In a recent post I talked about my back pain and about the idea that much of it is not due to physical injury, but to emotional factors (TMS or Tension Myoneural Syndrome as the originator of the theory - Dr Sarno - now calls it). It is still real physical pain – not imaginary – but the cause is emotional. Public speaking can make you blush – a real physical reaction – but the cause is emotional. Physical pain can be the same thing.
In this post I interview a guy called Monte Hueftle, a long distance runner who has also battled back pain. He explains where his pain came from, how he finally identified the cause and - crucialy - how he has managed to cure it.
I first read Monte’s book – Get Rid of the Pain in your Butt Now! – a few years ago when my own back was playing up. My pain has returned recently and I have gone back to Monte’s book and one or two others. You may find this stuff a bit challenging and but I’d urge you to read and consider what Monte is proposing. I thoroughly recommend his book.
Monte can you give the readers a little bit of background on you as an athlete: what is your record as a runner?
Sure. I have been running since cross country in high school. I mainly focus on the longer distances. I have run 6 marathons with a PR of 2:42, 8 half-marathons – PR of 1:16:50. Haven’t run a 10 in a couple of years and that was around 36:10
Are you still competing?
Yes, I’ll be 49 in December, can’t wait to get to the 50-54 age group though. I train about 75 miles per week and have my sights set on running a new PR in the half early next year. One of my goals is to continue to set PR’s.
Most of the readers of this blog are fairly serious amateur athletes. We may not be that good, but we enjoy our training and love the sheer pleasure of movement and exercise. We take it seriously and it is a big part of our lives. As an athlete do you understand the frustration that many of us feel when we are unable to train or compete because of injury?
Absolutely I relate. Running was and probably is still the most important part of my life. When I had piriformis for 3 years it was the most depressing/frustrating time of my life. And this carries over into work life and your relationships. When you can’t do something you love and can’t completely figure out what is going on with the body it’s not much fun.
What sort of pain were you experiencing at its height?
I had chronic lower back pain from about the time I was 18 years old. I would get back spasm about 3 or 4 times per year and chronic stiffness in the legs and back. Incredible inner knee pain that came totally out of the blue but it was the piriformis and sciatica that just make running and life in general miserable. I had non-stop piriformis for 3 years.
Your book explains that you went through a whole series of treatments – physical therapy, massage, yoga. Did it help?
I got absolutely no relief from chiropractic, massage, nerve stimulation, orthotics, lower back brace, specific exercises to strengthen, acupuncture, relaxations exercises and knee brace.
How did you finally work out what was causing the pain?
I found Dr. Sarno’s book on healing back pain. The book described my physical condition, my Type-A personality and stated that the pain was caused by psychological dynamics like inner stress and tension. It also stated that the biggest key to healing the pain was to Think Psychological. This means that you must stop treating the pain/injury with physical treatments and that the pain symptom is always a signal to reflect on your thoughts and your emotions---what and how you are feeling.
How quickly did you manage to conquer the pain?
My chronic stiffness and back pain were gone within weeks—at least 90% of it. The piriformis and sciatica I had to work on myself a little more. It took me about another 7-8 months to be fully pain free. Much of that was due to learning how my thoughts and behaviours were generating inner tension and then on how to reverse or change those patterns. That was the hard part and this is why I have written three books on how to permanently end this pain disorder.
At first did you think that this approach – the emotional aspect of pain - was all a bit too “alternative” / hippy / weird stuff or did it make sense?
Two things about this:
1. When you have tried everything and are at a loss you are probably going to be more open to an alternative diagnosis.
2. I earned a degree in clinical hypnotherapy and had studied the mind body connection for quite a few years, so I was very open to it from the beginning. This is quite important to understand. A person must accept the mind body diagnosis in order to begin to think psychological and stop all the physical treatments. This is the biggest challenge for people and especially athletes who are really conditioned to treat any pain as an over-use or muscle imbalance injury.
