I think if I asked around there wouldn’t be many who would disagree with me for saying 2020 has been a challenging year. It’s been difficult and stressful for the vast majority of us. Whether it’s the virus itself that has been the main stress factor; shielding ourselves and our loved ones; contracting the virus; or even losing someone close to us. Or the knock-on effects of living through a pandemic; worrying about your job or finances; not being able to see friends or loved ones; or just the breakdown of normality. Whatever your personal experience of coronavirus, there are very few of us who can say they haven’t been increasingly stressed by it.
As I scroll through my social media I am bombarded with images and messages about stress and the effect it is having on our mental health as a nation. We are becoming more and more aware of mental health as an issue, whether it’s something that affects you directly, or someone close to you, it’s possible to say these days that mental health issues affect each and every one of us in some way. And of course, as a resilient nation we are, in many cases, banding together to overcome the struggle. I see so many lovely people passing on messages of support to one another, doing buddy checks and generally talking about mental health to bring it to the forefront and destroy the stigma which surrounds it.
One thing I haven’t seen much of, however, is any discussion about how stress affects us physically. Working in the clinic I have noticed over the last few months, since the end of the first UK lockdown, a definite trend towards stress related pain and injury, which I don’t think was there before. The physical affects of stress can take a few different forms, and I’d like to briefly discuss them here. I think that many of us aren’t as aware of our physical bodies as we could be. Many of us live with pain unnecessarily, because we’ve either lived with it so long we almost forget what it’s like to be without it, or because we think it’s just part of getting old, or doing a desk job, or being sporty, and so we accept it. But most of these pain symptoms can be resolved. We just need to know how, and recognition and understanding is the first step to recovery.
Stress related injury #1 – Tension
Are you aware of where you carry tension in your body? Do you recognise when you are tense? Or is it so permanently fixed, that you no longer recognise it as anything other than normal?
Tension can sit in the body in many different places, but the most common is in the shoulders and neck, or in the stomach. Do you ever notice, when you get angry or emotional your shoulders start to lift up towards your ears? Or your stomach starts to become unsettled or tie up in knots? All of this is a result of tension building up in our muscles as a result of stress. Without going into too much detail, stress causes our fight or flight response to kick in. Signals to the brain tell us we are threatened, and so the brain signals our glands to release hormones such as adrenaline and cortisone. This is to prepare us to either fight whatever is threatening us, or to run away from it. The physical response is so deeply ingrained in us, from when we had to run away from bears and tigers and such, that we cannot switch it off. It is what is called an autonomic response.
So all these hormones being released have various effects on our bodies. One is to divert blood flow away from organs we aren’t we going to be using to either fight or run away, such as our digestive system, so it can better fuel more vital systems such as our muscles. This is why we often need to go to the toilet when we get angry or upset, or why our stomach starts churning quicker, to try to eliminate our last meal quickly. The effect on our muscle system is that it becomes tense, ready to take action. Of course, when we get stressed, there is often nothing we can do about it physically. But our body will continue to operate in this state of readiness to fight. Over time, as the stress builds up, it can have a more lasting effect on our body. We begin to lose our appetite, we have trouble sleeping, and our muscles remain fixed in this position of being ready to spring into action at any second.
Our muscles in this state of readiness are in a permanent contraction. They are poised to fire. Have you ever held your arm out to your side and tried to keep it there? How long can you hold it before it starts to ache? 1 minute? 10 minutes? How much would it hurt if you held it there for an hour? So imagine this muscle tension being held for days or weeks on end, while you deal with a particularly stressful situation. Imagine how long your muscles have been tensed, since all the coronavirus news started hitting our televisions. Without a release of that tension, our muscles just stay put, and of course, this inevitably causes pain. Muscle aches, particularly around the neck and shoulders are common indicators of stress. Headaches can be a follow up effect. These are the most typical areas to feel tension, but it can also cause muscle aches in your legs or arms, as they prepare to fight or run away.
Stress related injury #2 – Fatigue
Holding all this tension in our bodies requires energy. It’s tiring. And the increased hormones in our bodies can often mean getting less sleep, eating less, and generally feeling more restless. Our brains require a lot of energy, and they will also be working overtime as they try to deal with whatever situation is causing the issue. Everything we go through during a stressful time causes us to be more and more depleted in energy. And what happens to us when we become fatigued? Let me tell you.
Firstly we become less co-ordinated in our thoughts. We start to get distracted easily. Our brains try to switch off from whatever is tiring them out. As our thoughts become more distracted so our signals out of the brain become less efficient. Our muscle co-ordination begins to suffer. Have you ever been on a long run, and as you become more and more tired, noticed you start to stumble? This is because the nerve signals from your brain to your muscles are slowing down. Our muscles themselves are also becoming more tired too. We are running out of energy to make them work, which means weaker and slower contractions. As everything slows down we become clumsy and uncoordinated, with less attention being paid to what we are doing. And of course, that is when injury is most likely to occur.
