The acute and chronic effects of stress and how they relate to your pain
Pain is most frequently the reason people visit their chiropractor.
“Doc my back hurts.”
“Doc when my shoulder moves like this it hurts.”
“I woke up and my neck was killing me!”
These are some of the complaints I have heard from my patients when they present to the clinic. I have yet to have a patient walk in telling me they have strained their quadratus lumborum or transversospinalis which is the source of their low back pain. I tend to see a lot of athletes, Crossfitters in particular, and the more common verbiage is “the morning after my WOD my back started speaking to me.” Or something along those lines.
If you’ve talked to me before you probably have heard the phrase “pain science” thrown around along with “pain is pretty dang tricky.” That’s because pain is rarely as straightforward as the biomechanical model would have you think. Let’s take the low back as an example. There are literally dozens of structures located in and around the lumbar spine that are innervated by nociceptive, or pain sensing, fibers. This means that they can all contribute to the experience we call pain. Many clinicians will do a physical exam, testing this and that structure, and maybe even take some imaging then come back with the conclusion that one structure is the source of their back pain and if we fix that structure you will be pain-free. According to the evidence, this is becoming harder and harder to say with absolute certainty.
If only it were that straightforward. Blaming pain on one single structure is like blaming the course of world history on one single event. It MAY have played a part in the genesis of pain, but there is always a context and other confounding factors that contribute to the current state of. If you follow the biopsychosocial approach to healthcare, this probably makes sense to you, but if not I wrote about it HERE. In short, pain is something that is highly nebulous in nature and can be affected by biological (physiologic processes going on inside the body), psychological (how the person interprets and feels about their pain), and social factors (factors such as work and family stress). These factors all play a role in the pain milieu and taking a microscopic view on one single factor could potentially be more harmful than helpful.
These different factors can all be looked at as “stressors” to the body, which are very important when considering someone in pain. Stress can be psychological, for example, when someone is waiting for the results of a blood test. It can be social, like trying to meet a deadline at work. This post will focus on the physical effects of stress, such as the stress of exercise and the benefits and potential risks it brings.
First, we need to agree that exercise in and of itself is a stress, and that is not necessarily a bad thing. Stress can divided into two different categories. The good stress, eustress, is a stress that you can adapt to and you are better off for it. Think of the stress a final exam brings. If we are adequately prepared for the test we are equipped with the knowledge required to pass the test. We have newfound knowledge to apply and are able to continue on in our education. This is generally a good thing. On the other hand, distress, or bad stress, is something we are not able to adapt to and can leave us worse off. Think about a final that you are not prepared for, you didn’t go to class and you end up failing. This means you have to pay for the class again and you aren’t able to continue on to the next class. This is obviously not a good thing.
Exercise can be viewed similarly. In the right dose, exercise provides eustress that allows the body to adapt and become more robust and resilient. For example, when someone who is trying to get stronger utilizes the principles of progressive overload the body is able to adapt to each successive increase in weight, becoming stronger after each stimulus. If the increase in weight is too much, or excessive volume is performed, the body cannot complete the task and will not make the necessary adaptation to become stronger and more resilient, also running the risk of overtraining and injury.
This concept is important for athletes to understand, and I look at runners and Crossfitters in particular, due to the vast amount of volume stress they put their bodies through any given day. For those who have adapted to the high volume snatches or the 20 mile runs on the weekend it probably isn’t an issue, but for the majority of people who in the more novice category, this high amount of volume can be a huge contributor to your pain state.
When we exercise we are breaking tissue down…that’s the goal. We break tissue down in order to build it back up and become stronger than before. In any given workout the goal is to accumulate enough stress to stimulate a response, but not so much to where we cannot recover. With too much weight or too much volume, the eustress is bound to turn to distress which can eventually lead to the experience of pain.
Think about the pain experienced after the first long run of a marathon program, or how bad your triceps may feel after doing a high amount of skull crushers for the first time in a while. Hopefully, this is transient and you are able to recover in a relatively short time so you can train again. If you do too much too soon, for example increasing your long run by a significant distance above the 10% increment rule or trying a 50lb PR in the deadlift you are putting yourself at risk of accumulating too much stress.
The effect of too much acute stress is highlighted, unfortunately, by what is deemed a crowning achievement of many gyms, rhabdomyolysis, which is a result of the breakdown of muscle tissue and the release of their contents into the bloodstream and can potentially lead to kidney failure. A less serious scenario would be shin splints in runners who run too much, shoulder pain when one gets above 30 reps in the clean & jerk, or low back pain after too many deadlifts. There is a good chance there are readers out there who have had complaints like this and there is also a very good chance that complaint is a result of too much stress and its associated fatigue rather than “imperfect form”. The simple solution would be to pay attention to what point your pain starts to come on and tone the volume/weight back to a point where the pain isn’t present.
Chronic stress/fatigue is very similar but needs to be observed over a longer period as opposed to a single workout. This can be viewed over the course of weeks to months. With the accumulation of stress from any given workout, the body needs adequate time and supplies (nutrition) in order to recover enough to perform again. If there is inadequate time or supplies, the stress and fatigue will accumulate over a program and can lead to the genesis of pain and a significant drop in performance. Examples here can be people who tend to burn out several weeks into a training plan, someone whose worst running performance happened to be on race day, the development of an injury such as plantar fasciitis, runners knee, or shoulder impingement.
An effective solution to both acute and chronic stress is working with someone who has knowledge and experience in programming and is adept at noticing the signs and symptoms of acute/chronic fatigue and stress. They can help create a program to control the amounts of stress and fatigue to a desirable amount, avoiding overtraining.
Core1Chiro, your Downers Grove chiropractor, specializes in working with people who are dealing with aches and pains during training and can help design a program to improve fitness while decreasing pain and minimizing injury risk. Click on the link to schedule a FREE CONSULT to get pain free and STRONG.
