What is TMS?

Sean Hershey, LCSW | Gay Somatic Therapist NYC

Automatically Transcribed

Hello and welcome back. This is MindBodyMedicine for Chronic Pain and my name is Sean Hershey.

I am glad you're here with me again for season one, episode two today.

And I'm here recording this in early spring in Brooklyn and it is a cold morning and it is cold in this little home office. And I kind of feel like curling up and taking a nap, but I'm like, here I am with my cute little smart wool socks on. And rather than taking a nap, we are going to do a whole deep dive into what is TMS. So that is our topic for today. And I hope you get something. I actually, I shouldn't even say I hope I'm, I'm pretty sure that you will get something out of this. Okay, so let's go. TMS is a term coined by Dr. John Sarno, who published his first book, which was called Mind Over Back Pain in 1982. In that book, he certainly talked about TMS. This is nothing new. This has been around for a long time. And yet a lot of people have not heard of it. And the medical community for some reason continues to, um, like not take this seriously, even though the TMS theory and using the mind body connection has been so helpful to so many people, certainly hello, me, myself included. And yet this stuff remains, um, often unknown. So we are going to shed a lot of light on it today. And, um, we're going to talk about it. So TMS coined, it's a term coined by Dr. John Sarno. It stands for, uh, when he was first read, I mean, I mean, it's an evolving concept as all concepts are, you know, it is an evolving concept. He, when he first started writing about it, it stood for attention myositis syndrome through his career and through more discovery, more work with patients, um, seeing more like different outcomes, different, uh, ways to, um, like utilize TMS theory, different symptom presentations that this stuff works for and helps. Uh, he then began to call attention my own neural syndrome. And as his career went on, my, um, I think this is true. TMS eventually stood for the mind body syndrome because the more that he practiced, the more that he realized these concepts apply to so many different symptoms, conditions, and presentations, which we will, um, get into today. So, okay. The basic definition of TMS is that it is an umbrella term to describe all chronic pain, chronic symptoms, and chronic conditions that are caused by emotional and psychological factors. So, uh, the number one question in this world of TMS healing often tends to be, is my, insert symptom here, TMS? Is my back pain TMS? Is my shoulder pain TMS? Do you think my IBS is actually TMS? Do you think my headaches are TMS? Do you think my hip pain is TMS? Do you think the pain pain in my foot, the pain in my, um, the ankles, the pain in my knees, the, uh, fibromyalgia all over my body? Do you think my long COVID is TMS? My, um, oh, what is that? Like dizziness, chronic dizziness, chronic, um, tinnitus or tinnitus? People say that either way, like chronic ringing in the ears. Is that TMS? Well, the answer is all of those could be. So let's look at it. All right. We're going to get back to, is my insert symptom here at TMS. And we're going to later in the podcast, do an exercise where, um, you will get to go through the diagnostic criteria yourself and, um, make, make an, an empowered assessment with the information I'm sharing with you and make that assessment yourself. Okay. So pain is a danger signal and pain is generated in the brain. Pain is always a danger signal. Pain is always generated in the brain. It feels like the pain is because like, like for me, for example, my symptom imperatives with my IBS and my hip pain, it feels like, of course, the pain is coming from my hip. The pain is coming from my brain because our brains create our experience of life. The brain creates all of our sensations. That's a process called, um, some call it predictive processing and some call it predictive coding. Uh, but whatever you call it, the fact remains true that the brain creates our experience of life and the brain creates all sensations. Okay. So I want to get into a little bit, um, of the different names for TMS because there's so many different things to call this. TMS is a Dr. Sarno term. Uh, that's like the original term for this phenomenon. Um, TMS equivalence, uh, that is also a Dr. Sarno term and the difference between TMS. So my, my impression is that when Dr. Sarno first started writing, um, and practicing and practicing using the TMS theory, TMS referred to musculoskeletal pain. Like this was like, I mean, back pain was his specialty. Uh, TMS referred to like back pain, shoulder pain, knee pain, hip pain, ankle pain, you know, it's musculoskeletal pain. As he continued through his career, something that became apparent to him in his practice was that other symptoms like chronic headaches, chronic