I’ve realised since starting work as a physiotherapist that there is an unexpected benefit to personally sustaining an injury, or experiencing pain for whatever reason. It reminds us of what patients are going through. I often find myself saying to patients - “I’ve had a similar injury.” A dislocated knee cap, broken collar bone, sprained ankle, patello-femoral pain syndrome, tennis elbow, shoulder tendinopathy and of course, one of the most prevalent pains of all, back pain. I seem to be slowly building a pretty diverse list, though luckily nothing too dramatic. However, there was a trend among all these issues. There was a clear reason for them. Rugby, slipping on wet tiles, training less than sensibly in the gym, rowing with poor mobility….. Cause and effect. However, the other day I had an experience that opened my eyes to something I tell patients all the time. “Your pain is worse because you’re stressed.”
In the lead up to the experience in question, I had been working hard - full time in the NHS and part time for a private clinic. For the previous year or so I had planned on getting a more senior NHS role with part time hours, and taking on more hours privately. All this planning and effort was in the balance a few weeks ago, as the day of the interview for my new role fast approached.
The night before the interview, I got maybe 3 or 4 hours sleep. These interviews are more like exams, and the morning of I woke up at 5am to go over yet more clinical scenarios. To be honest at this point it probably did more harm than good. In the end, everything worked out. I got through the interview without letting myself down, and then worked the rest of the day until about 18:15.
When I got home I flopped down on the couch, looking forward to some food and tv. As I sat I started to wiggle around a bit. I felt pretty uncomfortable. I started asking why. I realised my back was actually feeling pretty painful. I was confused, and started running through a checklist in my head - I hadn’t picked something up and suddenly felt pain, I haven’t been less active than usual, I haven’t increased my training volume in the gym….. Why am I sore? And then I realised.
“You slept 4 hours last night. You’ve barely eaten today. You spent the majority of the last week stressed. That’s why you’re sore.”
To explain….. When you’re stressed you release hormones, which have many effects. In the short term, they are helpful in keeping you alert, speeding up your response times, causing your body to move blood to the areas it may be most needed in case you need to escape a situation (this is a primal mechanism) or fight a threat. Unfortunately, the longer these hormones are present the more you will start to experience their negative effects - exhaustion, poor concentration, low mood, etc. These hormones also have the unfortunate effect of increasing muscle tension, and heightening the pain response of the body. The bitter irony is that deep sleep is one of the things you need to get rid of them - but they inhibit deep sleep. All of this leads to a perfect storm - of you experiencing more (and often what feels like completely out of the blue) pain. To further reinforce the point, here are a few studies to show these effects:
A correlation between sleep deprivation and raised inflammatory markers is shown HERE.
Significant evidence of sleep quality's ability to predict future pain can be seen HERE.
A strong correlation between levels of stress and pain can be seen HERE.
I’ve always been in the habit of asking my patients if they’re stressed, particularly if there is no obvious cause of their pain. The responses can be so predictable it’s almost beyond belief - almost always “yes”. I couldn’t count the number of people who have presented to me in pain without any recent history of trauma or activity overload, but who have revealed with probing that a family member just passed or is very sick, or they are stressed at university or work. Simply pointing this out can be hugely helpful in managing their symptoms, and along with some guidance and exercises to stretch or strengthen whatever structures need it, they often see quick and significant improvement in symptoms. It is far and away one of the most satisfying parts of my job.
So the next time you are stressed and feel some physical issues developing, book an appointment and we’ll make sure nothing else is going on. Then, we’ll do everything we can to make things better - including a long talk if that’s what’s needed. People seem to be a lot more amenable to physiotherapy when your treatment includes half an hour a day to sit down with a coffee, spend time with a friend or read a book! Either way, I hope the information in this blog has maybe helped some of you understand the issues you may have been experiencing lately. Any feedback is welcome at info@mkphysiotherapy.com.
Here's to a relaxed and pain free Christmas!
Mike.