During my time working as a pitchside rugby therapist, I always used to dread the last quarter of a game, especially if it was against a particularly physical or heavy opposition. As my team got more and more tired, I noticed more and more things starting to go wrong. Sloppy tackles, slower uptakes, poor ball handling all increased in the last quarter. And slow reactions always meant more chance of injury. Not just from not falling over more or not getting out of the way quick enough, but also from over-firing of muscles causing things like sprains or tears in the muscle fibers. Our bodies ability to recognise where we are in space, and the state of tension in our muscles is called proprioception. As fatigue sets in, proprioception decreases. Our brains can no longer gauge our physical position in relation to other players, the ground, or one end of a particular muscle to another. And as reaction times also slow down, we cannot change position quick enough when we are threatened. The risk of injury increases exponentially the more tired we are.
Stress related injury #3 – Pain perception and our decreased ability to heal
The final downside of stress is again to do with the brain (isn’t everything?) and our perception of injury. When we are stressed we have a tendency to perceive situations to be much worse than they actually are. You’ve heard the phrase ‘the straw that broke the camels back’. When we are faced with stressor after stressor, suddenly even the littlest things can be catastrophic. Have you ever totally over reacted to something really trivial like a broken nail or a small scratch? What else was going on in your life at the time? We often handle the big stuff much better than the small stuff, because our brain is using all of it’s energy reserves to deal with the big stuff, it has no energy left when something tiny happens, so we crash.
The same principle can be applied to pain when we are stressed. Something we would normally consider to be a minor injury, such as a minor calf strain, can be experienced as much worse when we are stressed. It can be more painful, and it can also take longer to heal. During my consultations with clients, following an injury, I always take a detailed history of how the injury happened, how it affects the client, how they would rate the pain etc. During our discussions I always try to find out if there was anything else going on at the time, any particularly stressful situations, or anything which might be affecting their mental health or state of mind. I have found in so many cases, that the client’s perception of pain is much higher when they are under stress. I have also noticed that the effect of the injury tends to be more out of proportion to the injury itself. For example, in the last week before a particularly big event, which the client has spent months training for, a minor tendon flare up will be twice as painful as the same injury might be if it had happened three months before the event.
In our desperation to resolve the injury we can also be counter productive in our efforts to heal it quicker. While the case of the tendon flare up might be easily resolved with a few days rest, while we perceive to have time to rest it, in the last few days before a race, we try everything in desperation to attempt to make the pain go away. So we over compensate, over stretch or just try to train through it, often making the problem much worse. Our increased fight or flight physical response, will also slow down the healing process. Remember that constant muscle contraction we talked about earlier in the text? Holding a muscle in tension will not allow the muscle fibres the rest they require to heal and repair. In much the same way as training hard without taking a rest day for recovery will eventually lead to injury.
What can we do to avoid stress related injury?
Physical injury is always something which is out of our control. I don’t know anyone who purposely goes out looking to get injured or who wants to be in pain. So how can we take steps to avoid getting injured? There are lot’s of ways we can indirectly reduce the risks. The first step is to sit down and take some time to analyse and recognise what might be causing your pain. Are you particularly stressed at the moment? Is your headache down to dehydration, or could it be tension in your neck? Are you getting enough sleep, or have you noticed being lethargic or clumsy during the day? Are you more accident prone than normal?
Recognising that you are stressed is the first step to taking control and reducing the risk of that stress affecting you physically. There are many proven ways to help reduce stress and it’s effect on the brain. You might want to try meditation, gentle exercise such as yoga or pilates, going for a walk or taking a bath. All of these things can help to relax your muscles, and/or get you away from the stress factors so your brain can rest from them and build up more energy to tackle them later. Eating well, sleeping better and staying hydrated can also help to reduce the physical effects of stress. Try turning your phone off an hour before you go to bed, for a better night’s sleep. Breathing exercises or progressive muscle relaxation exercises can help to relax both body and mind.
I’m not talking about particular mental health issues here, by the way. I know that often there is more to resolving anxiety disorders than going for a walk or taking a bath. It’s no secret among my clients that I am an advocate of using medication in certain circumstances for depression and anxiety. But recognition of having a more chronic or severe mental health issue is an important first step, which leads to getting the help you need. And for that you need to take time out from your stressors, be aware of what is happening to you physically and mentally. Please don’t take this as an oversimplification of more serious issues. But for the majority of us, particularly this year, when stress has been somewhat relentless, just taking some time out for self care, can dramatically reduce the risk of us getting injured.
If you are suffering with pain, or if you are worried about your stress levels, then we have lot’s of treatment plans and ways we can help. We can help guide you towards recognising what is causing your pain, and take positive steps to reducing and eliminating it. We also offer relaxation treatments, so you can take that vital time to switch off, slow down and get back in touch with your body. Give us a call and we can chat about what is bothering you, in strictest confidence, and with no obligation to take up a treatment plan. If our therapists can’t help directly, then we can signpost you to somebody who can. Don’t live with pain, or with stress. Take the first step to living your best life today. It may impact more than you originally thought.