migraines, chronic irritable bowel syndrome, symptoms like that, that were not musculoskeletal pain also followed the same logic and resolved with the same treatment that the musculoskeletal TMS symptoms are followed and resolved with. So that's why he would call those TMS equivalence. Um, I think it's easier to just refer to all of them as TMS. There's also the word psychophysiologic disorders. People use that there's, um, uh, perceived danger pain. Um, if anyone knows, I hope some people are familiar with, uh, uh, Dan Buglio, who makes amazing videos about chronic pain, he refers to it as perceived danger pain. There's neuroplastic pain is another name for TMS. That is a term used by Alan Gordon, who is a really excellent psychotherapist who wrote a book called the way out highly recommend. He talks about neuroplastic pain, neuroplastic, meaning like neuro it's comes from the brain plastic, meaning it can change, you know, it is malleable and it's not stuck. Okay. There's also, uh, the phrase neural circuit pain that is from, um, Dr. Howard Schubiner, who, uh, I mean, it's like, you know, neuroplastic pain, neural circuit pain. It's like, it's, it's, it's the same thing, but it's, but it's called something slightly different. And, um, Dr. Howard Schubiner has several books, uh, most notably unlearn your pain. He, I would say, I mean, I, I did like a seven week, uh, training with him. I would pretty confidently say that Dr. Howard Schubiner is probably considered like one of the, one of the, if not the most prominent, um, medical doctors in the TMS chronic pain, mind, body healing space right now. I mean, of course the grandfather of, um, this branch of medicine is Dr. John Sarno, who sadly passed away, um, at the ripe age of 93. I really, I think this is correct. I think he passed away one day before his 94th birthday, something like that. Um, and with him gone, uh, Dr. Howard, Dr. Howard Schubiner, who trained with, um, Dr. John Sarno, I would say he's probably, uh, I would consider him to be like the leading MD or at least one of the leading MDs in this space. Okay. There's also the word, uh, stress illness, a toy, a term coined by, um, Dr. David Clark, another leading physician in this space who, um, wrote a book called They Can't Find Anything Wrong, which is connecting, um, childhood trauma to, uh, lifelong chronic pain. And then you can also always call the mind-body, you know, mind-body pain, mind-body symptoms, mind-body conditions. And there's probably other terms that I'm not aware of. And something that I also do want to be clear about is that, like, it's in the evolution of human history, um, and human cultures, it is not new to connect the mind to the body. There are many cultures and civilizations where that is, like, actually a total norm. So to say that, like, Dr. John Sarno, like, discovered that there is a connection between the mind and the body, that's not accurate. Like, people have known this for human history for, like, ever. But what I'm talking about is, like, if you follow the Western medical tradition, what, in which Dr. Sarno was schooled, he was an MD who, you know, graduated from medical school and all that. And he started integrating these theories into his practice. So I'm considering him the grandfather of this branch of mind-body medicine, even though we can all be clear that, like, some of this is actually, like, ancient wisdom. Okay? So we don't want to get lost in, like, this was developed in the last, you know, however many decades. Like, some of this is, like, old, old, ancient knowing. But okay, there's all the terms, and it's super, there's a lot of names, and welcome. It is a new burgeoning field. There's not a, there's, I would say there is actually a lot of consensus over how to treat this. So that, take comfort in that, because even though there's, like, different thoughts about, like, what do we call this? What exactly is causing this? The good thing for you, I'm speaking to you, you, the listener, the good thing for you to take comfort in, is that all of the treatment protocols that work and get results are different versions of the same basic thing. And that's what we're going to be talking about as this podcast goes on. So, fear not, even though there's, like, you know, is it called this? Is it called that? This doctor, you know, who should I follow? Who in the mind-body space should I follow? Listen, everyone is saying, well, okay, everyone who's getting good results is saying a slightly different version of the same basic thing. And I know, I get you, I get how the chronic pain brain works, because I, that's my brain, so I, I get it. I get that you're like, oh, let me find the right person to follow, but let me do exactly the right thing. Let me do exactly the right protocol. Someone just save me, save me for myself, save me for my symptoms. Oh, I