Anyone who has followed any of my blogs over the last couple of months, or read our newsletters that we send out semi-regularly will have heard me talk about how we’ve observed a huge spike in the numbers of people who are attending physiotherapy for treatment of painful conditions where their pain is really disproportionate to what they’ve done to their tissues. This is the situation where someone wakes up in the morning and can’t stand up straight out of bed, despite having done nothing out the ordinary the day before. Or they’ve bent over to pick up a sock, and then their back seizes up and they can’t move (with severe, scary, disabling pain). Or they’re getting daily headaches requiring strong medication.
It doesn’t seem likely that in the last five months that socks have suddenly become significantly heavier and more dangerous to lift, or that sleeping has become a risky and high-force activity or that there has been a sudden increase in brain tumours.
This spike became noticeable in April and has continued to worsen over the last several months. While there are many factors that could be causing this spike (since pain is a complex experience that involves physical, social, and psychological factors), it seems obvious that one major factor is common in all human experience over this time span.
The link between stress and pain has long been documented in psychology literature, but the link between the bodily experience of pain, and the psychological experience of stress wasn’t clearly defined. How can losing your job make your back hurt worse? How can watching the news and seeing bodies being carted out of hospitals every day make your tennis elbow flare up?
When you experience stress your system produces stress chemicals like cortisol, adrenaline and others. Your immune system is responsible for detecting threats like viruses, bacteria, foreign bodies and foreign chemicals. It also recognises the chemical signature of stress as the sign that you’re under threat, and starts releasing a bunch of inflammatory chemicals into your nervous system which makes your nerves more sensitive. Your brain also loses some of its ability to filter out the danger messages it doesn’t think are important (descending inhibition).
Think about this as turning up the sensitivity of an alarm system – if it is turned up too high you start getting alarm bells from things that are not threatening at all, like cars driving past your house or bugs flying past detectors. Your nervous system is the same if it becomes inflamed. Suddenly the pressure on your back from leaning forward to pick up a sock is enough to trigger danger messages to be sent to your brain, and this is more likely to result in a pain experience, as the nerve cells in the brain become sensitised too (for the same reasons).
Add to this several physical factors, like; clenching or grinding teeth during the day or in your sleep, causing TMJ pain and headaches; sitting for longer periods of the day as working from home has less structured breaks, or being stood-down from work and forced to stay home likely involving more Netflix; sudden change of activity levels as an office worker who loses their job takes a labouring or cleaning job to put food on the table. The gym and Pilates studio are closed, basketball stadiums are shut, cross-fit boxes silent – so your normal ability to blow off steam and stay strong and health has been taken away.
It’s a perfect storm as far as pain is concerned.
So what do we do about stress? Stop watching the news and looking at the numbers. Start doing guided mindfulness practice, going to bed at regular times, having a few days a week of cleaner food or less alcohol. These may sound trite but their effect on reducing inflammation and stress is very fast and very profound. You don’t have to be a saint, just take a little more care of yourselves and your families. Be kind to yourself and don’t worry if everything doesn’t get done because you’re home schooling. The clothes will still be there tomorrow so will the vacuuming (it’s Groundhog Day after all!).
The government has introduced universal masking to reduce the spread of COVID. I think they need to introduce universal meditation to reduce the spike in pain.
Ben Kewish, Physiotherapist and Director
Hills Physiotherapy Clinics
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