I'm curious about this, too, although in my case it's pelvic floor muscles that can go into spasm. It is tangible. In PT I learned how to tell the difference between a supple pelvic floor muscle and one in spasm, and I was able, with progressive PT stretches and exercises, to eventually eliminate spasm altogether. I have no doubt that muscle spasms were/are a clear physical cause of pain in my pelvic floor - I can feel the spasming muscle with my hand and can clearly tell how different it feels to the touch from when it's not in spasm. BUT, the muscle spasms weren't the *original* cause of the issue, and the solution was never going to be PT alone. I continued to hold my stress/anxiety in my pelvis after I successfully finished PT, and over time the muscles started to spasm again. Doing this TMS work, I've begun engaging my stress/anxiety before storing it in my pelvic and abdominal muscles, and my muscle tension has reduced somewhat.
So, as far as I'm concerned, I think the immediate cause of the pain may well be physical, tangible, and treatable (say, with PT or muscle relaxing drugs/herbs), especially when it comes to muscle spasm. But even though the immediate cause of the pain may be physical, it doesn't help me to think physically because the deeper cause IS psychological. I'll always have the pain as long as I'm storing stress in my body instead of addressing it. AND the fear-tension cycle that started the muscle tension in the first place still makes the tension worse, to the point of spasm, if I don't address the fear of the pain itself, too.
Thinking psychologically about physically spasming muscles is working very well for me so far. I run into questions when it comes to activity *in spite of* the pain, which I understand to be an important part of outcome independence. When it comes to pelvic floor tension, for example, I would never tell a woman to have sex even if it hurt, not just because of the obvious psychological, relational, and emotional issues at stake there, but also because pushing past those muscles when they are in spasm can lead to microtears, fissures, and muscle damage. For me there needed to be some degree of being gentle on spasming muscles while also learning not to feed the pain with fear, and to stretch and strengthen those muscles in a progressive, safe way (PT).
That may make me not a TMS purist, I'm not sure. I'm still only just learning - and waiting for somebody to return the Sarno book I have on hold at the library. No matter what, the root of the work for me is still learning how to experience emotions without fear and without pushing them down. And, when spasms occur, not to be afraid of the pain. (All that great pain recovery program stuff!) But at least in my case, it also means not completely disregarding when my muscles are in spasm and doing something that could actually injure them. TMS techniques so far have helped me greatly reduce the amount of time my muscles spend in spasm, because the second a pelvic or abdominal spasm starts now I immediately check in with my mind/heart to see what's up - and I am not as afraid of/resistant to the pain. It's amazing how much faster the spasm relaxes when I approach it that way - even if I do go a little gentler on my body in the meantime and don't exactly say, "Bring it on," like Alan said in the recovery program.