want to invite you to relax and know that most of these practitioners are doing slightly different versions of the same basic thing. So, whoever you pick to follow, you're probably going to get some good results. Okay, so here's a question. Do we need a name for TMS? This is something that some people ask, because it's, it is just the human condition. The mind and the body are connected. The body feels emotions. Emotions are felt in the body. And the threat of a rising emotion that you really don't want to feel, that threat, this happens below the level of consciousness, that threat, pain is a danger signal. So, as a threatening emotion rises, pain can absolutely be caused in the body. So, that happens to everyone. That's not just like, oh, because you have TMS, that happens to you. This happens to everyone. So, is there even a need to use a term for mind-body pain? Because it's just the human condition. Everyone feels it. And I mean, just some of you know this. Once you know about chronic pain and TMS and mind-body pain, whatever you want to call it, you start seeing it everywhere. Right? Like, like those of you who, who have traveled down this path a little bit, you know, like you see it everywhere. Everyone is talking about the, you know, this little pain, that little pain, going to this doctor, going to that doctor. Oh, my headaches. Oh, God. Somebody hand me a painkiller. Oh, my foot has been killing me for like two years. My God. But, but, but, but, but, you know, I got my guy. I got my guy who does my foot massage and blah, blah, blah. Fill in the blank. You see this everywhere. Because it's the human condition. So, is it helpful to have a name for it? Honestly, okay. Different people are going to have different answers for this. My answer is yes, it is helpful to have a name for it. Because when you first, for most people, like myself included, this is the story, as you know, from my last, my last podcast episode, the story is, what's wrong with me? Do I have, like, I'm going to take the IBS example. Do I have a gut microflora imbalance? Do I have a extreme food sensitivity? Do I have a liver issue? Do I have a gallbladder issue that needs to be solved by a liver and gallbladder cleanse? What's wrong with me? And when this is the question that so many people are asking, it is so helpful to be able to tell yourself, like, oh, it's TMS, right? So, I think it's really helpful to have a term for this. Because when you're thinking, what's wrong with me? I mean, the answer is basically, like, nothing's really wrong with you. It's just TMS. So, I do think it's helpful. But okay, what is TMS caused by? If pain is a danger signal, pain is not only caused by the fact that there's something structurally wrong with the body at the site of the pain. That is the old Western medical model paradigm of pain. And it's so limited. Pain can be caused by the fact that there's something structurally wrong with your body at the site of the pain. So, for example, my hip. If there was something structurally, physically wrong with my hip, then that could cause pain. If I had just been, like, you know, say, like, okay, something structurally, physically wrong with it. An example would be, like, I had just sustained a massive injury. I had just had, you know, I don't know, say somebody slammed something super heavy into my side and my hip was really killing me. Yeah. There might be something structurally wrong with my hip if that happened, and it would hurt. You see in there that pain is a danger signal. That pain would be telling me, like, something is wrong here. This is dangerous. And it could really be caused by a structural problem that can happen. But that's so limited. That is one cause of pain, and it is just one cause of pain. And usually, folks, that is the cause of acute pain. It is rarely the cause of chronic pain. Okay? Structural problems with the body at the site of the pain are very, very unlikely to be the cause of chronic pain. And I know you, you know, I know you because this is how I am myself. If you've been struggling for months, years, years, many years, a decade, several decades, that sounds like TMS to me. Okay, because pain can be caused by all different kinds of threats. Particularly, one, believing something is wrong with your body at the site of the pain. Two, feeling threatened by emotions you have not felt or you don't want to acknowledge or you don't want to deal with, and they are rising up. And three, feeling threatened by your true self, your desires, your drives, your needs, your, like, animal self, feeling like it's not okay to be yourself and that you are a threat. All of those things can cause pain. And those are the typical factors that cause chronic pain, which is why the treatments that focus on those three areas are the treatments that work. One, so I'm going to go back over