Does back pain worsen around Christmas-time? If you asked us, we’ve got enough anecdotal evidence to say yes. But why is that? Clinic gets busier, our patients report symptoms are worse and then blame it on the weather… Now why is this? Well, simply put, as we get towards the festive period and the existing stress in our lives is ramped up yet another notch, we often start to see physical manifestations of underlying stress rear their ugly heads in the form of pain and illness.
Now, it’s not news that stress plays a part in pain and disease. What we’re interested in is chronic stress, and how this can make us ill. I wanted to find out more about the role of chronic stress, so I’ve been working my way through a reading list, including “Why Zebra’s Don’t Get Ulcers” by Robert Sapolsky. Now, this blog isn’t really about the inner workings of a zebra’s digestive system, it’s a book which focuses on why we as humans have developed a whole range of accumulative diseases as a result of living our lives chronically stressed. It explains how our body adapts to stress and details what the healthcare profession have had to learn in order to manage our patient’s stress.
Where we used to be killed off by cholera, influenza and leprosy (which did the job fairly quickly, it has to be said), we now suffer long, slow diseases that come about as the result of gradually accumulating a number of healthcare issues. Cancer. Heart disease. Strokes.
In the words of Mr Sapolsky, “Chronic stress can make you sick.”
So why don’t zebras get ulcers? Simply put, zebras don’t get ulcers because they don’t spend hours, days, or weeks stressing about making the mortgage repayment. Or worrying about your big project which needs completing by the end of the month. They worry about if a lion is going to eat them in the next 10 minutes. Their stress is short and to-the-point. It’s only we humans who have geared ourselves up physiologically to have all sorts of physical manifestations to stressful events generated entirely in our heads. If you’ve ever experienced sweaty palms or a racing heartbeat whilst thinking about what might go wrong then you know what I mean. Zebras just don’t do that.
It’s safe to say most of us nowadays live our lives in a state of chronic stress. We don’t take time to look after ourselves and truly de-stress (a soak in a bath doesn’t count!)
In short- chronic stress wreaks havoc. Your body’s response to an acute stressor is perfectly suited for its job. You’re home alone and hear footsteps upstairs- your heart starts racing, blood pressure and breathing rate increase as your body prepares to transport nutrients and oxygen to your muscles STAT. Why?
Because your muscles are going to need that energy as you hot-foot it out the door faster than Usain Bolt! Your body also shuts down digestion (because absorbing dinner suddenly isn’t so important) growth and tissue repair stop, senses are sharpened, sexual drive decreases, and the immune system becomes inhibited (there’s plenty of time to hunt for tumours in a week or so- right now, all your body cares about is getting out of the house and out of danger pronto). Oh, and another neat feature: To stop your body going into shock from extreme pain, your pain perception is decreased. Handy!
So- all good responses from the body and we’re out of danger now thankyouverymuch. But what happens if that stressor doesn’t go away? If your stressor is a busy desk job in a Fortune 500 company, you’ll never be able to switch off the stress response. You might find your heart rate stays at about 180/100 and steers you towards an early heart attack. Your digestion is going haywire, tissue healing and recovery is halted so nothing is ever repaired (hello ulcers!). Not only that, but you’ll never store any surplus energy because your body is mobilised to use it all straight away, and you’ll fatigue quickly.
Sounds bad, doesn’t it? It doesn’t stop there though. Illnesses and viruses will be easier to pick up and harder to recover from if your immune system is permanently compromised. This becomes particularly noticeable at this time of year when germs and viruses are floating around. You’ll be shaping up for a very snotty Christmas indeed if you’re stressed!
Stress disrupts our lives. It can make us very ill. As a chiropractor, my chronically stressed patients have widespread muscular tension and sometimes heightened sensitivity to pain. They suffer from headaches or jaw pain, visual disturbances, lower back pain, tummy upsets… Stress causes changes in our nervous system and can result in muscle tension, spasm, and pain. Now, I can adjust their neck to alleviate the headache, but that won’t help if the headache is a result of chronic stress. We need to manage their stress and anxiety or the headaches will just keep coming back (as any of my patients will tell you- I’m focussed on the long-term resolution.)
There are various management techniques and these all work for different people- you’ll have to find what works for you.
Exercise: A simple place to start is with exercise- being physically fit can lower blood pressure, resting heart rate and increase your lung capacity (yes- directly counteracting the effects of stress). Simply put, exercise releases endorphins and endorphins make you happy PLUS it increases your feeling of self-efficacy and achievement. Instead of sitting at a desk getting tense, you’ll be using your stress response for what it’s meant to do- explosive activity! That’s how exercise can be a powerful way of reducing stress.
There are a few caveats to this though:
Psychotherapy: For natural stress-heads (or, to use the correct term- type A personality), psychotherapy can change your behaviour, lower cholesterol levels and reduce your risk of a heart attack. Stress often depends on how we view problems, and some studies have found that in the face of terrible news, denial and hope are strong coping mechanisms. Don’t accept a poor prognosis and hope for the best- miracles can’t happen.
Ommm… Zen: Meditation is another interesting one. It can decrease glucocorticoid levels and decrease muscle tone/tension. But again, studies show that it works while meditating, but doesn’t necessarily have a long-term effect.
Social Support: In the immortal words of the Beatles, “I get by with a little help from my friends.” Giving and receiving support from the right friends is going to help, as will the support of a partner or spouse. A problem shared is a problem halved!
