Stress is a loaded topic. Most of us are familiar with the emotional effects of stress, but did you know that you can experience physical stress too? Stress management is linked to angelic faces, calm waters, white noise and burning incense. You may consider it a sign of weakness or the enemy of success. Or maybe it is your silent superpower. You cope and perform better when you are under pressure, have a million things to do or deadlines to reach. It is better to understand the facts about the symptoms of physical stress, how to manage stress and ultimately experience stress relief, than to get lost in the fiction.
What is stress?
In a physiotherapy setting we love stress. As a profession we have loads of “stress tests”. These tests allow us to evaluate the integrity of a specific structure, usually a ligament or tendon. If you experience pain with these tests, or you have more laxity on your injured joint, we can make a diagnosis of a ligament sprain of tear.
Stress is defined as mental or emotional strain or tension that results from demanding circumstances. Almost like life is testing your integrity. Like physical load may be too much for a specific structure, stress load may be too much for your emotional or mental integrity, and it can feel like you are hanging on to only a few fibers of intact sanity.
The World Health Organization defines depression as:
“… characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-esteem, disturbed sleep or appetite, feelings of tiredness and poor concentration. Depression impairs an individual’s ability to function at work or school or cope with daily life.”
Stress isn’t all bad for you, it enhances your performance by:
- releases energy
- increases oxygen availability
- aids in pain resistance
- increases muscle power
- enhances mental acuity
- promotes immune defenses
The critical difference between “good stress” and “bad stress” is the duration of the stress experience.
The loss of balance in physical stress
Like all things in nature our bodies strive to be in a state of balance or homeostasis. This means we function optimally with a certain pH level, blood pressure, body temperature etc. Like an orchestra needs to play in tune and in time, our bodies need this same harmony.
But luckily for us we have the ability to adapt and change to our surroundings. You can sweat to stop from over heating on a hot summers day and shiver to stay warm in winter. When faced with a challenge, be it traffic, public speaking or an exam, your body undergoes certain changes to make you at your sharpest. These changes have an evolutionary background, because it was needed back then for survival, hunting, fleeing or fighting. And as you are still here today, reading this article, your ancestors were pretty good at these adaptations and passing their genetic material on to you.
Stress is the magic phenomenon that allows these changes that are crucial for survival, performance and thriving. So how could stress be crucial and also bad for you? Stress should be of short duration. It should aid in your performance and then your body should return to balance, this is known as eustress. The adverse effects of stress, or distress, is because of prolonged exposure. And unlike our ancestors that were faced with a problem, overcame it with the help of the stress response and then returned to “neutral”, we get stuck in the stress axis. We live there until something comes undone and the last fibers break too. It is ironic that this system which semented our survival, is one of society’s biggest threats today.
The effects of physical stress
In 2012 The American Journal of Cardiology published a meta analysis of the effects of chronic stress on cardiovascular health. They found that chronic stress increased the risk for coronary heart disease by 27%. To put in into perspective, smoking more than 5 cigarettes a day, high blood pressure or elevated cholesterol, has the same risk for developing coronary heart disease. Living a healthy lifestyle in terms of diet, exercise and sleep, but without adequate stress management, is equivalent to smoking or having high blood pressure or cholesterol. Physical stress negatively influences your heart health, the same way unhealthy habits would.
Chronic stress doesn’t only impact your heart health, it can wreak havoc in your hormonal, nervous, respiratory, immune, digestive and reproductive systems. That’s why prolonged (chronic) stress can lead to a range of physical symptoms, that include:
- muscle & joint pain
- colds & flu
- digestive issues (IBS/constipation)
- behavioral changes (sleep disorders, moodiness)
- infertility
Understand the physiology behind the stress response
The stress response follows two different routes. Richard Sutton explains it as “two distinct waves” in his book, The Stress Code, highly recommended. To boil it down to the basics you can consider how your weight responds to stress. Do you balloon like a blow fish? Or do you become as thin as a rake?
The first wave of physical stress
The first wave stimulates sympathetic-adrenal-medullary (SAM) axis. This is like your first responders in the event of an emergency. This process begins in the brain, within the amygdala or your “fear centre”. Messages travel to the hypothalamus, your “command centre”. Now the hypothalamus signals adrenalin release from the adrenal glands, on top of your kidneys. Adrenalin secretion increases blood pressure, heart rate and respiration so that circulation to the brain and major muscles are improved. Your immune response improves together with your sense sight and smell.