this. One, pain caused by believing something's wrong with your body. So that is, you know, what we're going to get into the psychological work. Knowing that you're safe and knowing that your pain is not coming from a problem in your body. Two, feeling threatened by emotions that are rising up and you don't want to feel them and you don't want to acknowledge them. That is why doing the emotional work is so helpful because the easiest way to teach your brain not to be afraid of your emotions is to feel them. Because when you feel them, it's like, I mean, it can suck. Like, yo, doing this work, I'm like, fuck. Like, there's some emotions that I really, really don't want to feel. And like, damn, like, because just initially, I'm like, I don't feel any emotion. I don't care. Like, I don't want to feel hip pain. I don't want to have IBS. Like, I would feel any emotion over this. And then some of the emotional material that I discover comes up and I really start like leaning into it and feeling it. And I'm like, oh, God. Oh, please. Like, give me back the pain. Like, this. I hate this. I hate this. So just know that that emotional stuff, it's hard and it's painful. And there's a reason why your mind-body system is protecting you from that. And then third, feeling threatened by your true self and feeling like it's scary to just be you. And you are you all the time. You know, wherever you go, there you are. You are with you. And so the fear of being yourself, that follows you everywhere. So learning to trust yourself, learning to honor yourself, learning to feel safe within yourself and learning to attune to yourself and recognize like you're just part of the universe, you know, like you're just here. And so because you're here, okay, you belong. And all your parts are okay. You know, that's a phrase in parts work. It is, oh, why am I blanking on parts work? What is that called? Internal family systems therapy. There we go. I'm like, come on, come on. Brain recall. Internal family systems therapy. The phrase, no bad parts. That basically sums up the work of patiently attuning to yourself and learning to feel safe with yourself. There are no bad parts. So the reason I'm going through all of this is to make it clear one, two, and three chronic pain is most often caused by these three things. And therefore the treatments, psychological work one, emotional work two, and patiently attuning to your true self three. That's why those things really help. Okay. So now that we're like getting deep into that, the main question, let's get back to the question from the top. The main question people usually ask is, is my fill in the blank symptom here TMS? So let's talk about that. Is your symptom TMS? So I want to go back to Dr. Schubiner who I talked about before. He's, like I said, definitely considered the leader in this space of mind-body medicine if you're not familiar with him. Here I have this little website pulled up so I can just like say a little bit about him and like get it right. Dr. Howard Schubiner is an internist and the director of the mind-body center at Ascension Providence Hospital in Michigan. He has authored more than a hundred publications in scientific journals and books. He lectures regionally, nationally, and internationally, and blah, blah, blah, all this other impressive stuff. Author of three books, Unlearn Your Pain, Unlearn Your Anxiety and Depression, and a book called Hidden from View. He also helped develop a treatment modality for chronic pain based on TMS theory, which is called emotional awareness and expression therapy or EAET. And it has been used in clinical trials and has actually been proven to be superior to usual. I mean, obviously, because the usual treatment in the Western medical model is not good. EAET has proven to be superior to treatment as usual. So, okay, this is where I'm reading all this to legitimize because I know, again, I know how the chronic pain brain works. I know you're thinking like, is this real? Is this real? And I get it because I have been there a thousand times. And so I'm saying this to like, speak to that part of you that's asking, is this real? Is this legit? And I just want to say like, my answer is yes. And I hope you can take that in. And I hope that me reading Dr. Schubiner's credentials helps that part of you take this in. But okay, I did a training with Dr. Howard Schubiner where he, so it was a bunch of different medical and mental health professionals. And he was trained, one of the main things was he was training us how to diagnose neural circuit pain, or, you know, that's his way of saying TMS. It's all there. They're all the same thing. So this is how he diagnoses this. And I'm telling you, people come from all over the world to Dr. Howard Schubiner to ask him the question, is my fill in the blank TMS? So he is like one of the leading experts on this. And