Stress means a lot of things to a lot of different people. It can be interpreted as anxiety, worry and tension. It can also be excitement and anticipation. With such a widespread impact, it is almost understandable that it is misinterpreted as something controllable, intentional or solely mental.
Let’s get something very clear. Stress is not just in your head and it is very real.
In fact, the academic definition of stress is “any intrinsic or extrinsic stimulus that evokes a biological response.” (Phillips et al., 2011)
It is only in your head in the sense that your head houses your brain which can actually be structurally changed in response to stress causing alterations in cognition and memory.
In clinic we are seeing more and more clients come in with complaints of muscle tension, headaches, gastric upset and a host of other symptoms. While there are many contributors to a patient’s presentation, what we are seeing almost across the board is that one of more of those symptoms has its derivative in either physical or emotional stress.
As a result, we can no longer successfully treat the complaint without looking at the overarching contribution of stress.
Why Has Stress Become Such a Widespread Concern?
There is no doubt that the impact of stress is vast. The biggest concern is that it has become so prevalent that it is now affecting the mental and physical health of much of our population.
To put this into perspective, when we were cavemen, stress was mostly felt in situations of intense danger (i.e. being chased by a tiger). Through our sympathetic nervous system, a fight or flight response was initiated, releasing epinephrine into the body. This would cause an increase in circulation and blood pressure to pump blood quickly to our muscles and a dilation of airways to increase oxygen to make our brains more alert.
When the stressful stimuli was removed, levels of cortisol, the stress hormone, would fall to reverse the reaction and send blood and oxygen back to systems required for basic daily functions like digestion and regulating the body (Woolf et al., 2007).
The problem we are seeing now is that there are perceived threats all around us every day. Looming deadlines, financial responsibilities, child rearing, busy streets, amongst others, contribute to the constant presence of stress. In essence we are always being chased by a tiger and our nervous systems were only meant for sprints, not marathons.
The result? Physical and mental break down. Too much epinephrine contributes to elevated blood pressure increasing the risk of stroke and heart attack. Increased cortisol can lead to elevated levels of fat and obesity. Constantly triggering our nervous system without rest and recovery decreases our firing threshold making us more reactive to smaller stimuli. Our bodies are not equipped to handle an ongoing stress response (Thacker et al., 2012).
What Are the Signs and Symptoms of Stress?
Unsure if you have stress. Listening to your body is a good way to find out.
The Mayo Clinic, identifies the following as physical manifestations of stress:
- Muscle Tension
- Chest Pain
- Decreased Sex Drive
- Stomach Upset
- Disrupted Sleep
- Decreased Immunity
- Nervousness and shaking
- Dry Mouth
- Clenched Jaw or Grinding Teeth (Mayo Clinic, 2018, Phillips et al., 2011)
Sound familiar? When a client describes their life as stressful, we can usually check a few, if not many of these symptoms off the list.
What does that mean for treatment? If we do not address the stress response and how patients cope, the stimuli for dysfunction will always be there. In other words, we can work on a muscle for days but if we don’t decrease the stress causing it to be tight, we will never make any progress.
Implications of Stress Postnatally
One of the patient populations most affected by this phenomenon is our postnatal pelvic floor clientele. Many of our clients come in following labour and delivery expecting that their symptoms of incontinence and low back pain to be caused by weak muscles and the mechanics of motherhood. Often they are right. However, what surprises many new moms is when we tell them that pelvic floor is tight and that intense exercise might be contraindicated.
If you consider the stresses placed on new mothers (physical healing, sleep deprivation, being the primary caregiver to a new baby, increased nutritional demands), a tight pelvic floor makes perfect sense as do many of the other symptoms reported by new mothers.
A tight pelvic floor, like any other muscle in the body, can be a sign of a nervous system under chronic stress. Difficulty shedding post baby pounds can be a reflection of elevated cortisol levels. Mommy brain may actually be the cognitive implications of structural changes to a brain under constant levels of stress.
We can stretch, massage and exercise all we want but until new parents can calm their nervous systems, they will not be successful in alleviating their symptoms. Moms are not going crazy, they are under immeasurable chronic stress and we need to find ways to help them manage that stress.
How Can We Alleviate Stress?
