end of the day, the pain and the physical tension were gone. I'm sure that if I had bought in to the fear and continued treating it like a structural injury, the pain and tension would have persisted. I believe that by interrupting the fear cycle, the neural pathways that were sending signals to generate tension in my heel were effectively switched off.

The muscular tension is real, but the source of the tension is the brain, and the way to ultimately relieve it is not through a physical intervention, but a psychological one.

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

Click to expand...

Laleah Shoo Shoo · Oct 22, 2021

Hello everyone,

After several years of living without pain ~ having moved through 3 years of debilitating pain via educating myself through Dr. Sarno, Ozanich and this forum....
I am now in relentless excrutiating pain, severe sizzling tingling down the leg, shocking pain back of knee, crapped squeezed calf and half numb foot. I had a smaller version
of this for one year,12 weeks ago i awakened with these sensations a hundred times more intense. Haven't been able to sleep much, walk teeny steps, haven't been able to go outdoors,
there truly isn't one position i find respite in. After finally getting to the ER last week (an utterly appalling experience, which i won't go into, as it is difficult to type standing up....
so to the point ~ I have decided absolutely this is TMS....and doing all i know to unravel all that has such a grip on me....listening to your audio book, Alan Gordon..practicing somatic experiencing which i know well (Peter A. Levine) ...the list is long...ihave so much at my disposal, many internal resources and so on....And i find it impossible to believe that i should SIT on this
intractable nerve pain! Even though coming from the brain. I am not being as articulate as i would like to be....too painful to type standing up. So i will leave this half-baked note...
Doing all i possibly can to stop feeding the brain that is in error. It's one long day that goes on and on, while i continue to practice and surrender into Divine guidance.
Love and the best to you all xoxoxox

Laleah Shoo Shoo · Oct 22, 2021

There is much i have left out, due to typing difficulty with pain....which would flesh this out more and explain why i feel this happened....and why i wonder at how long
i can go on and on this way. I am from Montreal, Quebec and have been 'stranded' in Victoria, B.C. (long story) wanting very much to leave. I know not a soul here...all friends and family back home.
And so i am with this on my own, which isn't a good thing as we are 'wired for connection' and need each other in this life. I have always been surrounded with many....so being in isolation with all of this...ai yai yai! okay, more another time

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