That's Where I hold My Stress!

Workplaces have been intense this year. Whether business have suffered, or in some cases boomed, there have been so many external factors influencing the place we know to call 'work'. With the surge in work from home arrangements, staggered staffing and endless amounts of 'zoom' conferencing, it would be understandable if you had said that 2020 has left the mind a little stressed out...just a little.

What's been interesting across all our clinics, is the rise in the frequency of people presenting with neck pain. Of course, that may well be from being less (even less) mobile than before; and perhaps a less than advantageous work from home setup... but what has been consistent, is increased stress. 

A 2016 study by Oretgo et al. reviewed and categorised research performed to assess the association between stress and generalised neck/shoulder pain.. When collating their findings, there was a strong association found between stress and neck/shoulder pain, with the proposed causing mechanism being "cognitive-emotional sensitisation". (visit this study here - or ask us for the full copy)

"Cognitive-emotional sensitisation" refers to the "overstimulation of pain related areas in the forebrain and brainstem regions'' due to psychological stress...

Yes, your pain may have become more noticeable because of stress.. but that doesn't mean it's all in your head. 

Psychological factors create a hypersensitivity of nerves, and so your brain detects more signals being fired, in comparison to less stressful circumstances. 

Here are some questions about stress and how it relates to your pain: 

- If stress is related to my pain, will treatment help? Yes, not only will it help you achieve some targeted relief, but with the release of endorphins that come from receiving treatment, you'll also have a chance to change your state of mind. It has been documented that after receiving treatment you have an increase in serotonin, dopamine and oxytocin - which are all hormones which make you feel good.. Of course, this feeling is temporary, but it gives you a chance to improve your thoughts and actions in the short term. 

- Why do I 'feel my stress' in my neck? There are multiple causes for this.. It may be that you already have an existing issue in the neck and stress is sensitising it; it may be that you're also straining your jaw which has a strong relationship with the neck; it's common to take short shallow breaths when you're stressed, so it may be that you're not breathing through your nose, and neck pain is linked to breathing shallowly through your mouth; it may be that you're staying in a fixed position all day, looking at your computer creating a "compter vision syndrome" (check out our instagram post about it)... We could continue coming up with reasons why it's your neck that becomes irritated, and it's largely dependent on your unique situation. 

- So my pain won't go away until I stop stressing? I'm always stressed... Stress is a normal part of life. It's unreasonable to ask any person to "stop stressing", but what we need to look at is how you're managing that stress. Do you have enough strategies in place to help you deal with the psychological load placed on you. Firstly, it's ok to not be ok.. but you need to speak up.. especially to help you manage the people or events around you that can afford to ease up and let you ride out the wave of stress. Try not to manage to many high stress things at the same time - this is very dependent on your personal ability to tolerate stress - know you're limit. You're pain can go away if you learn how to manage your stress levels. 

- If I can't reduce my stress, how can I manage it better? 4 easy ways that you can do right away... 

1. Exercise - this immediately changes the way your brain is working. 

2. Food - Get to know which foods you should avoid for your gut health and have a good balance of protein, carbohydrates and fats to help nourish your brain with the fuel it needs to function - (comfort foods taste good, but lead to more discomfort). Also if you need a good nutritionist, let us know. 

3. Breathing exercises - breathing in for 6 seconds repeatedly will allow you to take control of you breath and your mind - as the breath is one of your body's indicators of whether you're in a relaxed or stressful state. We like to take 3 drops of RocketFuel to clear the upper airways and nose breath 6 seconds in (letting it out) for 90seconds every morning and every night. (Ask us about our get to sleep routine). 

4. Meditation - building awareness and leanring to manage your emotions is a skill that can be learnt. Meditation allows you to face them and wrestle with your mind so, long term, you can learn how to control your mind. If you manage to do all 4 stress management strategies we have put forward here, you have given yourself a fighting chance to manage and control the stress you have in your life... Especially if you can't lower the causes of your stress. 

Our Chiropractors and Physiotherapists are always here for you, ready to Make a Difference to your life, and to your family and friends. If you know someone that could do with our help in Castle Hill, Bondi Junction, Brookvale, or Penrith OR, if you know someone on the northside of Brisbane, in Virginia, feel free to Make a Difference to them by sending this to them and we hope to be able to help them the same way we have helped you - to the best of our abilities.

Why Do My Shoulders & Neck Always Feel ' Tight'?

Patients come to us time and time again..

“My neck and shoulders are just constantly tight and nothing I do helps”

Usually these people have seen multiple Chiros and Physios and some “get it” better than others… It’s not really until we start to dive deeper and ask a simple question.. “Did you injure your neck? Or did this develop gradually?” most people say, “...it developed gradually”.

When a problem is not traumatic, and is behavioural, we need to look at why YOUR behaviour creates pain, rather than trying to find a ‘fix’ or a solution in the clinic.

