Chronic stress is insidious and its effects are everywhere in our body. We must learn to recognise this and begin a process of learning to manage stress more effectively
Here is my long, partly accidental and very much ongoing story. A story of learning what stress does and how to manage it
I haven’t experienced lower back pain (LBP). It is the search for ways to help people who have that has ended up helping me in quite a profound way.
I have a few chronic health issues. They are, or rather were, apparently unrelated, manageable but very irritating. The IBS is serious and disrupting and I have talked about it before https://www.pilates-leeds.com/me-ibs-how-do-i-banish-the-blues/ ) It is definitely not Crohn’s Disease serious or Coeliac Disease serious. Sometimes I can be laid up in bed with Migraine and at other times I have serious levels of pain with numb hands and feet but nothing too lasting. Today and yesterday it is little dizzy spells. I experience anxiety but only in extreme situations
So that’s me. I thought this was normal for 54. Perhaps it is, but it shouldn’t be. I have been trotting along, adapting to sub optimal stress and patently failing to manage my stress levels whilst sometimes spotting struggles with stress management in others
I am also a Pilates instructor and I’ve been teaching for nearly 18 years. In that time there is one group of people who I have not served as well as I wanted to: Clients with chronic lower back pain. I didn’t completely fail them, or make them worse, I simply didn’t help as much as would have liked.
Difference between Chronic and Acute Pain
As a side note I should define Chronic here because it is important for the little story. Trauma, disease, injury, surgery, accidents and other things can cause acute, sudden onset pain. The source of the pain is readily identifiable and can the treated. Pain becomes chronic if after 12 weeks or so, the injury or trauma has healed but the pain remains. There is no identifiable cause for the pain and therefore no obvious course of action regarding treatment.
Some people have ongoing chronic pain with a definite cause like a friend of mine who desperately needs a hip replacement This is a different thing altogether because the cause was never an acute episode in the first place. The same would apply to ongoing pain from say, Rheumatoid Arthritis.
Other people can have non specific ongoing pain which is treatment resistant but who never have an acute injury in the first place. They just have back pain which is chronic
David Hanscom puts it in a bit more detail here https://backincontrol.com/clarifying-the-new-iasp-definition-of-chronic-pain/
As a Pilates instructor trying to help people with chronic pain, I thought my knowledge was lacking : probably wrong, that Pilates was bound to work : definitely wrong. I have also repeatedly observed over the years with clients in my studio and in class, those with LBP had often seen multiple practitioners and got conflicting diagnoses. They often moved really well with good alignment and form. There was often no poor alignment or weakness thus removing my “way in” so to speak. I couldn’t correct something that did not appear wrong. On the converse, if there was something correctable, that didn’t necessarily reduce the pain
Always on the look out for people who can educate me regarding better caring for clients with LBP, last Autumn I stumbled upon the work of David Hanscom. He is a back surgeon who basically treats most people by NOT giving them back surgery. In essence he is saying that their chronic lower back pain is an outcome of stress running riot and over working the nervous system. which is then triggering effects in different body systems.
He calls this NeuroPhysiologic Disorder, or NPD.
However, a word of caution. NPD is also the initials for Narcissistic Personality Disorder and Neurophysiologic Disorder is also an umbrella term to describe Multiple Sclerosis and Parkinson’s disease so in Google terms it is not a very good name. If you want to google it, then use David Hanscom’s name or the other names given below
Neuro Physiologic Disorder (also referred to as Mind Body Disorder and Stress Illness Syndrome)
The probable cause of chronic LBP and many other chronic conditions
Here was my massive shock: there are 33 other chronic conditions that are also an outcome of chronic, unmanaged stress. I have 8 of them.
IBS, Migraine, chronic tendinopathies, dizzy spells, numbness and tingling of the feet and hands, TMJ issues (jaw pain, & clenching) , anxiety, Tinnitus. Also relevant is a history of Depression for over 20 years, although not any more . My symptoms are, across the board, getting worse not better
My symptoms are ALL caused by chronic stress overwhelming the nervous system
I cannot tell you how much of a shock that was
It was kind of good and bad, all at the same time. None of it has ever made sense. The IBS is idiosyncratic and doesn’t seem to play by the rules, apart from that fact that it rules me. I have never understood why my tinnitus came and went, and likewise the dizzy spells. My tendon issues: left shoulder and right Achilles are not logical in their presentation. They just randomly “come on” and then go again.
How could I not have realised? That I need to manage stress better?