For your body to manage these changes, some things go neglected. Adrenalin directs blood away from the skin, digestive and reproductive systems, because glowing skin and digestion is at the bottom of the priority list now. This explains why you look pale or experience digestive symptoms, like bloating or constipation, during stressful periods. And even if you feel well able to cope and perform, these symptoms may be the first indication that you body is under stress.
Decreased circulation to the digestive system influences the functioning and movement, peristalsis, of the digestive organs. This in turn can affect the bacterial colonies within the gut too. These changes impairs healing and growth both in adults and children. The effects are concerning when adolescents are exposed to stressful situations for extended periods of time. It may contribute to impaired growth and predispose children to developing pain syndromes and health problems later in life.
When you get caught in this wave you’ll lose weight without trying to.
The second wave of physical stress
Following this adrenalin wave that crashes through the body, the brain signals secretion another hormone, cortisol, also from the adrenal glands. This is known as the hypothalamic-pituitary-adrenal (HPA) axis. Adrenalin and cortisol work together to boost the immune system, for a short period of time. Where adrenalin mobilised the immune system, like getting all the soldiers ready for action, cortisol regulates immune function, adding strategy to the soldier’s fight against intruders. Cortisol has the opposite effects when your body is exposed to high levels for a long period of time. Then it does the opposite and suppress the immune system. This may cause bacterial or viral infections after a stressful period.
Long term elevation of cortisol can cause your body to become resistant to the effects of cortisol. This may lead to auto immune disorders, by suppressing the immune system or failing to regulate is completely. Cortisol also causes:
- increased activity, like fidgeting
- disrupted sleep
- demineralization of bones
- muscle breakdown
- increased gastric acid (heartburn & reflux)
- increased appetite
- decreased sensitivity to insulin
- reduced growth hormone levels
- weight gain (if you get caught in this wave you’ll gain weight, no matter how hard you try to lose it)
The role of cortisol in physical stress
The effects of cortisol on your brain
- fear
- anxiety
- decreased attention span
- memory impairment
- poor focus
- emotional instability
In 2012 researchers at Yale University found a direct correlation between chronic high levels of cortisol and decreased brain mass of the prefrontal, insular and anterior cingulate cortex. These different brain areas are responsible for high cognitive, complex intellectual function, coordination and motivation. You may experience this as feeling “slow”, unable to remember or find words. “Brain fog” describes it beautifully, you know what you are looking for is there, but you cannot see it clearly.
Chronic elevated cortisol can also change brain composition. The brain consists of white and grey matter. Grey matter is responsible for higher functioning, and have a lot of nerve cell bodies to accomplish this. White matter is full of the axons that connects the cell bodies. Axons enable a communication network. Glial cells supports the nerve cells in white matter. High levels of cortisol results in more white matter formation and less grey matter. So in essence you have more “pathways” for thoughts, but less capability for these thoughts to be meaningful.
This increased connectivity causes faster more intense fear responses too. Because the hippocampus and amygdala, our emotional centres, have highways connecting them, and not the normal 2 lanes needed of the past. Hyper vigilance and increased fear, then leads to even more sympathetic activity and higher cortisol, this is a bad cycle to get stuck in.
The role of oxytocin in physical stress management
If long standing high levels of cortisol is the Joker, then oxytocin is Batman. Oxytocin is our bodies own, innate antidote to stress. It has been called the kindness chemical or hug hormone, because that is causes you to feel warm and fuzzy on the inside.
Oxytocin is a hormone that greatly influences our psychological and physical wellbeing. It is best known for its affects during child birth and the bonding of mother and new born, when all pain is forgotten. It also increases feelings of:
- self worth
- confidence
- empathy
- optimism
- calmness
- generosity
On a physiological level oxytocin lowers cortisol to protect the brain and lower blood pressure. It also increases growth factor to aid healing and repair. This will decrease the symptoms of physical stress.
