Can you exercise with Tension Myositis syndrome (TMS)?

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Tension Myositis Syndrome (TMS), also known as Tension Myoneural Syndrome, is a condition popularized by Dr. John Sarno, a physician and professor of rehabilitation medicine.

TMS is characterized by chronic pain, often in the back, neck, and limbs, which Dr. Sarno attributed primarily to repressed emotions rather than structural abnormalities.

Given the widespread impact of chronic pain, many individuals diagnosed with TMS wonder whether they can safely engage in exercise.

By understanding how movement and physical activity affect TMS, you can make informed decisions about your fitness routine and overall well-being.

Understanding TMS and its psychological origins

Dr. John Sarno’s groundbreaking work on TMS suggests that the pain experienced is not caused by physical damage but rather by the brain’s response to unconscious stress, anxiety, and repressed emotions.

He discovered that the body restricts oxygen flow to certain muscles and nerves as a defense mechanism, leading to discomfort and chronic pain.

According to Dr. Sarno, the key to overcoming TMS lies in recognizing its psychological origins. He advised patients to resume normal activities, including exercise, without fear of injury.

Dr. Sarno emphasized that movement itself is not harmful but rather that fear and stress about pain can reinforce the cycle of discomfort.

Can you exercise with TMS?

The short answer is yes - you can and should exercise with TMS.

Dr. Sarno strongly encouraged physical activity as part of the recovery process. He believed that avoiding exercise due to fear of pain could reinforce the brain’s pain pathways, further entrenching symptoms.

Exercise helps recondition your mind and body, reassuring your nervous system that movement is safe.

However, it’s essential to approach it with confidence and the understanding that discomfort does not necessarily indicate damage.

Role of exercise in TMS recovery

While Dr. Sarno’s theories were largely based on clinical observation, recent scientific studies support the idea that exercise can be highly beneficial for individuals with chronic pain conditions, including TMS.

1. Study on pain neuroscience education and movement

A 2024 study published in The Journal of Pain examined the effects of pain neuroscience education (PNE) combined with graded exercise therapy in individuals with chronic musculoskeletal pain.

The findings showed that participants who learned to reconceptualize pain as a brain-generated phenomenon experienced significant reductions in fear-avoidance behaviors and increased physical activity levels without worsening their symptoms.

This aligns with Dr. Sarno’s assertion that understanding the psychological basis of pain is key to overcoming it.

2. Exercise and chronic pain desensitization

A 2020 study in Pain Medicine explored the effects of aerobic exercise on pain perception. 

Researchers found that consistent exercise led to decreased sensitivity to pain, likely due to the release of endorphins and improved neural regulation of pain signals.

This supports the idea that movement can help retrain the brain and reduce pain perception.

3. Psychological factors in chronic pain relief

A 2012 study in Archives of Internal Medicine investigated the impact of cognitive-behavioral therapy (CBT) and physical exercise on patients with chronic lower back pain.

Results indicated that both approaches significantly reduced pain levels, but those who engaged in regular exercise showed greater improvements in function and overall quality of life.

These findings reinforce Dr. Sarno’s perspective that overcoming fear and engaging in physical activity are critical components of TMS recovery.

Best types of exercise for TMS recovery

If you have TMS and are hesitant about exercise, consider starting with activities that encourage movement without excessive stress or fear.

Some recommended forms of exercise include:

• Walking - Low-impact, accessible exercise that promotes movement without excessive strain.
• Yoga - Encourages flexibility and relaxation while helping you reconnect with your body in a non-threatening way.
• Swimming - Provides full-body movement with minimal impact on the joints.
• Strength training - Helps build resilience and confidence in your body’s capabilities.
• Pilates - Increases muscle strength and tone, particularly of your abdominal muscles, lower back, hips and buttocks.
• Dancing - Adds an element of joy and playfulness, reinforcing positive emotions and movement.

The key is not necessarily the type of exercise but your mindset. Approach physical activity with confidence and a belief in your body’s resilience.

Overcoming fear of movement and pain

One of the biggest challenges people with TMS face is the fear that exercise will worsen their pain.

However, this fear can actually reinforce pain pathways in the brain. Here are some strategies to help you overcome it:

• Acknowledge the psychological component of TMS - Recognize that your pain is not caused by structural damage but rather by the brain’s learned response to stress and emotions.
• Gradually reintroduce movement – Start with gentle activities and slowly increase intensity as your confidence grows.
• Challenge negative thoughts – Remind yourself that movement is safe and necessary for recovery.
• Engage in enjoyable activities – Choose exercises that bring you joy, helping to shift focus away from fear and toward pleasure.
• Seek professional guidance if needed – A therapist or coach familiar with TMS can help you navigate the process of returning to exercise.

Conclusion

Exercise is not only safe for individuals with TMS, but it is also a powerful tool for recovery.

Dr. John Sarno’s work suggests that movement is essential in breaking the pain cycle by addressing the psychological roots of chronic discomfort.

Recent scientific research supports the idea that physical activity, when approached with the right mindset, can help rewire pain pathways and improve overall well-being.

If you have been avoiding exercise due to fear of pain, consider shifting your perspective.

Recognizing that TMS pain is not a sign of physical damage but rather a conditioned response can empower you to move freely again.

By gradually reintroducing movement, challenging fear-based beliefs, and choosing activities that bring you joy, you can take meaningful steps toward recovery and reclaim your physical health.

References

Moseley, G.L., Leake, H.B., Beetsma, A.J., Palermo, T.N., Meeus, M., Ryan, C.G. (2024) Teaching patients about pain: The emergence of pain science education, its learning frameworks and delivery strategies. The Journal of Pain

Hansen, S., Dalgaard, R.C.,  Mikkelsen, P.S., Sørensen, M.B., Petersen, K.K. (2020) Modulation of exercise-induced hypoalgesia following an exercise intervention in healthy subjects. Pain Medicine

McBeth, J., Prescott, G., Scotland, G., et al. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. (2012) Archives of Internal Medicine

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