STRESS

We all know 2020 was a difficult year and we’re not quite out of the woods yet. However, global pandemic or not, life stresses emerge regardless so it is important to acknowledge stress and implement strategies to cope with it. Sometimes when you have a musculoskeletal injury, the focus is on how you are going to recover physically. But it is important to realise stress levels can have an impact on your recovery.

Therefore it is important to confront and manage your stressors to ensure you are addressing all possible contributing factors to your injury.
This article explores what stress is, how it manifests in the body, and why it is important to manage. Strategies on how to improve stress levels are discussed.

What is stress?
Stress has been defined as “experiences that are challenging emotionally and physiologically” (McEwan, 2007). Stressors may be acute (e.g. hassles), chronic (e.g. bereavement) as well as small (e.g. stuck in traffic) or traumatic (e.g. violent attack).

What is the physiological effect of stress on the body?
The brain determines our perception of stress and communicates with the cardiovascular and immune system to prepare the body to deal with stress. The body responds to stress by releasing chemicals that increase heart rate and blood pressure.

This response is appropriate for acute stressors such as climbing a flight of stairs. However, if the brain is constantly perceiving stress, the physiological response to increase heart rate and blood pressure becomes chronic. These chronically elevated markers essentially wear the body down and can increase the risk of disease – for example, cardiovascular conditions such as atherosclerosis, strokes, heart attacks, obesity, as well as cognitive dysfunction, dementia, and excessive fatigue.

I’m not measuring my blood pressure every day, so how can I identify if I am stressed?
The British Mental Health Foundation provide a list of common signs and symptoms of stress:

● feelings of constant worry or anxiety
● feelings of being overwhelmed
● difficulty concentrating
● mood swings or changes in your mood
● irritability or having a short temper
● difficulty relaxing
● depression
● low self-esteem
● eating more or less than usual
● changes in your sleeping habits
● using alcohol, tobacco or drugs to relax
● aches and pains, particularly muscle tension
● diarrhoea and constipation
● feelings of nausea or dizziness
● loss of sex drive

What has stress got to do with my injury and recovery? Short answer: a lot.

Research from Guo & DiPietro (2010) suggests stress affects the immune system and can trigger the body to overproduce particular hormones and chemicals (such as cortisol) that impair the normal activity of cells trying to repair tissue injury. Further compounding the body’s healing capacity is the fact that stress can also lead to negative emotional states which can negatively impact our likelihood to engage in healthy behaviours.

Research from Nippert & Smith (2008) demonstrated sustaining an injury significantly changes one’s self-esteem, increases the risk for mood disturbance, and can bring about depression and anger. Guo & DiPietro (2010) add to this saying stress can cause us to have poor sleep patterns, poor nutrition, less exercise and can lead to an increase in abuse of alcohol, cigarettes and other drugs. These behaviours can slow the body’s healing capacity. Put simply, stress can significantly delay the body’s healing process by affecting us on a physiological level and in the way that it impacts on our decision-making. Managing your injury may involve physical changes – perhaps to your activities, movement, or postures – but you should also focus on managing your stress to gain the best outcomes.

What are strategies to manage stress?
The following list has been formulated based on information from The Mental Health Foundation (UK) and Black Dog Institute (AUS).

Healthy eating

○ Reduces risk of diet-related disease (e.g. obesity, hypertension, diabetes)
○ Improves mood

Avoid or reduce the amount you smoke and drink alcohol
Exercise
○ Helps to relieve stress (more on this later)
○ Even light exercise is better than no exercise! Getting fresh air and your blood pumping with a simple brisk walk is helpful. A walk at the Ocean Grove beach or the Barwon Heads bluff is ideal!

Take time out
○ Giving yourself permission to prioritise self care is important for mental wellbeing

Treat yourself to a remedial massage. What better way to relax than to have 60 minutes of massage to decrease muscle tightness and increase blood flow around the body!

Be mindful
○ Mindfulness involves paying attention to thoughts and feelings in a way that improves our ability to manage stressful or difficult situations.
Practicing mindfulness can take the form of breathing, stretching, listening to a mindfulness app (such as Smiling Mind, Calm, and Headspace).
Research suggests mindfulness reduces the effects of stress, anxiety, insomnia, poor concentration and low mood

Restful sleep
○ Amend your sleep environment and bedtime routine if you’re finding it hard to get to sleep. Strategies include exercising after work to unwind, reducing screen time prior to bed, and ensuring the bedroom is a calm, clean space.

Don’t be too hard on yourself

○ Perspective is key! We all have low moods every now and then. Going easy on yourself is necessary at times

Recharge activities
○ Make time to do the things you love. Enjoying ourselves is energising so ensure you allow time to devote yourself to whatever activities get you going

Having routine
○ Predictability can help reduce stress
○ A regular exercise routine will mean you’re more likely to commit to it

Does physical activity help reduce stress? Short answer: yes.

According to McEwan (2007) regular exercise, as well as social connection, can help reduce chronic stress, benefiting the health of your brain and body as well as improving one’s resilience. Research from Stults-Kolehmainen & Sinha (2014) suggests exercise impacts one’s mental health positively and improves quality of life. Exercise enables people to better cope with stressful encounters because it reduces the release of ‘stress hormones’.