Does you pain ever recur? How would you / how do you cope if it does?
Never like before. I have not had one spasm in nine years. The low back pain has never reoccurred. On occasion I will feel the sciatica or piriformis sensations. They are like a reminder to make sure you are paying attention. The key to coping is to always, always, always Think Psychological. The biggest key to remaining pain free is paying attention to your thoughts and behaviours. A person knows when they are creating inner tension or losing energy to a person or situation. When you monitor the psychological aspects of yourself and then change or redirect when you are creating lots of inner stress you can keep the pain disorder from coming back.
I must admit that I am pretty convinced by the argument that you and Sarno and others advocate. It seems obvious to me that mental and emotional issues have very real physical impacts on the body. An example I think of - which I suppose reveals my base nature – is sexual arousal. An image – even a mental image – that is explicit can easily cause a physical change in the body – an erection or whatever. Something wholly mental has an impact on the physical body. Does that make sense?
Yes, perfectly. Also people accept for example the tension headache or the ulcer caused by stress. Scientist have now shown us that emotions have physical locations in the body. The challenge is accepting this for chronic soreness, back and knee pain or piriformis, especially when you are an active person and you can associate the pain with activity.
How would you explain your approach to pain to - say - a recreational athlete struggling with persistent / intermittent back pain?
First, take a look at your history of pain and of treatments. Have you been able to successfully heal these pain symptoms or injuries? Also does it appear that you win certain battles of pain but then always seem to be fighting a new one, a new injury or a new pain symptom or location? It is important to take this type of investigation so that you can open your mind to looking at a completely different diagnosis as the cause of the pain.
Next I would want to make the association that people have with a tension headache and stress in their life or an upset stomach and stress. We all in some way are able to identify stress with affecting our body in some way. I would then ask this person if they identify themselves with the Type A personality behaviours—Striving, People Pleasing, Perfection, Highly competitive. Do they consider themselves the type of person that worries a lot and is being self-conscious and/or do them seem to hold their feelings inside. I would then explain that it is common for people with many of these qualities to generate a tremendous amount of inner tension and that there is a chronic pain disorder that is caused by this generation of inner tension. I would explain that this is real pain and it closely resembles the pain sensations felt by physical injuries.
Next I believe it is important for people to understand the biochemical event taking place in the body that is manifesting the pain. When our autonomic nervous system becomes overloaded with inner tension it will automatically constrict blood vessel walls. This means less oxygen is making its way to muscle and nerve tissue. When these tissues have their oxygen supply restricted the result is a variety of pain symptoms—burning, soreness, spasm, stiffness, shooting, burning, tightness and numbness.
While understanding the argument, I still struggle with back pain myself, particularly at stressful times of my life. I do my best to “think psychological” as Sarno prescribes, but sometimes I’m left more frustrated. I am aware of some of the things that stress me out – work, a relationship – but thinking about them doesn’t seem to get rid of the pain. Where could I be going wrong?
You just explained the major struggle most people have and why they remain stuck to some degree in this pain disorder.
For some, at least initially being aware of this pain disorder caused by psychological factors is enough to reverse the pain. However, I have discovered that usually just being aware of the stress-pain relationship and knowing that stress is the cause is not enough to reverse this disorder. Here is why. This is a chronic pain disorder caused by our daily, moment to moment, chronic behaviours and thoughts. So a person will be aware that they are in a striving, people pleasing mode, and they know that this is generating inner tension and then pain, but they don’t do anything else!
My work in this pain disorder is focused on helping people understand that they must begin to change their chronic behaviours and thoughts that generate inner tension. If a person doesn’t stop generating inner tension/stress they are not going to stop this pain disorder. It is significant to understand that a person in worry or being very self-conscious or holding in anger is doing two things:
1. Generating new inner tension and
2. Repressing emotional energy or holding it down, which also generates inner tension.
Awareness is where you must start, but once you are aware that you are generating tension/stress, you must learn how to change or redirect out of those patterns.
