Introduction
Dr. John Sarno identified a condition he called Tension Myositis Syndrome (TMS), which he believed was the cause of various forms of chronic pain. According to Dr. Sarno, these pains are an unconscious “distraction” created by the brain to help repress deep-seated emotional issues. To alleviate the pain, he advocated first understanding and accepting that the source is emotional rather than physical, then working mentally to address both the syndrome and the symptoms.
Here, I’ll briefly outline Dr. Sarno’s approach in light of my personal experience.
How I Discovered Sarno’s Insights
For several years, I suffered from persistent knee pain that limited my ability to practice yoga and enjoy long hikes. This pain primarily affected poses like Padmāsana, Janu Śīrṣāsana, and Vīrāsana, where I worried about further aggravating my knee condition. Although I could do standing poses and short walks (up to 30 minutes) without discomfort, longer hikes—especially on downhill paths—would trigger pain. Trekking, which I love, became increasingly difficult. I had to reduce my time on the trails and relied on pain relievers when I did go.
An X-ray revealed worn cartilage in both knees, with the left side worse than the right. However, my pain often shifted between knees, with the right knee usually causing more trouble—an unusual pattern, but as I later learned, typical of TMS.
I treated my knees with yoga therapy, which did help but didn’t solve the problem completely. It gave a temporary relief, and kept the mobility and strength of my knees and legs, but the pain in the knees persisted.
Last May, a student at my retreat in Morocco introduced me to Dr. Sarno’s work. She mentioned someone who had recovered from severe back and knee pain through Sarno’s method and was now able to run and compete in triathlons pain-free. I met this person, who introduced me to Dr. Sarno’s insights and guided me in applying his method.
Who Was John Sarno?
John Sarno (1923–2017) was a Professor of Rehabilitation Medicine at New York University School of Medicine and an attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine. Through years of treating patients with various orthopedic issues, Sarno recognized that conventional treatments often failed to provide lasting relief. He observed that even back surgeries frequently offered only temporary respite, if any at all.
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Understanding TMS
Dr. Sarno defined TMS as a psychosomatic condition that causes chronic pain in the back, neck, and limbs, often unresponsive to conventional medical treatments. He expanded this concept to include other ailments, such as gastrointestinal issues, as TMS-related. According to Sarno, the root cause is often psychological and emotional. Pain or other symptoms act as an unconscious “distraction” to suppress deep emotional issues. When patients start to explore what might be causing this unconscious distress, they disrupt the mind’s repression strategy; as a result, the pain can subside once its purpose is understood.
Sarno wrote, “TMS is a new diagnosis and therefore must be treated appropriately. Just as antibiotics target bacteria, treating pain caused by emotional factors requires a psychological approach” ([1] p.16). Steve Ozanich, another proponent of TMS theory, elaborates, “Pain has a protective purpose. People don’t want their pain—they need it to conceal inner turmoil” ([2] p.19). He explains that feelings like fear, anxiety, and anger manifest as physical pain, shifting the focus away from unresolved emotions.
In the chapter The Psychology of TMS, Sarno noted that traditional medical diagnoses focus on the body but overlook the mind’s influence on physical ailments ([1] p.49).
My Learning Process
To immerse myself in Dr. Sarno’s approach, I read Healing Back Pain: The Mind-Body Connection [1] and The Mindbody Prescription [3]. I also watched All the Rage [4], a documentary on Sarno’s work, and read Back Pain Permanent Healing by Steve Ozanich [2]. Additionally, I used the Curable app [5], which provides guided meditations, instructions, and personal healing stories based on Sarno’s principles. Podcasts such as Tell Me About Your Pain and Like Mind, Like Body [6], both produced in partnership with the Curable project, further deepened my understanding.
Rethinking Pain
Six Basic Truths About Pain
The Curable app highlights six key insights into pain, informed by contemporary science:
- Knowledge is power – Education about pain is a recognized medical treatment of pain (called: neuroscience education).
- Pain as protection – Pain is a danger signal meant to keep us safe, though it can also occur without any injury.
- Pain is more than physical – Physical injury is just one of many factors that contribute to pain. In chronic cases, it may be one of the least significant factors. People in life-threatening situations often feel no pain, enabling them to act quickly despite injury.
- All pain originates in the brain – Every pain sensation is the brain’s decision, based on signals it receives. An injury signals the brain, which decides the pain level necessary to protect you.
