COVID-19: Fight or Flight?

A Physiotherapy perspective: Fighting the way your body responds to stress

How are you taking care of yourself during COVID-19?

With the global pandemic raging, you might find it is rather difficult to stay focused and resilient. I am sure you are aware of the mental, emotional and physical impact of this unprecedented time in our history. Lockdown has been forcing most of us to spend an increased number of hours behind a desk/in front of a computer with the unavoidable consequence of a more sedentary lifestyle. Many of you might feel how it is taking a toll on your body with neck/back pain and tension headaches getting the best of you.

When talking about pain, we cannot only consider the physical aspects that contribute to it. There is a close relationship between your body and mind and in order to combat the way pain debilitates us – we must address the effect stress has on our bodies.

Stress can be defined as a state of disharmony in your body in response to a real or perceived threat/challenge. Your body’s stress response is an amazing tool for your body to act quickly in life-threatening situations. This is called your “fight-or-flight” response. However, a chronic stress response (that is often caused by an overreaction to situations that are not life-threatening) may be catastrophic to your physiological system.

Stress affects your body’s physiological system in many ways due to how the emotional centres in your brain are connected to the rest of your body.

Let’s have a look at how stress influences the following systems/structures in your body:

1. Nervous system and hormones:

For your neurological system to function optimally, a delicate balance between your sympathetic nervous system (fight-or-flight) and parasympathetic system (rest and digest) needs to be maintained. When your body’s stress response is triggered, your sympathetic nervous system initiates an organised process that is mediated by the chemicals adrenaline and nor-adrenaline as well as a hormone called cortisol. Adrenaline and nor-adrenaline are released in the initial stages of an acute stress response and are proinflammatory. After about 15 minutes, when the perception of stress starts to take place, cortisol is released. Cortisol has anti-inflammatory properties and helps to decrease inflammation so that your body can manage the stress effectively.

This sympathetic response aims to keep your body’s two most important functions intact – breathing and moving. The most important muscle for breathing is your diaphragm (a dome-shaped muscle that separates the chest cavity from the abdominal cavity), and movement is controlled by the action of your skeletal muscles (voluntary muscles that are able to contract and relax).

Simply explaining it, your sympathetic nervous system acts as a gas peddle for your body to release more energy and become more vigilant. Your parasympathetic nervous system, on the other hand, acts as a brake to help your body conserve energy and allow you to recover and heal.

But what happens when your body’s sympathetic stress response is prolonged? A chronic stress response leads to prolonged release of cortisol/repeated surges of cortisol that can lead to its dysfunction and the development of chronic pain. Even though Cortisol has an anti-inflammatory effect under normal circumstances, dysfunction of this hormone can cause widespread inflammation and increased sensitivity to pain. Therefore, what may start in your mind, becomes a dysfunction of your body – and the one cannot be addressed without the other.

2. Musculoskeletal system and the diaphragm

How does stress manifests in your body’s ability to breathe and move?

When you are stressed or in pain you automatically breathe faster and less deeply. This is because the contraction of your diaphragm is an essential part of your “fight-or-flight” response. Normally, your diaphragm contracts when you breathe in, and relaxes when you breathe out. However, a stress response creates increased tension in the diaphragm which causes it to sustain a partial contraction when you breathe out, which means it doesn’t release fully.

Similarly, chronic stress leads to your skeletal muscles being in a constant state of guardedness. When you are facing a stressful situation/threat your muscles tense up (Heel, n.d.) to prevent injury. This is helpful in an emergency situation, but in the long run an imbalance of stress hormones can interfere with muscle quality and function because of muscle protein breaking down. Chronic psychological stress can also increase your chances of sustaining an injury due to smaller, weaker muscles that are not capable of producing or sustaining the same amount of force as an unstressed muscle.

How can we manage this stress response in order to allow our bodies to function to the best of its ability?

One way is to be mindful of your point of focus. When your mind is constantly focused on things that cause you stress, your body operates from a place of weakness and this reduces your body’s resilience.

This is not always easy to do when your body is trapped in a sympathetic response. The best way to activate your parasympathetic response and allow your body to return to a state of rest, healing and recovery is by diaphragmatic breathing. You can try this by placing your hand just below your belly button – this is where you want to focus your breathing. Allow your belly to expand as you breathe in through your nose and out through your mouth. All in your belly, nothing in your chest!

Another important factor is exercise. Being physically active helps your body to deal with stress because of to the effect it has on hormone responses and release of chemicals in the brain (dopamine and serotonin) that influences your mood and behaviour.

Making sure that your body is moving properly, is just as important. When your diaphragm and core muscles (including your hip flexors and gluteal muscles) are not initiating movement due to them not activating properly, your body will operate from a state of implosion (collapsing) instead of expanding. When your body operates from a state of explosion, you will be better equipped to act upon the world rather than have the world act upon it. This is a clear differentiation between being in a parasympathetic versus a sympathetic state. Your physiotherapist can help you to address these aspects, and the Be Activated treatment protocol provided at Christiaan Moolman Physiotherapy Inc., is especially helpful in this regard.

Remember that not all stress is bad – it is normal to experience a certain amount of stress on most days and we cannot eliminate stress completely. It helps us deal with challenges and make us aware of what we regard as important in our lives. However, stress becomes a problem when it is experienced too often and starts to impact our behaviour, relationships and health.

Therefore, contrary to popular belief, dealing with stress does not require us fighting it, but rather changing the way we respond to it by allowing our body and mind to work together more effectively.

For more information on our service offering and how we can help you with stress imbalance, visit our website at:

Take care!


Reference List:

Allen, D. L., 2010. Acute daily psychological stress causes increased atrophic gene expression and myostatin-dependent muscle atrophy. American Journal of Physiology, 299(3).

Anon., 2018. Harvard Health Publishing: Harvard Medical School. [Online] Available at: [Accessed May 2020].

Green, I., 2012. The Role of the Diaphragm in Self-Awareness and Transformation. RMIJ, Volume 5, Issue 2.

Green, I., 2012. The Role of the Diaphragm in Self-Awareness and Transformation. RMIJ, 5(2).

Heel, D., n.d. Be Activated Level 1 Course Module.

Jackson, E. M., 2013. STRESS RELIEF: The Role of Exercise in Stress Management. ACSM’s HEALTH & FITNESS JOURNAL, 17(3).

K.N. Poornima, N. K. R. S., 2014. Study of the Effect of Stress on Skeletal Muscle Function in Geriatrics. Journal of Clinical and Diagnostic Research, 8(1), pp. 8-9.

Kara E. Hannibal, M. D. B., 2014. Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy Journal, 94(12), pp. 1816-1825.

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