I admit that I still get a regular massage. Most of the time it is purely for relaxation but when I have a back spasm or cramp I do submit to their treatment. Could this be an issue – me still looking for a physical cause?
I am extremely anal when it comes to physical treatments. The short answer is that if you are doing anything to treat your body in the hope that it is going to somehow fix or cure your pain/injury, you are breaking the number rule on how to heal from this disorder. This is the crux of Think Psychological. It means that every communication that you make back to the body/pain/injury is psychological. In the beginning a person must be this anal about getting or even thinking about physical treatments. This may sound quite knit picky, but I am telling you it is a big, huge deal. If you can truly go and get a massage because it makes you feel good and by no means do you believe it is going to fix your body then yes, have at it. You must be completely honest with yourself here though.
Thinking psychological is also hard work! It is not easy to dwell on things that are painful / frustrating and disappointing to me. I sometimes feel that I am fighting my own mind.
Yes, in the beginning, it is mentally exhausting. For maybe the first time in our life we are actually paying attention to what we are thinking and then we are analyzing it and then trying to change it. But this becomes much easier and then it actually begins to give you more energy. At first you need to listen in on your inner conversations so that you are aware of what you are thinking. Once you are aware of your thoughts, the chronic ones become a signal for you to change or redirect out of that thought.
Here is what I mean. Let’s say you are a big worrier. You know that this worry generates tension and anxiety within you. The next time you catch yourself in these worry thoughts you make the choice to deliberately think a new thought, one that is not so much in worry, and then you built on that thought with another one. It is a process and it takes discipline and practice.
When we make the decision to stop generating inner tension so that we can stop manifesting pain we find the inspiration and energy to continue on. Because suddenly we begin to feel the results in our body and then we go “wow” this is fun, this is working and we keep moving forward with it.
How much pain do you think is caused by mental factors? Is it the predominant cause of pain and disability in our society?
I believe it is easily 90% and probably higher. My own case as an example. I’m 48 and I have averaged running about 50 miles per week for the past 30 years. I have had all sorts of back, neck, leg, piriformis, itbs and sciatica pain. Chronic stiffness and soreness and probably 25 back spasms. I can say that 100% of this pain has been due to psychological factors creating inner stress/tension. For the past 5 years I have been consulting with chronic pain patients and it is phenomenal to hear the success stories of people who have been in physical pain for half of their life, tried every treatment known to man and when they begin to apply the principles of treating chronic pain caused by inner stress/tension and anxiety, their pain goes away. It is absolutely astounding!
You seem to take quite a “spiritual” approach. Other writers working from the same premises seem to be a bit more into positive thinking. Fred Amir for example focuses very much on goal setting, rewarding his “inner child” and mental imagery. Does this just reflect your different personalities or are your approaches really similar?
Everyone at the core practices "Think Psychological". This always means the pain is a signal to think about how you are being/thinking and not to think physical injury or treatment.
I am 100% confident that this disorder is caused by inner stress/tension/anxiety, as are all TMS doctors. I take the approach of then getting to the core of how a person is generating this inner tension in order to reverse the effects. Everyone is generating inner tension through behaviours and thoughts. Period!
I was fortunate enough to experience my pain subside greatly though a very physical power yoga practice. What I realized though, it was not so much the physical exercise as it was the tremendous amount of mindful focus that it took to breath, hold locks, stay balanced, count your breaths and change postures that was the transformational healing force. Understand that it is impossible to be in angry or worry thoughts when you are counting breath #3, contracting your perineal muscle, holding in your abdominals, breathing closed mouth, while keeping your balance in a position that is stretching legs, arms and everything else.
It is impossible to be generating inner tension when you are being so mindful. So I began to apply this mindful focus to simple mindless activities like: eating, taking a shower, brushing your teeth, walking up steps. When you do this or I should say be this way you are not in your dominant chronic behaviours and thoughts that generate inner tension. Having been a certified, clinical hypnotherapist, I believe that imagery and hypnosis are very beneficial in helping a person understand their psychological make-up. I have been fortunate to be pain-free for the past 8 years.