he told me and a whole group of people how he goes through this diagnostic protocol. And I want to share that information with you because he was so chill about it. He was like, like, this is really not rocket science. So I'm going to go through his protocol for how he diagnoses neural circuit pain. And like, hi, do it on yourself. Like, hello. As you're listening to this, that's my invitation to you is do this on yourself. Okay. So there's two parts. First, the rule out. Second, the rule in. So we're going to start by talking about the rule out. So the first part is if you have chronic pain, you do want to rule out any serious medical condition that might be causing chronic pain. Like I said before, those are rare, but it is possible. You know, it could be that like, you know, say your back hurts and you have a tumor on your spine. That's possible. Rare, but possible. Um, there are other conditions like that. You know, I, I don't know all of the conditions like that. I'm not a medical doctor. I'm certainly not pretending to be absolutely not. I am a psychotherapist, but what I do want to say, and I will say very confidently is that those things are rare. That said, it is important to get checked out by a medical doctor because like you want to know if there's something going on in your body that is not TMS, treating it emotionally and psychologically will not be the answer. Emotional and psychological modalities are always good as like, you know, supplemental treatment. But if say you have cancer, unfortunately, emotional work and psychological work is not going to cure that. It might help you as you go through your treatment process. I mean, I shouldn't even say might, it will help you as you go through your treatment process, but it's not going to be the cure. TMS is cured by emotional and psychological work. And the other, the other modalities don't help because the core of the problem is emotional and psychological. And that's why that is the work that you have to do in order to heal. So, okay. You always want to rule out some serious structural cause. That's part one. Part two is that you want to rule in neural circuit pain. How do you do this? Dr. Schubiner says you use the FIT criteria, F-I-T, that stands for functional, inconsistent, and triggered. If you're a notes person, honestly, I would say like, get out your notes app, get out your pen, and whatever you're going to write with. And I would write this down. FIT criteria. Functional, inconsistent, and triggered. All right. So we're going to go through what each of those things means. To rule in, is this neural circuit pain? You ask, is this a functional disorder? Now, a functional disorder is, I've got this pulled up so I can read this to you as well. Functional disorders are conditions characterized by physical or psychological symptoms that can not be explained by a known underlying medical condition. They are thought to arise from disruption in the functioning of the body's systems rather than structural abnormalities. So if your doctor is telling you you have a functional issue, like for me, I was diagnosed with a functional bowel disorder. That is a clue to rule in TMS. All right. That's part one. Functional. F-I-T, that's the F. Part two. I, this is inconsistent. Does the pain come and go? This is something that I literally did not know until I took Howard Schubiner's training. Pain that's caused by a structural abnormality will basically remain constant. I did not know that because so many people, basically most people in our world don't know about the difference between structural pain and emotional pain manifesting in the body or psychological pain manifesting in the body. And so people think that TMS symptoms are structural and therefore people think it's normal for symptoms to wax and wane and some days be fine and other days be terrible and every night it's bad, but every morning it's fine. That is a sign of TMS. That is a rule in criteria. It's not normal for structural pain to be so inconsistent like that. It's not normal. So if your pain is inconsistent in that way, that is a call to rule in a neural circuit disorder or to rule in TMS. Okay. And neural circuit disorder, I shouldn't put it that way. Neural circuit pain, that's what it's called. It's not really considered a disorder. Okay. And the last functional inconsistent and triggered FIT. T triggered. So this one I think is kind of funny because it's like, it really like calls me and everyone who gets into this shit. It calls us all out. It's triggered by things that really shouldn't trigger pain. Um, if your pain is triggered by like, uh, like my example that, you know, from, um, the first, uh, episode, if my severe pain that lasted in my hip for decades was triggered by one walk and one time that I was like doing a stretching yoga routine that I do like all the time. No, that