Can prolonged stress affect your pain and healing? Research now suggests that it can, particularly with chronic pain. If you suffer from ongoing pain you may have noticed this relationship yourself. Many people know that their pain is worse when they are stressed but they don't know why.
Stress activates your sympathetic nervous system, this is the where we can move into "fight, flight or freeze" mode. The sympathetic nervous system is responsible for keeping us safe when we are in danger, however it can be activated for prolonged periods and many of us lack the skills to return control to our parasympathetic nervous system, which is responsible for helping us to "rest and digest".
How would this affect pain?
During this state muscles become tense and ready for action, the nervous system is extra sensitive to stimulus, blood pressure is raised and we are more likely to notice and have negative thoughts. Tense muscles can become tired and sore or put extra stress on other structures, causing pain and irritation. Often when in a stressed state our breathing becomes shallow and rapid, even when not really exerting ourselves, such as while sitting in an office.
Use your breathing to recover.
An effective way to help your body return control to the parasympathetic nervous system is to consciously change your breathing. One method is to hold your breath for as long as you can, once you relieve your breath your body senses that a threat has passed and can return to a more relaxed state.
Another commonly used technique is box breathing. To do this, breathe in for four seconds, hold for four, breathe out for four, hold again for four and repeat. Do this for a few minutes until you start to feel more relaxed and calm.
Show your body that you are safe.
Other activities that can help your body to relax include yoga, going for a swim or having a shower, or doing some intense exercise where your heart rate is raised.
Speak to your physiotherapist for more information on this topic and tips to help you relax during the day.
What are they?
The hamstrings are a large group of muscles located at the back of the thigh. Their job is to bend the knee, extend the hip backwards and stabilise the leg. The muscles can be injured at any point along their length but are most vulnerable where the tendon and muscle fibres join together. This is a common injury for players of all sports that involve running, and particularly those that involve quick movements and kicking.
What are the causes?
As the hamstrings cross two large joints (the hip and the knee), they need to perform complicated movements, often activating suddenly and with great force. They are often stretched during a fall, a powerful kick of a ball or a sudden take-off. Factors that increase the chance of a tear include poor flexibility, strength or neural mobility. Other factors that contribute to hamstring injuries are muscle imbalances, abnormal lower limb biomechanics, fatigue, and inadequate warm-up. The biggest predictor of a future hamstring tear though, is a previous hamstring injury.
What are the symptoms?
The most common symptom of a strained or torn hamstring is a sharp pain at the back of the thigh, often immediately after intense activity. There may also be swelling, bruising, difficulty walking and pain with knee movements.
Your physiotherapist can confirm that the pain is due to injured hamstrings rather than any other issues, and tell you how bad the strain or tear is. Although not usually required, diagnosis can be confirmed by having an MRI or ultrasound scan.
How can physiotherapy help?
Once a diagnosis has been made, the first step is to follow the R.I.C.E protocol (Rest, Ice, Compression, Elevation). During the first 48 hours, you should apply ice for 20 minutes every one to two hours to reduce swelling and bruising. Consultation with your physio will include advice about your recovery, and when it is appropriate to return to sport. Your physiotherapist has many techniques that can promote healing and reduce scar tissue formation, which may include ultrasound, deep tissue therapy, electrotherapy and dry needling.
Crucially, they will also prescribe you an exercise program to return strength, flexibility and control to your muscles, getting you back to your sport quickly and safely. Due to the high chance of recurrence, rehabilitation is very important and usually takes 6-12 weeks. If the muscle is completely torn, surgery may be required before rehabilitation can start. Your physiotherapist will work with you to help you set goals to get you back to your favourite activities as soon as possible.
Why are workplace injuries so common?
The nature of work is that we are often required to complete the same task for hours. We can also find ourselves faced with time constraints and deadlines that lead to poor postures and taking shortcuts, simply to get the job done.
How can they be prevented?
Workplace injuries can happen suddenly, through an accident like a fall or by lifting something too heavy. However, just as many workplace injuries occur over time due to repetitive tasks. Often these conditions begin slowly and take many months to resolve. Here are a few tips to keep yourself pain free in the workplace.
It's important to assess any risk before you start. Do you need to ask for help or use an assistive device? Your legs are the strongest part of your body, so ideally you should use them to power your movement, rather than your arms or back.
