This is a question patients ask me very often: can stress bring pain in your muscles or your joints?. Well, the simple answer is ‘quite possibly’.
The following is just one of the many stories I have seen while in practice and hopefully will illustrate the matter a little bit better.
I used to have a patient with a very bad shoulder. A pain that would come and go over the years. When the pain arrived it was very debilitating, making sleeping a ‘nightmare’ and seriously affecting movement. The pain could come at any time, from lying down on a beach to working on the computer. It could stay there for weeks and then disappear until the next episode. My patient seemed like a ‘very laid back’ person, quite happy in life and with not a single apparent symptom of ‘stress’.
All attempts to diagnose him did not bring much light to the matter: GP would put him on anti-inflammatories and pain killers ; MRI scans showed some ‘bone growth’ that may be accountable for the problem (according to the consultant); other therapist attempted laser therapy, deep tissue massage, ultrasound… and nothing seemed to have a lasting impact.
The patient had had a road traffic accident years ago, the car was a right-off, he suffered a bit of whiplash but nothing seemed to need treatment at the time, he was fine and got a new car.
SO WHAT WAS WRONG WITH THE SHOULDER?
As it happens, the shoulder was mostly fine, but all the therapy received up to then was completely obsessed in finding something wrong there, if they could not find it, they would still treat it and hope for the best. That shoulder was probably more bruised from on-going therapy than from the car crash.
After the first visit to the practice it became obvious that the patient could move the shoulder pretty well. Yes there were a few deep ‘knots’ in the muscles, but rather than just go and deep massage those knots we need to ask : why were those ‘knots’ there?
OUR BODY RESPONSE TO STRESS
English language is full of expressions using body parts: ‘a weight lifted off my shoulders’, ‘he has a broken heart’, ‘I can feel butterflies in my stomach’. Language recognises that our body is a recipient for emotion. How many times you can suffer from ‘stomach cramps’ facing an exam, starting ‘cold sweats’ from talking in public or ‘palpitations’ waiting for a phone call with important news? After all, we are humans, and emotion is an important part of our DNA. Emotions happen in a body, so a physical strain can also affect your emotions (you only need to look at the variety of runners reactions on the finishing line of a marathon). In the same way, a deep rooted emotion such as fear, anxiety or shock will also have an impact in the your physical body.
One of the main principles of osteopathy is that a person’s well-being is based in a good working order of the physical, mental and emotional part of each of us. Osteopaths look into that interaction and we try to influence the structure of the body: mainly muscles, bones and joints to promote that desired balance. Freeing up joints and assisting to improve movement is our medicine to restore that body balance.
Unfortunately allopathic medicine still struggles with that concept. They have realised that conditions such as ‘depression’ can affect ‘back pain’ and even that ‘back pain’ can lead to depression. Some pain clinics run programmes using cognitive-behavioural therapies to help people with chronic pain, but still for most of the general public is all about anti-inflammatories, pain killers or in the best case scenarios some physiotherapy and exercise.
HOW DOES STRESS AFFECT YOUR BODY THEN?
This post is not intending to be a scientific paper so I am going to oversimplify something which is far more complex.
All our body functions are ultimately controlled from the brain, which through the nervous systems liaise with all your organs: such as the heart, the liver, the kidneys and so on, which also include all your muscles. The brain controls where the blood needs to go and which chemicals have to be secreted by your glands to make everything to run smoothly. We have two nerve systems: one that is the auto-pilot, and the other one that kicks in a situation of immediate survival.
So let’s say that you are at home watching TV and suddenly a roaring lion comes in the living room: survival instincts will kick in and your body will go into a quick reaction of ‘fear’, your body may ‘freeze’, may get ready for a fight or you may try to run away. All of them physical responses to a situation of ‘stress’
To get all that done, your ‘survival nervous system’, the one that is ready to get ‘switched on’ at any situation of danger, the first thing it does is to redirect blood to your muscles and brain, and divert it from your skin and gut. The emergency response needs you to think quick and react quicker.
To do that a whole lot of chemical changes will be happening in your body (one of the most known effects is the adrenaline rush which can take you from alertness to euphoria depending on the situation). This type of reactions has kept us alive since the time of the dinosaurs, so it is obviously, deeply rooted in our beings.
The switch-on of this survival system should be a short term measure. It will be costly to the body to keep that state of increased alertness for too long, there is overflow to your muscles with blood and chemicals, depleting other vital body systems. Being on a survival mode on the long term will create body in-balances and can lead to strain, injury or disease.
IS STRESS ALWAYS A ROARING LION?
These days it would be a rare situation that a roaring lion will come into your living room, but what about the emotions that bring you a dreaded deadline at work, a recent bereavement, moving home, a ‘broken heart’, an anxiety, a frustration… or even the threat that you could have been seriously injured in a traffic accident?.
It seems that your brain may have the same response for all those: switching on your emergency nervous system and drive your body on that ’emergency’ control rather than the auto-pilot. This will happen in different degrees on different occasions. It will also be driven differently by different people at different times of their lives.
WHAT HAPPENED TO THAT ‘STRESSED’ SHOULDER?
Very often your brain may decide to ‘re-wire’ an area of your body due to a temporary need. It is common that people who sprain an ankle, may still twist that foot months after recovering. With the sprain, the brain probably lost nerve connections to the foot, so now that foot, even when the sprain is healed, may still not work properly as the area is still weaker and/or the foot has lost some of is nerve connections with the brain.
In the same way, an area affected by a ‘stressful’ situation can develop a re-wiring which may produce a switch on of the emergency nerve system rather than the usual ‘autopilot’. That area can become more hypersensitive, over stimulated by blood and chemicals. Over time, this part of the body may not necessarily find a mechanism to release all that stored stimulation, so this is when pain kicks in.
SO WHAT WAS THE TREATMENT FOR THAT SHOULDER THEN?
In Osteopathy we try to find clues in the whole body pattern, so for example, indeed that particular shoulder had ‘knots’ in the muscles. Also other areas needed plenty of attention: upper back, neck, elbow, hand. In osteopathy that shoulder needs to be assessed and treated as part of the whole musculo-skeletal system. Going back to that patient, there were ‘misalignments’ in the back and neck affecting the strain in the shoulder. The shoulder muscles could not operate properly because the rest of the spine was not working either. That’s why just getting a massage would have had a very temporary relief.
In this particularly case we used ‘dry needling’ therapy as a way to help removing trigger points and osteopathy to improve the movement of the joints. It took a couple of months to ease years of trouble.
It became really interesting to hear that, in the past, the patient used to suffer from lots of stomach upsets whenever there was a stressful situation. Now the stomach upsets were gone, most possibly because over the years that stress found a ‘shoulder’ to manifest itself.
We did not see each other for about a year, until I got a phone call. Shoulder pain was back (less intense though), and this time the patient was trying to buy a house.