does not trigger severe, long lasting chronic pain. Other things like, I mean, I mean, okay. Celiac disease is separate, but say you have a gluten, you believe you have a gluten sensitivity and you're like, Oh God, I cross contaminated one little morsel. I ate a, um, say a French fry out of a, that was, you know, whatever, uh, deep fried in oil, the, the same deep fryer that they used fries coated with flour. Oh God, this is why I have severe IBS and I've had it all week. No, no, no, no, no, no, no. The human body can withstand food. And, um, unless so, so that there's a good example, a structural abnormal, like a structural problem. Say you have celiac disease. You'd want to rule that out. If you don't, but one little morsel of flour got in your body and you think that that triggered a cascading effect of weeks, months, years of, um, chronic pain. No, it didn't. That's not how that works. This one is hard because you have to dig deep and be real with yourself because a lot of us really hold on to the idea of triggers. We really believe in our triggers. And we really think that like people are, you know, like maybe people are invalidating how hard this is. And like, someone's just going to like, Oh, I'm lactose intolerant. And you're just like, Oh, here you want a cookie. Oh, what's in it. Oh, I'm not sure. Fuck off. Like, please respect me. I have a serious, um, dairy intolerance. But here's the thing. I say this with love, kindness, and gentleness. You probably don't have a severe dairy intolerance. Okay. You probably have TMS and it's caused by emotional and psychological factors. And I just want to invite you to look at this, you know, the fit criteria. This is how to rule in TMS, functional, inconsistent, and triggered. Question your triggers. Question your triggers. Because there are many things where pain is triggered by things that should not trigger, um, pain. They really shouldn't. Okay. So I just want to say to close that out, I want to remind you that Dr. Howard Schubiner, who is considered one of the leaders in this field and people, like I said, come to him from all over the world for a diagnosis, asking is my fill in the blank TMS. I just want you to know that he was so empowering to all of us about making a diagnosis ourselves. Many, and I want to pass that on to you. Okay. Be empowered to make this diagnosis yourself. And of course, can you rule out all structural abnormalities in your own body? No. If you need one, if you need to see a doctor for that, like, yeah, by all means, please do. And here's the thing. If it's an old symptom, you've already seen the doctor. Okay. You know that. You've already seen the doctor. And they would have discovered it. But, but say, say you're in a state of panic and you're like, I need one more opinion to calm my nervous system down. Great. Do that. You know, do that. But when it comes to ruling it in, ruling in using the fit criteria, Dr. Schubiner empowered me and all the people that were in that training with me to make this diagnosis ourselves, I want to pass that on to you. I want to empower you to make that diagnosis yourself. The literal expert is saying like, this is not rocket science. You can do this yourself. So, okay. All right. Take that at face value and, and believe it. All right. So I'm just going to quickly, I don't want this podcast to be too long, but there's, there's so much to say. I just want to quickly go through my diagnoses using the fit criteria so that you have an understanding of how to do this. So we're going to start with IBS. First, always. So if I'm asking the question, is my IBS TMS? First, what do we want to do? As you know, we want to rule out structural causes. And Lord knows, did I rule out structural causes. I went to many doctors. I had an endoscopy. I had a colonoscopy. Every time they were like, dude, you're like, your stomach is fine. Like, I know that you have problems, but like, we can't find anything wrong. There's, there's like, it looks fine. Interestingly enough, that is the title of Dr. David Clark's book on this stuff is they can't find anything wrong. So there we go. We have ruled out structural causes. And actually, literally I had, okay, so moving on to part two, ruling in TMS using the fit criteria, functional, inconsistent, and triggered. I actually literally had, like I said, I had a doctor say that this is a functional bowel disorder. So there we go. Someone literally told me like, yeah, this is a functional problem, not a structural problem. Already. That's, that's the first part of the fit criteria. And that is like, right. Okay. TMS pain, emotional and psychological in origin, if it is functional. Okay. Inconsistent. My symptoms were like, they were like, they varied a lot. Like some days are much better than others. Certainly when I was stressed, they were a lot worse. Um, and if it were say