So why then can we not regulate the stress response efficiently? Oxytocin is metabolised within 5 minutes in the human body. Which means that even if it was developed into tablets, you’d need to take one every 5 minutes to have a lasting effect. But you can up your dosage very cheaply by physical contact and social behavior, like:
- hugs
- handshakes
- eye contact
- acts of caring and kindness
- compassion and support
The effects of chronic physical stress on your cells
Chronic stress damages your DNA. Stress shortens the DNA telomeres. Telomeres are protein complexes at the end of the DNA helix that protects the structure. They organise our chromosomes, prevent them form sticking together and protects DNA during cell replication. Shortened telomeres lead to mutations, cell inactivity, poor functioning and premature cell death. It is the primary cause of ageing and chronic disease.
Stress management strategies
Stress management for athletes
If you want to improve your stress management skills, look to and learn from people who flourish under stressful situations. There is no better population to build your strategy on than athletes. They tend to cope and manage stress better than the rest of us because of tools they acquire over a life time of participation. It may look like a dream when you watch your favorite athlete win the gold, but behind the scenes they manage training, injuries, social isolation, disappointment, financial pressure and uncertainty from early in their careers.
On average athletes live 5 years longer that non-athletes and have a lower risk for heart disease and cancer. This is not merely because of being fitter than the average population. Athletes have a holistic approach to their health and wellbeing. They tend to eat better, supplement their diets, use visualization, meditation and breathing exercises to compliment their training. Music is incorporated into stress management and yoga based maintenance practices are done regularly. Physical treatments are not frowned upon, even though they may not have symptoms at present. Nothing is neglected and they definitely do not wait for a problem to spontaneously heal, to seek treatment. This doesn’t sound far fetched for an athlete and could be part of your own stress management strategy.
Symptoms of stress
Seeking help & consulting a professional
Because the body, as magnificent and amazing as it is, cannot distinguish actual damage from potential damage, stress can wreak havoc on your homeostasis. The body is essentially behaving as though it has sustained an actual injury. Like mentioned before, we are experts at testing structures in your body. We will be able to distinguish actual structural damage from the effects of physical stress. This knowledge of wether there is or isn’t damage is all ready greatly beneficial for calming down the stress response. That, in combination with discussing your concerns about the healing time and prognosis has a tremendous healing effect for stress management.
Increase your threshold
Muscle spasms, stiffness or tightness accumulates where the nervous system is hyper vigilant. This can happen and be sustained of you do not address the cause. A strong muscle is less likely to “act up” by shortening the lever it has to contract over. The stronger your stability muscles are, the less “worried” your nervous system have to be about possible injury. The nervous system can keep calm because the muscles have control over the range you need them to move in. There for trigger points and tightness becomes less frequent. We can test your muscle strength and endurance and prescribe the right exercises for you to do, while also addressing the areas of pain.
Exercise for stress management
Any physical activity that increases your heart rate counts as exercise, you don’t necessarily have to be fit and sweating after a session for it to count. Exercise prescription is important when used locally to load injured tissues to aid healing. But exercise also has a systemic effect on the whole body. Physiologically exercise increases endorphins, your “feel good hormones”. This is commonly known as a runner’s high, the elated feeling of well being once you have exercised. Endorphins not only make you feel good, but boosts the immune system and return the body to homeostasis.
The World Health Organization (WHO) suggests “adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week.”
Depending on the exercise you choose you may also learn a new skill, like swimming or boxing, or meet new people in a class or group setting. Muscles have memory and it is true that you’ll be able to “get your swing back” quicker that somebody completely new to the activity, but unfortunately you cannot “save up” exercise for a rainy day. You cannot expect the benefits of the exercise you did 10 years ago to last until today. That’s why is is important to choose something you like doing, so that your exercise regime is sustainable in the long run.
Breathing exercises for stress relief
Breathing is the first thing we do by ourselves out of the womb and the last thing we do on this earth, yet we pay little attention to all the breaths we take in between. The average adult takes 12 – 18 breath per minute, that’s about 672,768,000 breaths in a lifetime, if you are healthy enough to reach 80. Controlled breathing exercises stimulate baroreceptors, which relay change of pressure from the cells to the brain. By breathing well, controlled and deep, less pressure is exerted on blood vessel walls, which then decreases heart rate and blood pressure in turn.
The lung tissue expands when you take a deep breath in. Mechanoreceptors, which relay change of stretch or load, within the lung are stimulated with deep breathing. This can decrease heart rate and blood pressure even more.