Partly because this is not mainstream knowledge: that an over adrenalised nervous system is disrupting health pathways. Adrenalin is the nervous system signalling molecule (neurotransmitter) that is used to place the body on high alert. (By the way, it is also a hormone)
We kind of get the idea of stress don’t we? That we all stressed out. Some of us, working too much, doing too much others with financial stress, poverty and poor housing to contend with. Where did we think that stress would go? It doesn’t just shift to the bottom of a wine glass or get dissipated on a morning run or yoga session even if those things help
Like many others, I have been told repeatedly over the years that I am doing too much but when you are running your own business, looking after kids, sick parents, managing a house and attempting to have a bit of a social life: well , when do you rest? When do you switch off from all of that stuff? The patterns of idiosyncratic chronic illness were forming years ago, but I didn’t see that
Stress affects the body not just the mind
I think we get the idea of stress as ” being stressed out”. Feeling overwhelmed and overworked; short tempered, struggling with sleep, appetite. This is the mind side of it. I can only speak for myself here, but I have been guilty of doing the mind /body split thing. Seeing stress, or thinking about how to manage stress, as an issue that affected my mind but not my body. A huge amount of focus is placed, and rightly on helping the mind cope with stress but we need to consider the body.
The mind symptoms are right there aren’t they: in the mind…so we notice them and miss the body stuff.
Last year with some life events and the pandemic, along with huge numbers of other people, I really struggled in the 2nd wave of Pandemic. It was only partly the pandemic but anyway: I grasped the significance of the anxiety, fatigue, insomnia and generalised worry but didn’t join the dots with the big upsurge in body symptoms. At one point my dizzy spells were lasting 30 or more minutes at a time and my tinnitus was worse than usual. I still didn’t make the connection
We must manage stress on the body not just manage stress on the mind
Another issue is that we kind of ignore our body until it goes wrong. At that point we are used to applying the medical model of identify the symptoms and treating them, generally in isolation. Patients do it and Health Care Professionals do it. We want a diagnosis for the symptoms and a cure, hopefully quickly. This is the oft derided Medical Model
To be absolutely clear, I don’t view this is a failure of the Model or of Doctors. I don’t really think that Medicine should change its model. It is more a question of when to apply it and when not However, it probably falls to Doctors and other Health Care Practitioners to start to identify this in people: the over-adrenalised nervous system disrupting things
Can you imagine what the NHS might currently be spending treating chronic illness that is probably not going to respond to treatment because they are treating the wrong thing? Not to mention the fact that the NHS has to screen for other things. For example, take dizzy spells. A GP needs to rule out infection of the ear, too much blood pressure medication, anaemia and other things before reaching a possible conclusion that dizziness is stress related. (Not that I have had that kind of assessment!)
A very quick note on the Nervous System
I cannot proceed without giving you a really basic introduction and explanation of the autonomic nervous system because without it, none of this makes sense.
There is a central component to the nervous system of the brain and spinal cord along with the nerves going to and coming back from the rest of the body (sometimes called the Peripheral Nervous System), The Peripheral nervous system has 2 parts: We have the nerves that give us awareness and enable us to have conscious control of our bodies. How we walk, move, see , hear, process information. In addition we have the Autonomic Nervous System
The Autonomic Nervous System
The Autonomic Nervous System is a more ancient system which evolved millions of years before mammals took to the earth. Make no mistake however, it still serves us well, organising functions which are not under conscious control: breathing, heart rate, digestion are three classic examples of its domain. It has 2 sections: the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). Very simply, the SNS is: flight, fright, flee. The PNS is rest, digest, reproduce. It is a calmer, gentler state allowing us to function day to day whilst being more open: to the world around us, to family, to friends because we are not on high alert. Critically, it should be the default state of humans and other animals.
What happens if we are repeatedly, or even constantly under stress?
The unconscious body does not know the difference between a sabre toothed tiger chasing us or your boss demanding work on a too tight deadline, or for me, coping with a 7 day week and years of the low level trauma of severely sick parents. So we swing in to Flight / Fright. Body systems are up regulated, The hormones and neurotransmitters of the stress response: Cortisol and Adrenalin pour into the system. An over adrenalised system cannot cope for ever and it will manifest itself as little things going wrong in the body. Nothing you can put your finger on, get cured. I’ll pop a table at the bottom of this blog with a list of the 33 signs of an over worked Nervous System (also from the work of David Hanscom)
What do I do now to manage stress better?
I’m an Exercise instructor who tells people how to move, for a living, who doesn’t appear to know her own body
I was embarrassed too but I’m over that now, or I wouldn’t be writing this blog. I reckon I’m not the only one in this boat so ..better to ‘fess up
Now, what to do?
Take a break; take it easy; relax; rest; go on holiday, do less, All that has been suggested to me
I run my own business teaching group exercise, specialist classes and 1:1 Pilates. There is marketing, social media. emails, admin admin admin, ideally some self practice and study. Benjamin and Elinore are my two children, one still at school, both at home, I have one very very sick parent It never ends. Ever. You know that, dear reader. The pots don’t wash themselves do they (and the same goes for staking the dish washer!) My son is 19 on January 26th and is making his own birthday cake on the 24th. So, “hooray” no cake baking. Not really, just the rather depressing realisation that I don’t have time to do it.