Bending and twisting when lifting is also a common mechanism for injury. It is much safer to lift, then step to turn before putting an object down again rather than twisting on the spot. Also, pushing is a more efficient movement than pulling and is always preferable if you have a choice. Try to push at waist height and keep resistance as close to your body as possible.
Overuse injuries can occur by always using the same side of your body rather than alternating sides. Practise using both left and right hands for taking phone calls and using your mouse.
Be aware of your posture. Good posture isn’t just about having a rigid and upright spine, it’s about being able to let your spine sit comfortably in its natural curves and be able to move in and out of this easily. Stretching can help to counteract positions you find yourself in for long periods, and remember, there's no substitute for regular movement. Set an alarm on your computer or phone every 30 to 45 minutes to stand up and move.
A physiotherapist is a great person to speak to about preventing injuries in your workplace, be it about heavy manual work or repetitive, sedentary office work.
Nothing can ruin your enthusiasm for a new workout program faster than the pain and stiffness that sneaks up on you the day after. This delayed reaction from your muscles, known as DOMS (delayed onset muscle soreness), has affected almost all of us at one time or another. While there is no sure-fire cure or prevention for DOMS, here are a few tips to help reduce your symptoms next time you hit the gym
Understand what it is
DOMS is thought to be a result of micro tears in muscle tissue during eccentric exercises in particular. While DOMS is not a sign of a serious injury and usually goes away on its own within 48 hours, it can be very uncomfortable and a deterrent to continue exercising. It can also leave you at a higher risk of injury, and for athletes who are competing in a tournament and need to recover quickly, DOMS can be particularly problematic.
Warm-up and cool-down
By taking the time to let your muscles warm-up, your muscles can operate at optimum flexibility, reducing the tension on muscle tissue during exercise. A cool-down encourages effective blood flow to muscles after exercise, so that any waste products such as lactic acid and calcium can flow back into the bloodstream rather than staying in the muscle tissues.
Get a massage or use a foam roller
By massaging tight and sensitive muscles, you can improve blood flow, promote tissue healing and reduce pain. Both massage and foam rolling can help to relax tight muscles and enhance tissue recovery in the first 24-48 hours after exercise.
Keeping hydrated allows your body to remove waste, stay flexible, and help tissues heal optimally. The trick is to maintain hydration throughout your day, not just when it's time to exercise. It's also essential not to wait until you are thirsty, as you could already be dehydrated at this point.
Other ideas includes gentle exercise such as 20 minutes on a stationary bike, and mild stretching. If you are particularly brave, ice baths have recently been shown to have mild benefits in pain reduction following intense exercise.
What Are They?
Trigger points are what are often thought of as muscle "knots" and can feel like painful, hard lumps located in your muscles. These points can both be painful to touch and refer pain to surrounding areas. It is thought that trigger points form when a portion of muscle contracts abnormally, compressing the blood supply to this area, which in turn causes this part of the muscle to become extra sensitive. Trigger points are a common source of pain around the neck, shoulders, hips and lower back.
What Causes Trigger Points?
Many factors can cause trigger points to develop. Repetitive stress, injuries, overuse and excessive loads are common examples. Inflammation, stress, nutritional deficiencies and prolonged unhealthy postures may also contribute to the formation of these painful areas. Generally speaking, muscular overload, where the demands placed on the muscle mean that the fibres are unable to function optimally, is thought to be the primary cause of trigger points. This is why you might notice trigger points in weaker muscles or after starting a new training program.
Signs and Symptoms
Pain caused by trigger points can often be mistaken for joint or nerve-related pain as it can be felt in a different location to the site of the trigger point. Trigger points feel like hard lumps in the muscles and may cause tightness, heaviness, aching pain and general discomfort. They can cause the length of the affected tissues to shorten, which may be why trigger points can increase the symptoms of arthritis, tennis elbow, tendonitis and bursitis.
How Can Physiotherapy Help?
Your physiotherapist will first assess and diagnose whether trigger points are contributing to your pain. If they feel that treatment will be beneficial, there are a variety of techniques that can help, including dry needling, manual therapy, electrical stimulation, mechanical vibration, stretching and strengthening exercises. While these techniques may be effective in treating trigger points, it is important to address any biomechanical faults that contribute to their development so they don't keep recurring.
Your physiotherapist is able to identify causative factors such as poor training technique, posture and biomechanics and will prescribe an exercise program to address any muscle weaknesses and imbalances. If you have any questions about how trigger points might be affecting you, don’t hesitate to ask your physiotherapist.