It has been said that “stress should be a powerful driving force, not an obstacle”, and although this may be the ideal way to approach our daily activities, it is often difficult for most people to put this into practice.

Stress is a difficult concept to define as it is a subjective experience, but it is important to remember that everyone stresses and most of the time there are universal stressors, such as the covid-19 pandemic or financial concerns that affect us all on a daily basis. Stress could therefore be described as the mental and physical way our brains and bodies react to challenging situations.

In a temporary, short-term setting, stress is not necessarily a bad thing and in an immediate setting stress results in the natural reaction of “fight or flight”. During this response there is an increase in heart rate and respiratory rate, and the muscles are put into a state of readiness in order to fight against whatever stressful stimulus is presented. This reaction is stimulated by the activation of the hypothalamus in the brain, which then further stimulates the adrenal glands to release hormones called adrenaline and cortisol which in turn results in fight or flight.

Situations that can cause this chain of events to happen include scenarios such as meeting a deadline at work or avoiding a car accident. However, once the perceived threat is gone, the hypothalamus should send a signal to the rest of the body to tell all systems to return to normal.  If the body does not receive a clear signal to return to normal functioning, the body remains in a persistent state of stress, which can become a long term or chronic condition.

Stress can present itself in many different ways, and each person may experience it’s effects in a different manner. Chronic stress disturbs the immune, digestive, cardiovascular, muscular and reproductive systems. It also plays a role in increased or decreased eating patterns, sleep patterns and alcohol or drug consumption, specifically as an attempt to cope with stress. Stress can result in increased social withdrawal, anxiety and depression, and can result in other serious health problems such as heart disease, high blood pressure, chronic headaches and diabetes.

When looking at the effect that chronic stress has on the respiratory system, it can make breathing difficult due to constantly raised respiratory rate, as the flight or fight response attempts to distribute oxygen rich blood to the vital parts of the body such as the heart and muscles. During this oxygen distribution process, the constricted blood vessels result in increased blood pressure.

When chronic stress is experienced, the heart can be put under too much pressure for too long, which can unfortunately lead to an increased risk of having a stroke or a heart attack due to the constant state of high blood pressure. Long term stress has also been shown to have negative impacts on liver functioning as well as glucose regulation and production.

When we experience stress, our bodies produce extra glucose in order to meet the demands for the increased energy boost needed in a stressful situation. However, when the body is unable to return to its normal function after the stressful stimulus is gone, it is not able to keep up with the demand for extra glucose, and the production of insulin is also prohibited. This further leads to the increased risk of developing type 2 diabetes. In terms of the immune system, long term stress weakens the immune system and decreases the bodies response to an infection or injury, which results in an increased susceptibility to the flu and common colds. Unfortunately, due to financial and work-related pressures, we often don’t take time off of work when we are sick, which further increases our levels of stress and anxiety.

Another system that is largely affected by short or long-term stress, is the musculoskeletal system. Stress causes tense muscles throughout the body as it is the body’s way of guarding against injury and pain. When we relax after a stressful situation, the muscle tension releases as well. However, with chronic stress, the muscles remain in a constant state of “guardedness”. This can cause pain and tightness in many muscles.

Work stress plays an important role in a lot of our stress-related pain and tension, with specific points of pain noted in lower back, shoulder, neck and jaw areas. Tension headaches have also been increasingly reported with high levels of stress and they are often linked to tense muscles in the head, face and neck. These headaches are reported to be part of a tension triangle which most people experience due to stress and posture. The tension triangle incorporates the shoulders, head and jaw.

Daily stress often causes tension headaches, tightness in neck and jaw muscles, as well as knots and spasms in the neck and shoulders, which all contribute to pain and stiffness in the jaw. Moving into other parts of the back, the mid back is also often affected by stress. The muscles in this area are influenced by a change in breathing pattern and from being in a stressed posture of the shoulders in an elevated and forward position, and the neck in a forward poking position. Stress also results in sedentary behavior, with less exercising and stretching on a daily basis. These changes in body position and function cause pain and stiffness in the mid and lower back, as well as in the hips, neck and shoulders.

One of the most effective treatments for the stiff and painful muscles caused by stress is physiotherapy. Physiotherapy consists of different modalities, many of which can be effective in the management of stress. One of these modalities is soft tissue mobilizations and myofascial release. These techniques are often used on the neck, shoulders, jaw and back muscles. In these techniques, controlled pressure is applied to specific parts of a tight muscle that may have trigger points present in them or may be in spasm. This hands-on maneuver uses muscle manipulations to decrease tension and increase blood flow and movement. It also helps to restore range of movement.

Postural correction is another important aspect of physiotherapy treatment in order to decrease prolonged positions that can cause pain and stiffness. When stress manifests in the body, we all tend to elevate our shoulders, put our heads forward, strain our necks and tighten our jaws. Although this is a protective mechanism in a stressful situation, it is not an optimal body position and physiotherapy can assist in implementing procedures that correct this posture.

Physiotherapists can also assist in education and prescription of the most beneficial relaxation positions and sleeping positions in order to improve sleep quality and duration, thus improving our ability to manage pressure and stress daily. Another extremely important aspect that physiotherapy can assist with is the prescription of effective and appropriate exercises programs in order to strengthen and stretch affected muscles.

Exercise is a simple and inexpensive strategy to cope with stress and has a positive effect on our mood due to the release of hormones called endorphins, which help us stay positive and calm. Exercise also increases the production and transmission of dopamine, which is a natural anti-depressant. The exercises that the physiotherapist may prescribe will be based on each person’s specific lifestyle, with various aspects such as medical considerations and barriers to exercise taken into consideration. These barriers such as level of motivation, fatigue, time availability, diet, sleeping habits and work pressure will all be assessed and taken into consideration as these are all associated with increased stress and would all result in decreased exercise compliance and adherence.

In order to manage the chronic stress we all feel on a daily basis, it very important for us all to be observant in order to identify the signs of stress. These signs could include any noticeable differences in our daily lives, such as difficulty sleeping, being easily angered, being depressed, or having very low energy levels. It is also important to remember that every person deals with stress in their own way and that progress looks different for everyone.

Research tells us that regular exercises of at least 15-30 minutes a day, for at least 3 days a week improves mood and overall health. Any movement-based activity boosts the bodies “happy hormones” and can be achieved through something as simple as walking. Regular relaxing activities such as meditation, prayer, yoga or breathing exercises could provide us with strong coping mechanisms.

Other options such as goal setting have also been shown to decrease and manage stress levels, as it implements appropriate time management abilities. Another important change to make is to prioritize our own limits and boundaries, and although it may be difficult for a lot of us to say “no”, we need to be able to do this if we feel we are doing too much in order to decrease external pressure and stress. It is very important for us to acknowledge our own achievements and not get stuck on focusing on the things we haven’t done yet.

A good support structure is also vital in dealing with stress and we should always remain in contact with friends, family, mentors or support groups in order to effectively manage pressure, anxiety and daily stress. It is also important to try to maintain a healthy balance of eating and sleeping enough, and to surround ourselves with peaceful and happy interactions in order to improve resilience and decrease negative influences daily.

“Each day brings a choice; to practice stress, or to practice peace”

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