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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?