While it is clear that sources of stress are not going anywhere, there are actionable ways we can better manage our stress.
- Exercise: The benefits of exercise are well documented for almost any health ailment and stress is no different. A minimum of 20 minutes of light exercise a day is recommended for healthy circulation, to manage weight and to improve sleep (Norris et al., 1992). Exercises that have been particularly well documented to help with stress include yoga, tai chi and Qi Gong.
- Relaxation techniques: Meditation and deep breathing can be very powerful tools to combat the effects of stress. The best part about them is that they can be applied in short bursts that can fit into the busiest of days. Alternating nostril breathing is an excellent trick to calm a heightened nervous system and there are multiple apps, such as Calm, Headspace or Fitbit that offer quick guided meditations or deep breathing exercises.
- Positive Attitude and Gratitude: The idea of shifting our perspective can be a bit abstract but also a powerful tool for how we view our stress. Shawn Anchor, gives an excellent Ted Talk about the positive effects of leading with happiness and impact of gratitude called The Happy Secret to Better Work. It is a favourite and definitely worth the watch.
- Social Interaction: Did you know that having meaningful social interactions can have a more protective effect on your health than quitting smoking? Did the words social interaction just cause you more stress? No problem. Social interaction is defined as having two good friends, not necessarily being a social butterfly constantly engaging in extroverted outings.
- Self Care or Personal Time: This can be a struggle in our busy society but is a must. I think the important concept here is that all contributions are welcome and should relate back to what is meaningful to you. Being out in nature, or forest bathing, has been shown in research to positively impact stress but a more realistic version for you might be going to bed on time, taking a 20-minute uninterrupted bath or enjoying a coffee with a friend. Whatever it is, make sure it resonates with you and makes you happy. (Mayo Clinic, 2019)
- Nutrition: This is a blog unto itself but the simple version is that good nutrition, that fuels your body with nutrient rich whole foods has a positive effect on stress. Nutrition can be complex so you may want to start with small steps like eliminating sugar, reducing alcohol consumption or trying to eat more leafy greens. If you are unsure and need nutritional support, a naturopath is a great option because they can also test for stress hormones to make more meaningful recommendations.
Still feeling overwhelmed by stress. I can tell you from experience, that is pretty normal. Luckily health care is changing to take a more global picture of people’s health, including the impact of stress. Our team are better equipped to understand how stress affects our clients as well as to help you come up with tailored solutions.
If you feel as though stress is negatively impacting your life, stop, take a deep breath, then ask how we can help.
Melanie Stevens Sutherland, Clinic Director & Senior Orthopaedic and Pelvic Floor Physiotherapist
Melanie is a graduate of McMaster University and brings 17 years of experience as a senior physiotherapist to Body Co. She has enjoyed a long tenure working with active populations at prestigious sport medicine clinics. Past clients include Provincial, National and Olympic level athletes as well as members of the National Football League, the Canadian Football League, the Ontario Hockey League, the American Hockey League, the National Lacrosse League and Major League Soccer.
Following the birth of her own children, Melanie developed a strong interest in women’s health. She has taken specialized courses in pelvic floor physiotherapy and women’s nutrition. She is passionate about helping women find strength and confidence in their post-natal bodies following pregnancy and delivery.
Mayo Clinic Staff (2019, April). Stress symptoms: Effects on your body and behavior. Retrieved fromhttps://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-symptoms/art-20050987
Norris R, Carroll D, Cochrane R. The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population. Journal of Psychosomatic Research. 1992; 36 (1): 55-65.
Phillips K, Clauw DJ. Central mechanisms in chronic pain states – maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011; 25: 141-154.
Shawn Achor: The Secret to Better Work http://www.youtube.com/watch?v=fLJsdqxnZb0&list=PLvjK6s3rZ5JcGkqmKY9Jy27o0xvuErp5i
Thacker, MA and Moseley GL. First-person neuroscience and the understanding of pain. Might science need philosophy for a precise and complete understanding of pain? Med J Aust 2012; 196 (6), 410-11.
Understanding The Complexity of Pain https://www.youtube.com/watch?v=Zv6RPoVZx9M&feature=youtu.be
Woolf CJ. Review. Central sensitisation: implications for the diagnosis and treatment of pain. Pain 2011; 152:S2- S15.