The solution is already in your hands 

Here are 3 main things we find as significant contributors to this constant neck and shoulder tightness: 

Prolonged positions. Even if you have 'good posture', not moving for extended periods of time is not something to be proud of. Let's put it this way... Would you drink stagnant water? Conceptually we need to think of our bodies the same way; constantly moving, dynamic and fresh, like a flowing stream of water.

Staying stuck in a position also forces some muscles connected to your neck and shoulders to over work to maintain an upright position, especially if you're also in a seated position all the time. You don't have the support of your hips helping you out and you're mainly looking in one direction.

Not only that, but ‘Computer Vision Syndrome’ is something that people start to experience because of prolonged positioning, but also adding the strain of constant eye focus on the screen of your computer. So, a combination of not putting demands on your body along with an overuse of only a few muscles to keep your position constant and glaring at a screen can result in always feeling 'tight' in the shoulders and neck.  

Prolonged fight or flight.  Have you ever been told that you "need to reduce your stress"? And how likely is that? I'd say not very.

Stress is a normal part of our lives. Without it, we're all comfortable. It really does come down to getting to know yourself well enough to know how to manage that stress that's incoming… but even the best of us aren't perfect and we can creep into a chronically stressed state... and that's one issue that leads to a range of deleterious health effects and with respect to tightness in the neck - an increased sensitivity to pain signals and an upregulation of perceived environmental threat.

Sensitivity to pain signals - anything that was just a little bit tight, can start to feel painful. Mechanically it will 'feel' tighter but that's often because of the chronically stressful state rather than what's happening mechanically.

Upregulating perceived environmental threats - our nervous systems are geared for survival - in nature, we're smart, but we're not exactly hunters.... So really, if we hear something loud, or see something moving fast, we have reflexes that tighten our neck and shoulders so we can react quickly...

This is the same stress response we are eliciting when sitting at your computer, so your neck and shoulders are tightening up in preparation to fight or flight... That's why stretching them out doesn't really work - you need to change your state and change your environment to help you reset.

Poor breathing patterns. Let's combine stress with prolonged positioning, now let's just slouch a little too - now there is no room for your diaphragm to lower.... but you still have to get the air in - so you breathe through your chest by elevating your shoulders.

The way you breath tells your nervous system what state it's in, so when you combine everything we've talked about so far - you can see that it's a vicious cycle. Remember, your shoulders and neck are busy sustaining your position all day, but the added extra is that we take around 25,000 breaths a day, so if you're raising your shoulders to do so, now your shoulders and neck are working hard to help you breath AND sustain your position WHILST your in a stressful state...

I hope that explains why your neck and shoulders feel tight all the time!

We’re here for you, providing Chiropractic and Physiotherapy in 4 locations in Sydney - Norwest, Bondi Junction, Brookvale and Penrith and our brand new location in Virginia QLD - so hopefully we’re close to you or someone you know. 

Whether it’s neck pain, headaches, shoulder pain or just need some tips, we can help.. And if you’re not sure, feel free to reach out via email admin@balancehp.com.au or give us a call on (02) 9899 5512. 

7 Steps of Pain

According to the International Association for the Study of Pain, pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” (http://emedicine.medscape.com/article/1948069-overview#a1)

Lets discuss this. Yes, there is an injury present. Depending on what type of tissue and where the tissue is located, we may be more or less sensitive to it. So you’re not making it up, but you’re brain is definitely not helping!!

In my experience this is the general process in your head

1. Injury

2. Ignorance phase

3. Denial phase

4. Frustration phase

5. Analysis phase

6. Catastrophe phase

7. Referral phase

Let’s run through an example of how this process might work in action…

INJURY: (DAY 1)

Case history – 30 year old active tradesman, feels a little sore in the lower back during a set of deadlifts.

IGNORANCE PHASE: (DAY 2-3)

“Hmmmmm, that didn’t feel right. Probably a one off, let me try again next set see how it is”

The pain is still there and gradually increasing.

“I should stop but its probably cause its heavy. I’ll finish the workout cause its not that bad. Should be gone tomorrow, never really had it so it’s probably a one off”

Next morning…

“Ouch, my back is really quite sore, but its getting better after that hot shower, its probably just DOMS from the workout”

Been sore all day, must of been a tougher workout yesterday, I’ll go to the gym tonight though, see how it is.

No need to scale the workout - “I’ll be fine!”

DENIAL PHASE: (4-7)

Now it feels like it’s been a little too long for DOMS... Usually everything’s better by now.

“I should probably not train as hard and tell my trainer. I’ll do some mobility that should help”

FRUSTRATION PHASE: (DAY 7)

“This thing isn’t going away!”

It’s now stopping you from training and annoying you all the time!! Probably need to do something about it..

ANALYSIS PHASE: (Day 7-14) – where you now ask yourself the questions

– When is it hurting me?

