Stress is one of the great problems of our age. It seems to be everywhere, from anxiety disorders in our schools to absence in the workplace. The Health and Safety Executive estimates that over half a million people suffered from work-related stress, depression or anxiety in 2016/17. From an orthopaedic perspective, stress is difficult to measure. What exactly is it doing to the body? The physical effects are sometimes hard to define. But in essence, I think there are three major ways that stress can affect our major joints. Let’s take a look at its impact on shoulders…
Stress can lead to inactivity
When we’re stressed, we tend to stop looking after ourselves so well. The trips to the gym suddenly fall by the wayside. Our eating regime deteriorates. We stop going for those walks that had been part of our lunchtime routine. From the body’s point of view, these kinds of drops in activity can have a considerable impact. Bodyweight increases (or decreases). Joints become stiffer. Muscles start to weaken and even waste – we know from experience with surgery that muscles begin to deteriorate within hours of underuse (which is why physiotherapy and exercises are so vital after an operation). Where shoulders are concerned, losing muscle bulk can cause instability issues or even frozen shoulder.
Stress increases tension
An obvious point, but stress really does seem to do something to our muscles. The science here is tricky to tease out, but essentially when we are stressed we tighten up – perhaps due to the ‘flight or fight’ response that makes our body tauten to protect itself from physical danger (one way we might define anxiety is as a hypersensitivity to threat). Over time this tension can feel very uncomfortable, perhaps even painful. Physically, it can also cause knock-on effects around the body. If you’re carrying tension in your neck and shoulders, you may overcompensate by using other parts of the body – by deploying your scapular (shoulder blade) to elevate the arms, for example, or the thoracic spine to reach objects above shoulder height. Doing this could result in new pain in those areas. It will also upset the natural rhythm of your shoulder – which should be, roughly, one third scapular-thoracic, two-thirds ball-and-socket.
Stress creates a vicious circle
The final point is a psychological one, but it’s important. Stress creates a heightened awareness of pain – so if you’re carrying a shoulder injury, it may cause you to focus greater attention on the painful symptoms in that area. This in turn can heighten stress. So a kind of feedback loop of discomfort is created. I sometimes observe this in shoulder patients after surgery. Stress can cause them to have a heightened perception of their pain; and in some cases that heightened perception may lead them to change, or to break off, their rehabilitation regime. This isn’t always ideal, since it can lengthen the recovery process when it might be better to relax and persist with the exercises.
So… if you are experiencing stress, what should you do? The first answer is to examine the roots of your stress. And the first way to do that is to talk. For anxiety, that might mean confiding in a friend – or seeking professional help through your GP or a counsellor. For stress that’s causing obvious physical problems in the shoulder and neck area, you might choose to speak to a physiotherapist. They will be able to help you unpack the issues: how things should be working, where the pressure points are, what kinds of exercises you could take up to alleviate the problems. Or of course you could book in with us for a check-up. I am always happy to analyse the issue, talk through the options and advise on the next steps.