The reason for this is three-fold:
1. Understanding that you must Think Psychological and not physical.
2. Realizing that you must change the unique ways that you create inner tension through your thoughts and behaviours.
3. Implementing an on-going practice: of paying attention, being mindful, having a focused practice like power yoga and utilizing different practices like guided imagery and journaling that help keep you in check and balance mentally-physically and emotionally.
One thing that I have thought of - prompted a little by Scott Sonnon is the idea that if the mind/emotions can affect the body, can the body also affect the mind/emotions? Are there physical things we can do that can prompt certain mental states?
I love what Dr. Elmer Green, the great Mayo physician and biofeedback expert stated.
"Every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state"
Physical exercise is the best example right. Go out for a high tempo 10 miler and experience the runners high. Do a highly focused 45 minutes of power yoga and you will feel emotionally and mentally clean. Practice guided imagery. Image energy or light moving through your body. Do it slowly at first and then have it move at the speed of light. Do this for 3-5 minutes and you and have changed the chemistry of your body and of your mind/emotions.
One of the themes of this blog is that I am very much sympathetic to the evolutionary fitness approach / primal blueprint. There are a number of writers now proposing diet and fitness approaches that start from the premise that we are still basically hunter gatherers and as such our activity patterns and diet should be those of hunter gatherers to promote health. We are still physically cavemen but we are living in a world that is very different form the one for which we were designed. One aspect of this approach that I think is underappreciated is the psychological. In his essay Evolutionary Fitness Art DeVany states:
Modern life leaves our minds restless and under utilitized because we are confined, inactive, and comfortable. That is why we restlessly seek stimulation and sensory satisfaction. Some find it in entertainment (an industry that could not exist but for the extraordinarily stimulating environment of our ancestors) in the form of television, movies, or novels. Others seek it in simulated adventure like mountain climbing or dangerous sports (like me). We cannot be satisfied with more and more, because we are evolved for another lifeway in which material goods do not matter. The result is that we are deeply unsatisfied with modern life and don’t know why.
Do you think primitive man – or even present day hunter gatherers – experience the sort of chronic emotionally induced pain that seems to dominate our societies?
Sure. Anyone anywhere that is competing and being self-conscious or striving to please or judging, comparing and complaining, holding in resentment, anger, guilt from the past or wishing for the future to arrive and not living in the present moment is susceptible to generating inner tension. When this becomes a chronic way of being it manifest into chronic pain.
For any of us struggling with chronic intermittent pain and stiffness, what would be the first step that we should take in tackling it?
Think Psychological and not physical.
Check how you are being, what you are thinking, where is your focus.
Who or what are you giving thought energy to.
Go into this psychological mode while totally stopping the physical treatments and thinking. Look at your past struggles and determine if the physical treatment approach has worked. Be open to an alternative cause of pain and then trust your intuitive self.
If readers wanted to learn more, what would you recommend that they should do?
Find a TMS book to read. Sarno has 4 or 5 out there. (That is Dr John Sarno)
I’m a little biased as I believe that my most recent book and cd program, The Master Practice, gives people the tms knowledge they need but more importantly the “how to” knowledge needed to reverse this pain disorder. There is a tremendous amount of free information at my site: www.runningpain.com
Monte – thanks for taking the time to answer these questions. I have enjoyed and benefited from your books and hope that other people might learn something from this too.
It was my pleasure to share this information. Thank you.
Contact Monte at firstname.lastname@example.org
Thank you for this fantasic interview. Long before paleonutrition captured my interest, I had an interest in psychosomatic medicine that started with my personal very successful experience with Sarno's principles. I have given out or recommended "The Mindbody Prescription" to hundreds of patients and acquaintances since.
