Stress, Pain, and Injury. Can Physical Therapy Help Me?
Author: Joseph Paul Coviello, PT, DPT, OCS, Board-Certified Clinical Specialist in Orthopedic Physical Therapy
Physical Therapists frequently see patients where stress is a factor in their pain and injury. You may be surprised how it can show up.
“Stress and pain have an unpredictable relationship.”
Stress
Stress is a word you hear frequently and something that we all experience in one way, shape, or form. However, the factors that cause stress are different for every individual.
Stress can be caused by:
Work
Family
An upcoming big holiday
A pandemic
A busy schedule.
Changes in health or injury
And many other individual factors
Similarly, the effects of stress impact us in different ways and to different extents. While the mental strain of stress is easily acknowledged, the physical manifestation of stress is not as clear cut in its presentation. Some of the physical results are rather obvious and easy to feel such as muscle tension. On the contrary, effects such as fatigue are results of stress impacting other needs in our life such as rest and sleep that have a cascading effect.
Stress and pain have an unpredictable relationship. As a physical therapist, I am often asked if a certain pain or injury was caused by stress directly. Surprisingly, I am always happy when patients ask this question, because it opens a gateway into a very important conversation that is not always the easiest to enter. The relationship between stress and pain is different based on the injury, when it occurred, if it is progressing, and each individual's beliefs and understandings about pain and injury.
Understanding that stress plays into all injuries and pain but not in the same way in every case is very important in the healing process.
How Can Stress Affect Pain and Injury
The link between the mind and body is complex and something the scientific world is learning more about on a day to day basis. A simple way to explain how this connection is linked to pain and injury is to talk about our body’s fight-or-flight response. The sympathetic nervous system controls this fight-or-flight response and preps our bodies for dangerous situations. A good example would be seeing a bear while on a hike. This is pretty scary! Your body immediately increases its heart rate, decreases blood flow to your digestive system, increases blood flow to the muscles so they have all the necessary oxygen, and increases the tone in your muscles so they are ready to fire as fast as possible during a fight-or-flight moment.
It is phenomenal that the human body can respond like this subconsciously in a situation so severe! Imagine if this response stuck around for a prolonged period of time. Your body would become exhausted from working in that manner. Some issues that can arise from this prolonged state are:
Neck and back stiffness
Neck pain
Mid back pain
Low back pain
Muscle strains
Headaches
Jaw or TMJ pain
Please realize that my bear example is an extreme one, and is 100% of your body’s fight-or-flight response. Now imagine this response being turned on to 5% or 10%, but for a prolonged period of time. This partial fight-or-flight response is what is typically experienced when stress causes physical effects. A Physical Therapist is well trained to identify when stress is a cause or contributor to your pain as opposed to a strictly biomechanical injury. This is important to assess since treating root cause to a problem will have better long term results than purely treating the symptoms.
Traumatic Injury and Stress
Ankle sprains, hamstring strains, “throwing out” your back, and tweaking your neck are examples of traumatic injuries we see in our patients. While stress is definitely not the direct cause of these injuries, they can be a contributing factor as to why they happened in the first place. The list below does not explain why all injuries happen, but can provide some situations where stress could contribute to or increase risk for injury.
Fatigue: Stress takes energy. This can impact training schedules, game performance, and potentially lower the threshold for injury.
Decreased sleep: Sleep is when we rest, recharge, and heal. Stress often affects sleep, in-turn affecting our recovery from activity and increasing risk for injury.
Rest: It is great to be able to get energized and ramped up for activity or sport, but being able to turn off the intensity is equally important to get some rest.
Muscle tension: Muscles need to contract and relax at fast rates for both life and sports. Increased muscle tension will decrease the efficiency of this process.
More Sensitive Nerves: Reflexes and senses are on high alert with stress. This will lower the threshold for pain and potentially injury.
Stress and the Healing Process
Stress is almost a guarantee once you have become injured. Whether your job, family, mobility, or hobbies are affected, injury is sure to alter your lifestyle. No matter the severity of the injury, even the unknown factors about how it will progress can be stressful. The counterpart to your “fight-or-flight response” is your “rest and digest” system. This is controlled by the parasympathetic nervous system.
The parasympathetic nervous system is important in promoting a good healing environment. Especially in the initial phases of healing, being able to deactivate the fight-or-flight system and get into a rest-and-digest mode is imperative to healing. The fight-or-flight system will turn on in response to threat. Injury is definitely a threat to the body. Shifting out of this threatened state to progress into the healing process is important to get back to full function. This will be different for each injury since the way the injury occured will vary. Information from a professional is very important to set the mind at ease and develop a rehabilitation plan. Often, the act of setting a plan and knowing what is to come can reduce the stress surrounding injury. Booking an appointment as early as possible in the healing process will ensure you are on the right track and customize the process to your needs.
Stress and Chronic Pain
Chronic pain has many contributing factors. Rarely does a condition persist due to one singular factor. This can be due to a few things causing the initial problem, or the condition evolving over time due changes in movement patterns, daily activities, and strength. It is challenging to speak for a wide variety of chronic pain and injuries in one article, but this will at least scratch the surface of how stress can be a causative factor for persistent pain or contribute to why a new injury continues to be painful beyond normal healing times.
As mentioned above, the fight-or-flight response increases muscle tone for readiness, but when this response is activated in a non-physically threatening manner for a prolonged period, it may lead to issues such as muscle aches, stiffness, and frequently spine related pain.
When our fight-or-flight reflex is brought on due to a prolonged stressful time or state of mind, some of those muscles could also be turned on for prolonged periods. Some of the muscles that are part of this reflex are our upper trapezius and spine extensors—also referred to as your neck and upper back area. This reflex and its effect on these muscles may contribute to chronic lower back and neck muscle stiffness. It can also lead to muscle pain or change our movement patterns in a way that leads to other injury.
What Is The Solution to Stress or Pain?
While the name Physical Therapy would make someone think that a Physical Therapist’s tools are purely physical, this is hardly the case. We are definitely not psychologists or counselors, though Physical Therapists are trained to counsel patients on techniques, exercises, and practices that are specific to their condition when stress is involved. There is clearly a psychological component to stress, and this needs to be handled accordingly. It does not need to be in a formal or clinical manner with a professional. Maybe just a few minutes of reflection about your day before sleep, journaling, or making a to-do list. If you do not feel that you have the tools to manage stress to the point that it will interfere, then talking to a professional may be an awesome option for you.
Physical Therapists are trained in using specific exercise, hands on techniques, and educational strategies which can be beneficial to someone who has pain due to stress or is healing from an injury. It may be surprising but specific breathing techniques can improve your movement and function while having an impact on your fight-or-flight response. Physical therapists use exercise in many ways to achieve different benefits. Stretching and strengthening are best understood by our patients, but exercise can also be prescribed to release endorphins, improve mood, facilitate our rest and digest response, and make dangerous movements feel more safe.
The best answer to any physical ailment or injury is to get assessed by a medical professional. You and your injury or condition are unique, and deserve a thorough evaluation of the situation to consider every factor. If you are not sure that Physical Therapy would be able to help you with your condition, schedule a consultation with one of our highly trained physical therapists today, give us a call at 908-598-9009.