like, uh, you know, say I had like a bacterial overgrowth and that was the main cause of the pain, would that change that much day to day? And especially would it fluctuate with my emotional state? I doubt it. Um, yeah, I doubt it. So definitely inconsistent. Yup. That is there. Check and check, check for functional, check for inconsistent, trigger, triggered by the things that shouldn't, uh, trigger pain. Yeah. Now this is the hardest one because this involves unlearning things that, um, feel felt at the time when I was really struggling with IBS and I was like really trying all these diets and so desperate to just get better. Um, this would, this involves some unlearning and some unlearning of like things that I hold like tenderly and preciously because it's, it's part of my healing and part of my desperation to feel better. But yes, was it triggered by random shit that should not trigger severe pain? Absolutely. I mean, I thought that my pain was triggered by like eating a couple spoonfuls of like sweet rice pudding, like shit like that. They're like, uh, no, no, no, no, no, no, no, no, no, no, no, no. That does not cause a struck like structural pain would not be caused by that. Like that is neural circuit pain. That is TMS. That is emotionally and psychologically based. So, okay. Looks like, yup, my IBS, we can say confidently is TMS. And also the fact that it has improved so significantly to the point that it's like, I don't have chronic IBS anymore doing this work. I mean, that that's another like clear, clear piece of proof, but okay. I also want to go through the hip pain quickly because, uh, this one is a little more complicated. So my hip pain ruling out structural causes. That's the first step. So let's, let's, okay. Rewind, rewind. Let's start from number one again. We are ruling out structural causes. Now I went to chiropractors who like they found shit, you know, like if you start digging around in your body, you will find what Dr. Sarno terms, normal abnormalities. You'll find them like this disc doesn't look right. The, your hips are, I mean, my hips are, um, slanted tilted. Like they're not fully symmetrical. I have mild scoliosis in the bottom of my spine. Um, one doctor even said I have moderate scoliosis in the bottom of my spine. That was scary to hear that. Like shit. I'm like, Oh, that is why I have hip pain. Um, it's not, but I, but I thought for a while that that was why I'm like, there's, Oh shit, there's really something wrong with me. That's what's causing my pain. Fuck. And, um, that was the other thing. The SI joint. Many typically chiropractors and an acupuncturist one time, they're like, Oh, it's the SI joint. Yup. It's the SI joint. Yeah. A physical therapist also like, Yup. It's the SI joint. Did anybody ever tell me what was wrong with the SI joint? No, but quote, it is the SI joint was something that I heard a few times from a few different people. And I was like, damn, it's the SI joint. That said, what I came to realize is that those were normal abnormalities and that I'm bringing that up. And I want to bring that out into the open because that is the hardest part about ruling out a structural diagnosis in, you know, Dr. Schubiner's diagnostic, um, criteria here for, is it TMS or neural circuit pain or is it not? Because yeah, you're going to get false information on this one because people will, doctors will misinterpret normal abnormalities as if they are really problematic and as if they are causing your pain. So you have to be careful about that because just because someone says you have a structural abnormality doesn't mean it's the cause of your pain. So that's where you have to go into this process with like a lot of your own, um, like health literacy about your own, uh, body and, um, knowing that normal abnormalities will be misdiagnosed as the cause for your pain. So want to bring that up because that's hugely important in, uh, number one, ruling out a structural cause because other people will be trying to rule it in and it's like, please empower yourself. Like, just imagine what, what if you started doing this work and your pain was less and less and less and someday it goes away and then you can do so many things that you thought you could never do and you can like live your life in an elevated way. What if, what if, do you really want to give that up? Because like, oh, maybe it's the SI joint. So I'm just going to stick in that reality and maybe it's the SI joint. Really? Like your life is better than that. You're worth it. Move out of that space. Okay. Move out of that space. So, okay. That's part one with diagnosing my hip pain. Part two, is it functional? Is it inconsistent? Is it triggered? F I T. Um, functional? I'm like, I don't really know what to say about that. So, um, I'll leave that alone. Do I have a functional hip disorder? I mean, like, uh, you