I read MRIs for a living ( thousands of them by now) and I am convinced that perhaps 80% of all back, neck and shoulder pain - and tension headaches - is TMS - essentially due to the autonomic nervous system being used as an escape valve for painful or socially unacceptable emotions.
thanks for the comment. It is great to hear of a paleo supporter who believes in TMS.
Al the best
Excellent article. Many of us have come to these conclusions by our own route and in retrospect was a no-brainer. It seems that you must suffer to get there and the first step of salvation is to give up everything you think you know and learn how things are rather than what we want them to be.
Hans Selye(one of the most importants researchers on stress) said that "fascia is the organ of stress".
It's great to read something along those lines here :D Also, the current research on fascia is very interesting, if you got a bit of free time.
I am finishing med school and instead of doing the whole residency thing I am going to become a certified rolfer and prescribe paleo for a living.
a paleo prescription sounds good.
Not sure if rolfing would fit in with what Monte believes. It keeps the focus on the body rather than thinking psychological.
Thanks for your comment
If this is true, are there other disciplines that can/have applied Sarno's concepts to resolve other autonomic 'stress' issues? In other words.... can you lower your blood pressure without an expensive biofeedback machine? Let's take it further... can you lower intra optic eye pressure in a glaucoma patient? (IOP is a major known, though not exclusive, factor in glaucoma damage) Andrew Weil (sp?) wrote in one of his earliest books about creating a skin blister from hypnotherapy.... can anyone use it to cause cancer cells to die? IF Sarno is correct, the field should be wide open with other demonstrable examples.
Sarno's most recent book - The Divided Mind - looks at several other problems in addition to back pain. Blood Pressure is certainly one. Think of the common "white coat syndrome" where an individuals blood pressure rises in the presence of a doctor, simply through stress.
Fred Amir who also writes about this idea of TMS in his book - Rapid Recovery from Back and Neck Pain - states that he cured his hayfever through this approach and also improved his eyesight .
I think it is fascinating area - even the well recognised placebo effect when you think about what is happening is really intriguing.
Thank you for exposing me to this type of content as I have been thinking a lot about mind/body lately. I plan to check out more of the references, but my first reaction is that I believe the foods we eat are also a big factor in our mental health and physical pain. It is hard to argue that the effects of gluten and large amounts of sugar can reversed by practicing awareness. So many studies show how badly our bodies are affected by what we eat. But how can we leave out what our minds do to us?
It is so much easier to give up grains than to sit still for two 30 minute sessions each day!
if you read through the other posts on this blog you will note that I think a good - low carb higher fat, real food - diet is really important.
However, I also think that irrespective of diet much pain is due to emotional factors. Maybe a poor diet can exacerbate the stress but that may just be looking for a physical explanation for something that is clearly psychological.
Nick another thing which is related and which comes up in an interview that I'll be posting later tonight with Frank Forencich - is the idea of food as placebo. If you think something is good for you perhaps it will be! Again, the mind is powerful
Chris it is funny you mention food as a placebo. I picked up Sarno's 'The Divided Mind' yesterday. As I began reading his explanations, my naturally skeptical mind went to thinking about some of the issues that resolved when I switched to whatever one calls a paleo like diet with dairy (it started as a LC diet to manage blood sugar). One change was that my allergies went away. I started wondering if it was possible that there was some placebo effect that might be contributing to the change. However, this is not a change that I expected, so I'm not sure how placebo fits into that kind of model.
I agree that one dismisses emotional/mind factors at there own peril, though I keep resisting Sarno's explanations. It is the mind that holds us back in so many ways, and not just in how we may experience pain, but our enjoyment of life and the people around us.
Thanks for exposing me to so many new ideas on your blog.
p.s. I tried the Vibram Five Fingers and really wanted them to work. My toes are kind of curly and I couldn't get them into the slots!
Thanks for this wonderful article. emotions and one's mental state really are important part of physical fitness and training.
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