Further, exercise is associated with less perceived stress in daily life generally, meaning the body is less likely to release stress-evoked chemicals and hormones regularly. This reduction in stress perception means psychological stress is reduced which means release of stress hormones is lessened which results in less cardiac reactivity (i.e. increased blood pressure and heart rate). To put it simply, physical activity helps the brain, body and heart.

But there is also a challenge…
According to research from Stults-Kolehmainen & Sinha (2014), higher levels of stress can negatively impact on one’s effort of adopting and maintaining physical activity. In other words, sometimes when we feel stressed, exercise is the last thing we feel like doing. Which is a shame, because we know exercising can actually help us cope with the initial stress. To add to this, research demonstrates stress is associated with binge eating, increased caffeine consumption, and television viewing.

We’ve all been there – feeling tired, overwhelmed, or frustrated so we revert to trusty strategies like reaching for that cookie, coffee or losing ourselves in screen time for longer than we’d like to admit! How do we overcome this vicious cycle?

How do we find motivation to exercise when it’s the last thing we feel like doing? The following suggestions were selected from research conducted by Grave, Calugi, Centis, El Ghoch, & Marchesini (2011) as well as Ryan, Frederick, Lepes, Rubio, & Sheldon (1997).

○ Plan enjoyable or amusing exercise activities (e.g. dancing, group walking)
○ Make exercise social. Ask a partner, friend or colleague to join you. The 13th Beach Health Services ‘Move Club’ on Wednesdays at 6pm is a fantastic opportunity! We meet at the rotunda at the Barwon Heads bridge and walk or run to the bluff and also towards Ocean Grove. This group caters for all abilities, ages, and fitness levels.

Another option is joining one of the 13th Beach Health Services group classes for Mat Pilates or Reformer Pilates. This is a great form of low impact exercise that has many benefits such as improving strength, reducing pain, and increasing mobility! Check out Mat Pilates here

○ Adjust the reasons why you exercise to – extrinsic reasons such improved appearance are often unsustainable motives to exercise. While body related outcomes are often the impetus for exercise, they often do not sustain ongoing exercise. Instead, exercising with intrinsic motivations, such as enjoyment or the growth of competencies and skills, are stronger drivers that result in sustained exercise uptake, particularly if it is fun, personally challenging, and makes you feel strong, healthy and able.
○ Have a routine – you’re more likely to commit to exercise if it’s scheduled in, even when you’re having a down day.
○ Make exercise convenient for you. If travelling to a gym or class is annoying, engage in exercise at home on your own, online, or simply go for a walk.

○ Some is better than none – if you feel like you’re time poor and can’t commit to say, a 40 minute exercise session, do short (e.g. 10 minutes) higher intensity bouts of exercise instead.

○ Try exercising with people who have the same physical limits as you

○ The aim is to engage in moderate to vigorous activity for 60 minutes on most days (at least 5 days a week). If this sounds like too much time to put aside, try incorporating exercise in your day to day life. Walk to the shops instead of driving, take the stairs instead of an elevator, unwind after work with a walk instead of that 20 minute sitcom you’ve probably already seen!

We hope you got something out of this article and if you are feeling stressed this was useful to you. If you would like to speak to our Osteopath Ella please feel free to contact her at the clinic at reception@13thbeachhealthservices.com.au

If you would like more information for our Wednesday night ‘Move’ club, on our Mat or Reformer Pilates classes, or to book a Remedial Massage, please call the clinic reception on 03 5254 2668.

Resources:
McEwen B. S. (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological reviews, 87(3), 873–904. https://doi.org/10.1152/physrev.00041.2006

Stults-Kolehmainen, M.A., Sinha, R. (2014). The effects of Stress on Physical Activity and Exercise. Sports Medicine, 44, 81-121. https://doi.org/10.1007/s40279-013-0090-5

The Black Dog Institute (AUS)
https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/3-stress-and-its-impac t-on-you.pdf

Mental Health Foundation (UK)
https://www.mentalhealth.org.uk/publications/how-manage-and-reduce-stress

Guo, S., & DiPietro, L. A. (2010). Factors Affecting Wound Healing. Journal of Dental Research, 89(3), 219–229. https://doi.org/10.1177/0022034509359125

Nippert, Angela & Smith, Aynsley. (2008). Psychologic Stress Related to Injury and Impact on Sport Performance. Physical medicine and rehabilitation clinics of North America.19. 399-418, x. 10.1016/j.pmr.2007.12.003

Ryan, R., Frederick, C., Lepes, D., Rubio, N., and Sheldon, K. (1997). Intrinsic Motivation and Exercise Adherence. International Journal of Sports Psychology.
https://selfdeterminationtheory.org/SDT/documents/1997_RyanFrederickLepesRubioSheldon.pdf

Dalle Grave, R., Calugi, S., Centis, E., El Ghoch, M., & Marchesini, G. (2011).
Cognitive-behavioral strategies to increase the adherence to exercise in the
management of obesity. Journal of obesity, 2011, 348293.
https://doi.org/10.1155/2011/348293

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