know, I don't know. And you don't have to have all of them ruling in. Um, you don't have to have all of them. Is it inconsistent? Oh yeah. Even when my hip pain was bad. Yeah. It was inconsistent. I will say the one thing that was consistent is that it was always there. Sometimes it was significantly worse than others. And sometimes it was significantly better than others, but it was always, always there. Oh, so fucking frustrating. And honestly, still, it's still there at a very low level. A lot of the time, which fucking killed me. I mean, it's like, it's at such a low level. Even right now, I feel it at like a 0.5, which is nuts. It's like, it's really like literally there right now. So subtle, but, but, but it's there, but it is inconsistent. Fit criteria F I T. So, you know, um, and something that's really helpful to notice is the inconsistency. Start paying attention to your emotions. You know, stop keeping the diary. That's like, Oh God, uh, my, my hip hurt. Is it because what did I do? What did I do? Did I exercise yesterday? Did I, um, lift anything? Did I, this, this, that, the other thing start, start instead correlating like what's going on emotionally, thinking psychologically and emotionally rather than thinking physically and structurally, because then you're going to start seeing, Oh, these inconsistencies are not because I physically aggravated it. These inconsistencies are because of emotional triggers. Okay. And then the last thing is it triggered by things that shouldn't trigger pain? Yeah, for sure. Like my pain is triggered by like, I mean, I, I can be doing like kind of like extreme, like workouts or like extreme stretches and yoga and feel like basically fine in my hip. And then like later that same day, um, you know, and then, you know, walk around hip is fine. Everything's good. Later that day, have like a stressful, like conversation with someone in my hip feels awful, like searing pain. So yeah, it's triggered by, um, things that shouldn't trigger structural pain. So that is the fit criteria. That is how I am applying it to myself. And we've got two very easy. Yes. And yes, we've got two cases of, um, I mean, it's really one case of TMS, but we've got two TMS symptoms right there. Very clear. Okay. Let me say this also injuries heal. If you believe that your trigger is from an injury that was, you know, in the fit criteria FIT, you think your trigger is from an injury that was like last year, three years ago, 10 years ago. I say this with love because literally I thought this no injuries heal. Ongoing pain is the result of emotions or brain conditioning period. All right. So I'm going to just list some very common symptoms. We've just, we're, we're getting to the end of this one. I'm just going to list the very common TMS symptoms, just so you know how it often presents, but it, um, but it can present in so many ways, but these are like the very common ones. So I want you to be aware of them, back pain, neck pain, hip pain, shoulder pain, knee pain, elbow pain, uh, back pain that you think is coming from a disc bulge or a disc degeneration, any other musculoskeletal pain, chronic headaches, migraines, irritable bowel syndrome, irritable bladder syndrome, repetitive strain injury, complex regional pain syndrome, fibromyalgia, many eczema and skin conditions, arthritic conditions, because arthritis itself does not have to cause pain, uh, endometriosis, uh, interstitial cystitis, depression, anxiety, those are, yeah, like, like the, the mental health symptoms, fascinating. And, um, uh, chronic fatigue and not to forget long COVID, long COVID, long COVID, long COVID. All the symptoms of long COVID are like different for every person and like super random all over the place. And they're all TMS symptoms. So long COVID is like definitely TMS. And, um, something that, you know, if you follow Nicole Sachs's work and you follow her podcast, many people, she has interviewed many people who have fully recovered from long COVID using emotional and psychological modalities. Okay. So here we are. We are at the end of what is TMS. I hope that you have a good sense of what TMS is now, and you have the tools to start to figure out, like, do I have it? So what do you do now? Um, we will get into the treatment and all of the healing modalities. We'll get started with that next time. We're going to go through the psychological work. We're going to go through the emotional work, and we're going to go through patiently attuning to your true self. Those are going to be the next three episodes coming after this. But what I would encourage you to do now is use, use the rule out and rule in with the fit criteria. Try it out on yourself. And, um, it's been awesome talking to you. And I, uh, I'm wishing you the best on your healing journey. And I can't wait to talk to you again next week. Okay. See you then.