– What can’t I do at the gym and at work?

– Where exactly is the pain?

– Every time I think about it, the pain gets worse!

CATASTOPHE PHASE: (10-14) – you now think its the worst case scenario

No need to lie… we’ve all been in this place and asked ourselves many of the following questions:

– This isn’t going away, am I going to be stuck with it forever?

– What if I can’t go back to training, then I’ll put on weight and feel the way I used to feel..

– What if I can’t work? Then I can’t make money and support my family..

– Can;t even play with my kids, am I gonna be one of those guys! That’ll kill me

– Do I need a scan? What’s wrong with me???

REFERRAL PHASE: (DAY 14-28/or longer) depending on severity

– I need to see someone about this quickly, I don’t know who though... I know, I’ll ask my trainer.

Bottom Line: Analysing the problem before you present for a consultation will help the practitioner, but book in with someone BEFORE that 10 day mark – it’ll save you a whole lot of stress that your mind creates for you and the process makes your pain feel worse than what it is!!

Read More From Our Blog

Exercises Are Only Problematic If They Are Poorly Prescribed… Why Most People Misinterpret The Jefferson Curl

Coaches, chiros and physios all seem to miss the fact this movement is not a strength exercise! It’s not designed to load spinal flexion.

It’s time to set the record straight…the for and against of using this exercise

3 Reason You Should Learn The Jefferson Curl Before You Blow a Disc In Your Spine

Is Your Spine Intolerant To Flexion?

Every day I see patients who have a ‘flat spot’ in their lower back as they bend forward. To me, this is an indicator of either…

• a previous either a history of back pain or,

• an increased risk of injuring their disc.

You need to be able to flex your spine. If you struggle to do this it’s not a matter of avoiding it. You can’t live without spinal flexion. 

Instead of continually hurting your discs, would it not make sense to learn to flex each vertebra one at a time… This focus on motor control teaches the brain to understand a movement that should automatically occur, be reflexive.

A Jefferson curl starting at the neck then slowly curling your entire spine one vertebra at a time is brilliant in helping the brain understand how the spine should move into flexion.

Do You Need To Learn How To…

Simultaneously Maintain Spinal Movement And Center Of Gravity?

This control is critical every time you want to pick something off the ground. 

When you flex your spin, your hamstrings need to engage to maintain centre of gravity. Basically they are the anchors stopping you from falling forward every time you lean forward. 

The goal is not to build strength in the hamstring but teach them how to eccentrically load in conjunction with the spine.

Note again it’s about the movement and coordination of muscles. Not strength!

Can You Eccentrically Control Your Spinal Erectors?

For your spine to stay stable, you must be able to lengthen the spinal erectors under tension. 

This will only occur if you allow your core structures to take over. As you breathe out to flex the spine your…

• Lower abdominals

• Lower obliques

• Pelvic floor

• TVA

…all have to engage to create enough spinal flexion! 

At the same time…your lumbar and thoracic erectors have to eccentrically load firstly and then secondly so do your multifidus. Multifidi are usually the ones that fail. 

It happens near when you bend and rotate to pick something off the floor because you haven’t taught them how to eccentrically load. This is where people end up hurting their L4, L5, S1 discs. 

The Jefferson curls is a great because it…

• teaches the multifidus and spinal erectors how to eccentrically load

• helps you understand how to breathe for movement control

• help the hamstrings understand their role as anchors

• facilitates engagement of TVA

If you don’t know how to control this common movement, how are you going to pick anything up off the floor?

In saying that…

You Just Can’t Give This Exercise To Everyone

If you don’t know how to use your hips properly…

• You’re never going to be able to engage your hamstrings correctly

• You will always incorporate too much of a knee bend

Before You Even Contemplate a Jefferson Curl You Must Be Able To Hip Hinge

If you don’t you’re always going to rely on their quads. The problem with this, it’s not going to allow your posterior chain to eccentrically load. This puts pressure on the front of your hips first then straight through your discs.

Lifting weights without knowing how to hip hinge means it’s only a matter of time before you’ll start seeing lower back and disc problems.  

The ability to hip hinge takes priority over using a Jefferson curl to learn motor control of flexion.

Even Then It’s Not Your Go To Exercise

I will never prescribe this exercise until I know you can perform a regressed non weight bearing variation. I use band assisted roll up (sit up). It’s orientation to gravity is different so the challenge isn’t exactly the same, but it does follow the same movement pattern.

If you can’t perform this exercise I’m not going to add more variables and increase the challenge by having you stand up and do a Jefferson.

The Biggest Reason To Avoid A Jefferson Curl…

 PAIN!

If it’s aggravating your symptoms this exercise is way to advanced for you. Do not push through because you need to learn the movement pattern. Stop immediately, regress and then build up to a Jefferson.

Remember You’re Not Doing This To Build Strength

Focus On Movement Control And Save Your Spine