If you’ve downloaded our resource “Understanding Pain” you’ll already know all about this. If you haven’t downloaded it, we’d suggest you do! Control and belief in your own self-efficacy is a powerful thing. Whilst you can’t have full control over the fact that you have stressful projects to complete, you can gather information about how long the project is going to take for you to complete, what the goals are and who you’ll be working with. This predictive information about impending stressors can help to reduce your stress levels by giving you some control over the situation. This is in much the same way that learning about chronic pain can help you control, cope with and reduce your pain.
The caveat to this is that control isn’t always such a good thing psychologically. If, for example, you have control over a situation that ends up disastrously, that’s going to be completely detrimental to your psychological health. Believing that everything challenge in life can be overcome “provided we work hard for it”, can leave you in a stressed heap in the corner.
We also need to talk about cognitive flexibility. This is the ultimate ability to “cope”. Try problem-solving the issue and working out if it’s the stressor that needs altering, or your perception of it that does. This can be hugely stress-reducing. Admit that you’re finding something stressful and rely on social support from friends and loved ones- they’ll want to help. You’ll need a selection of coping strategies to effectively deal with stress. You might have a tendency to try to cope with an event, fail, and then go back in and try to cope even harder with the same strategies. If a cup of tea and a chat with friends hasn’t worked, try something different. A meditation class. The gym. Yoga. Speak to a psychotherapist. During times of stress, finding the right coping mechanism for you is critical.
In this blog we’ve learnt about just how stress can impact on our lives and wreak havoc in our bodies. There’s no one way to avoid stress- moving to a remote desert island is going to give you all sorts of acute stresses like our poor zebras. (Just think about all the poisonous critters who might see you as a tasty treat!) Fortunately there are numerous ways in which we can cope with and reduce the stress we experience.
The real world is full of stress yet many of these issues aren’t real, we’re worrying over what might happen. Imagined stressors can take over our lives with worry in anticipation of a horrible event happening. It may happen, it may not- worrying about it isn’t going to make it any easier to cope with!
Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference.
I like to practice what I preach, and so when I saw the “This Girl Can” campaign from Sport England, I thought it was about time I tried something new! I grew up playing team sports, and freely admit I am much more comfortable charging around a lacrosse field in sub-zero temperatures than I am in a yoga studio, particularly one that is heated to a tropical 40 degrees, yet that’s exactly what I did yesterday. I had heard a number of my patients mention hot yoga in Chichester, so after a brief chat with Natalie the owner, we went along for our first session.
Bikram Yoga is a series of 26 yoga postures with breathing exercises, and the temperature of the room is designed to warm and ease your soft tissues (muscles, ligaments and tendons) to allow a deeper stretch, as well as adding a little bit of mental challenge to the exercises. Anyone who thinks that yoga is a bit of deep breathing and a gentle stretch- think again!
Our clinic manager Rhiannon is already a bit of a yoga bunny, so she kindly accompanied me for moral support. It may surprise you to know that chiropractors can suffer with back pain too (mine is related to one-too-many falls off a horse) so I was hesitant about contorting myself into the bizarre postures that I’ve seen yoga fans perform, envisaging a few days of the inevitable grumbling lower back pain and achey I’ve-done-a-workout shoulders afterwards.
90 minutes? 40 degrees? We must be mad! However, fuelled with images from Sport England’s advert of women looking exhausted but triumphant, I decided that I wanted to be one of them and was determined to give Bikram a go. Trying something new and totally different was a little nerve-wracking (“What on earth is a tree pose? Who is savasana and why do they keep asking her to lie down?”) but after a while, and with some gentle advice from the instructor, I managed to get the hang of the exercises.
There’s a moment when you’re exercising or trying to get fit, where that little voice in your head tells you “It would be so much easier if you stopped”, or better yet “You really can’t do this. You’re never going to look like that girl over there so why bother?” Ignoring that little (or not-so-little) voice in your head is the real challenge. For me, that little voice kicked in after about an hour, when I caught sight of my red, puffy face in the mirror and realised that no, my leg really doesn’t bend that way. So I took a break. Yep, I stopped, sat down, reassessed, and watched everyone else sweating and stretching away. This Girl Can is encouraging us all to “wiggle, jiggle, move and prove that judgment is a barrier that can be overcome.” So when I sat down in a sweaty heap on my mat, a part of me expected to receive the inevitable raised eyebrows or smug “I’m-fitter-than-you” smirks. But no, not ONCE did I feel embarrassed about it, or lazy, or feel like a failure. I was amazed to receive a smile and a wink from the instructor, the girl next to me gave me a relieved s
mile and then plonked down on her mat for a minute, and the chap at the end of the room mouthed “You ok?” to me. That was when the dawning realisation came to me that we were all there trying to acheive the same thing- relaxation, fitness, flexibility, and I’m sure a few other things too! There was no shame in taking a break (yes, I got back to it a few minutes later) as we were all supporting each other to help get through what was a challenging activity!
Taking breaks when it becomes too much allows you to establish where your limits lie, and gives you an opportunity to identify problem areas that you might want to work on in the future. We all have to start somewhere, so whether you are an exercise addict already, or just want to try and get back in to shape, try something new, bring a friend with you, make it social and fun, or do like we did and go to Bikram and make it sweaty!
We conquered HotYoga, and although I am a little achey today, I know I’ll be going back. Because this girl can!