The challenge: to keep going and find a workaround, which definitely does involve attempting to work less
I need to down regulate the nervous system and bring myself back to living in a Parasympathetic State
Fortunately I already know one of the best ways to do this; using the breath. Breath work is fantastic . It can be in the form of a breathing meditation, mindfulness work, or just whilst you are driving to work, watching TV or doing your Pilates class
The hunt is on for a guided mediation that I can use twice a day whilst I bathe my eyes. (I also have chronic Blephritis) but haven’t found one that suits me yet. Most are just too epic with mantras that announce they will change my life. I need calm, baby steps. At present I’m trying out Buddify App. There is a small cost but it is steadier, calmer, easier to digest. You can find details here and there are some blog posts which look interesting too: https://buddhify.com/our-story/
Getting as close to 7 hours sleep as I can manage is a daily habit.
I walk 3 mornings a week and wonderfully, one of those times is with good company, and do a breathing focussed Yoga class once per week. For me cycling is quite calming, although it does cause shoulder tightness which is problematic. Side note: I have chronic muscle tightness that does not respond to stretching or massage. This is due, in my view, to the fact that I am quite literally holding the stress of the day in my body. Regular massage helps a lot but it won’t solve the problem.
After a hiatus of 25 years I have just restarted Piano lessons. I try to do about 10 minutes a day of practice which is a form of mindfulness. I am completely focussed on what I’m doing, in the moment. (It makes my shoulders worse though)
What am I not succeeding with?
To only work 6 days per week. This is very naughty indeed
I’m trying to lean what it feels like to be in a Sympathetic State and a Parasympathetic State. To quote the experts I am attempting to “befriend my nervous system” . This is extraordinarily hard. I can’t feel what they are talking about in my own body. However I’ll try and stick with. it because I do see the value. On a basic level I can recognise a Sympathetic state better now. To give a simple example: If I am on a walk and not noticing the trees, the birds, the clouds, and instead the inner voice is rabbiting on about stuff, or I’m just mostly worried about being in a rush, then I’m in that sympathetic state. This was a useful insight for me
What About Clients with chronic lower back pain?
In a 1:1 setting or in the Back Care sessions, Pilates is the means to deliver a positive movement experience. Movements are chosen to to show the body that it can move safely and pain free. Although I carefully select exercises , the body is in charge. The client and her/his body leans what pain free movement looks like and at the same time gain a little bit more strength and often crucially, stamina.
Some things work and some don’t. We have to be careful and imaginative. I am talking here of situations where there is nothing diagnosed. There is nothing specifically that needs to heal so there is no criteria for me to work with from Manual Therapists or Doctors
We need to consider stress as a cause or at least partial cause. There is a conversation to be had here although it doesn’t need to involve me. The client needs to think about how they might identify “pinch “points in their lifestyle, or what might have triggered episodic back pain
There are other ways to help chronic pain which would be out of my remit as a Pilates instructor but here are a few: resolve any issues around anger; ensure that you get adequate sleep and ideally 7 hours or so every night; avoid constantly talking about the pain because this amplifies it; write down intrusive thoughts, negative thoughts or ongoing thoughts regarding the pain and then throw the paper way, delete the digital. You are trying to detach from the thoughts and leave them behind. No journals. Just write and move on. No re reading it
APPENDIX ONE : Symptoms associated with Neuro Physiologic Disorder
- Heartburn, acid reflux
- Abdominal pains
- Irritable bowel syndrome
- Tension headaches
- Migraine headaches
- Unexplained rashes
- Anxiety and/or panic attacks
- Obsessive-compulsive thought patterns
- Eating disorders
- Insomnia or trouble sleeping
- Back pain
- Neck pain
- Shoulder pain
- Repetitive stress injury
- Carpal tunnel syndrome
- Reflex sympathetic dystrophy (RSD)
- Temporomandibular joint syndrome (TMJ)
- Chronic tendonitis
- Facial pain
- Numbness, tingling sensations
- Fatigue or chronic fatigue syndrome
- Chest pain
- Interstitial cystitis/spastic bladder (irritable bladder syndrome)
- Pelvic pain
- Muscle tenderness
- Postural orthostatic tachycardia syndrome (POTS)
APPENDIX TWO: Further reading
The book which has enabled me to reach a greater understanding of my own body is BACK IN CONTROL by David Hanscom
This is more niche and gives more detail regarding the Autonomic Nervous System. It is detailed but also cutting edge, talking about how, if we can help the Vagus Nerve, the main nerve of the PNS to function better ,we can bring beneficial change to the body
David Hanscom has done plenty of podcasts and the cutting edge info about the Vagus Nerve is referred to as Poly Vagal Theory. There are plenty of instances on Podcasts of this too giving a gentle introduction to a fairly new , complex but very interesting field. A podcast intro would be easier than the book!