- Pain is subjective – Pain reflects the brain’s opinion of how much discomfort you need to experience at that moment to stay safe.
- To heal, treat the brain – For chronic pain, the brain’s contribution is typically much greater than any physical factor. The modern approach to pain takes into account all contextual factors, not only physical ones. This is called the biopsychosocial model.
Pain Rarely Caused by Structural Abnormalities
Sarno critiqued the traditional view of pain, which often attributes it to structural issues in the spine or deficiencies in muscles. He argued that TMS is a physiological but benign condition of the soft tissue, not the spine, brought on by emotional factors.
For instance, he states, “…structural abnormalities of the spine rarely cause back pain” ([1] p.123). Studies have shown that spinal issues visible on X-rays, like degenerative changes, don’t necessarily correlate with pain. Sarno and Ozanich cite research from the 1970s comparing X-rays of people with and without back pain, which showed no statistical difference in degenerative issues between the groups ([1] p.136).
In Sarno’s view, disc degeneration is a natural part of aging, like graying hair or wrinkles, and is not typically a source of pain ([1] p.127).
These results were verified by many other studies. For example, a 2021 study found that describing MRI results to patients produces a negative perception and poor functional outcomes. This again shows the effect of emotions and psyche on pain perception [7].
Who Is Most Affected by TMS?
Sarno observed that individuals prone to TMS are often perfectionists, highly responsible, and self-critical. These people tend to generate stress, anger, and anxiety, often subconsciously, while maintaining a controlled and self-disciplined exterior.
He cited examples of patients who took on significant responsibility in both their personal and professional lives, describing them as highly motivated, disciplined, and self-demanding. Sarno found that those affected by TMS often repress their emotions, preferring to present a “put-together” image to the world, which comes at a cost to their physical health ([1] p.56).
The Path to Healing My Knee Pain
Several factors contributed to my recovery from knee pain:
- Understanding the true cause – Reading Sarno’s work and listening to related podcasts helped me recognize the emotional origin of my pain. This knowledge, once internalized, was transformative.
- Reevaluating physical activity – I learned that engaging in poses that challenge my knees, such as those I previously avoided, can be healing when done gradually and mindfully.
- Emotional awareness – Recognizing my tendency to suppress emotions, especially frustration and anger, helped me see how these feelings manifested physically. I started allowing myself to release pent-up emotions through movement and vocal expression, especially in private, natural settings.
- Managing professional expectations – As a yoga teacher, I am expected to be calm and supportive of every student. However, acknowledging that not all students invoke the same reaction in me and that some situations can be frustrating, I allowed myself to feel and release these emotions rather than internalize them.
One practice Sarno suggests is talking directly to your brain, reminding it that one can handle the emotions and the pain is not necessary. This approach, though initially surprising, has proven effective for many, including myself.
Conclusion
Dr. Sarno believed that to heal from TMS, one must accept that the pain has emotional roots. Although I didn’t entirely buy into his theory at first, I remained open to the possibility that it could help—and it did. I now practice all the poses that once caused me discomfort or that I had avoided altogether. I still sometimes experience mild pain in my knees, but I don’t worry about it; it usually disappears quickly. I haven’t had a chance to go on a challenging trek yet, but I didn’t suffer pain on the hikes I did recently. I now can practice all the poses that I used to avoid or had limitations with. This is very significant for a yoga teacher who practices daily and demonstrates while teaching.
Of course, it is important to rule out any severe conditions that may cause the pain. Hence, it’s important to get a diagnosis from a medical doctor with TMS experience. There are more and more doctors and therapists who know about TMS and can guide you with this. Seek professional advice in your region.
My journey of self-awareness and healing has been life-changing, allowing me to resume an active lifestyle without pain.
I am deeply grateful to Dr. Sarno for his work and to everyone who guided me along this journey. I hope my story inspires others suffering from TMS to explore these insights and find their own path to healing.
References
[1] Sarno, John E.. Healing Back Pain the Mind-Body Connection
[2] Steve Ozanich, Back Pain Permanent Healing
[3] Sarno, John E.. The Mindbody Prescription – Healing the Body, Healing the Pain.
[4] All the Rage
{5] the Curable app
[6] the podcasts: “Tell me about your pain” (See here) and “Like mind, like Body” (See here).
[7] “The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials”, (see here).
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