It can be overwhelming, and counterproductive, to choose a technique from the many breathing techniques out there. Why not start with just sitting back, closing your eyes and taking a deep breath in? Feel how is feels. Now try breathing in to a count of five, and then breathing out to a count of five too. Do 10 rounds like this whenever you need to, or before you lose your temper, through out the day. Easy as that!
Relaxation techniques for stress relief
Relaxation techniques can make you feel more able to cope with a stressful situation. For each of us relaxation means something different, but something easy you can try right now is Jacobson’s progressive relaxation technique. You need a quiet, comfortable space on the floor, your bed or chair. You may wish to read and record the next few lines so that you can close your eyes and just listen to your voice, or just work your way up your limbs by squeezing your muscles on the inhale and letting go on the exhale.
- Breathe in and out gently for a few rounds.
- pull your toes towards your knees, hold, then let go.
- Pull your knees together, hold, then allow them to drift apart.
- Squeeze your buttocks together, hold, then let go.
- Gently pull your belly button towards your spine, hold, then let go.
- Draw your shoulders towards your ears, hold, then let go.
- Clench your hands into fists, hold, then let go.
- Push your head forward, hold, then let go.
- Grit your teeth together, hold, then relax your jaw, by parting your teeth.
- Press your lips together, hold, then let go.
- Press your tongue to the roof of your mouth, hold, then relax your tongue away from your upper pallet.
- Tightly squeeze your eyes shut, hold, then let go.
- Frown and pul your nose up, hold, then let go.
Spend a few minutes breathing deeply and enjoying the new position of your limbs. Then slowly open your eyes and continue your day.
Yoga for stress relief
Since Jennifer Aniston took up yoga, Westeners have become more open to this ancient practice. Benefits of a regular yoga practice includes flexibility, balance, coordination and strength, and recent research suggests that yoga increases stress resilience. Being more resilient towards physical stress goes a long way to manage stress relief. Yoga is more than just exercise because of the emphasis placed on breathing and relaxation techniques. The physical practice aims to gain movement so that the body can be comfortable to sit upright for a meditation practice. The benefits far out weighs the risk, of feeling clumsy or not being able to reach your toes, everybody has to start some where. The common excuse of “not being flexible enough”, is almost the same as arguing that you are to dirty to take a shower.
There are so many different disciplines of yoga out there, from sweating it out in a Hot Pod or Bikram class to absorbing the benefits of a slow paced Hatha or Yin class. Iyengar yoga focusses on alignment to a degree that any piece of furniture can become a prop to the vigorous Ashtanga sequences that may seem like Circ de Soleil performances. Be curious, explore and find a style that suits you.
Meditation for stress relief
Meditation is an age old practice. It is a form of mental training that aims to keep the mind and thoughts quiet, the focus being on your breath or affirmation. For most people this can be more challenging than finding parking in the city centre. The mind tends to do the opposite from what it is told, like a small child. If you treat the experience with the same patience you would a small child, it becomes easier with practice.
Meditation improves mental acuity, attention, memory, cognition, emotional regulation and promotes creativity. It lowers cortisol, thereby reducing inflammation and improving the immune response. Best of all, it is completely free. You do not have to sit like Rafiki in the Lion King to get the benefits of mediation. You can sit on a chair and practice. There are many different techniques to explore and choose from.
Zen Meditation
This practice emphasizes focused attention while observing the breath. Sitting quietly this gives you time for introspection while concentrating on either the amount of breaths you take, or the duration of the inhale and exhale.
Loving Kindness Meditation
Causes of stress
conflict (In 2015 Harvard & Stanford universities publishes a meta analysis on the health implications of chronic stress. The study directly linked stress with premature mortality and decline in mental and physical health. The study found that ongoing conflict is associated with 90% chance of developing physical symptoms and a 160% chance of developing mental symptoms)
job insecurity
long working hours
Factors that contribute to high levels of stress at work are:
- high job demands
- lack of control
- injustice
- poor social support
- effort reward imbalance
- lack of authority over decisions
Chronic stress in children
Stress affects children in the same way it affects adults. The impact of the effects in a developing child may be increased. Height, overall health and mental and emotional integrity in later life may be affected.
Stress raises systemic (overall) inflammation. Chronic stress may result in persistent inflammation. Research has shown that stress early in life have heightened inflammatory response to phsychosocial stress. So an adult, who experienced challenging circumstances as a child, may have a disproportionate inflammatory respsonse to stress later in life.
