On this chronic inflammation blog series, we’ve journeyed through what it is, why it happens, and how exercise and improved sleep quality can help. Now we are moving on to how stress, especially chronic stress, contributes to chronic inflammation and pain. Many of us know this too well, but stress is a normal part of life and the human experience. Maybe you’ve experienced tight deadlines, financial hardships, uncertainty about your future, or conflict in relationships that all cause a whirlwind of stress. You certainly are not alone; stress is a completely natural response to challenging or difficult situations. 

Our bodily response to stress can actually be to our benefit by helping us respond to potential perils or risks. Stress can cause a rush of adrenaline helping us to respond to a threat, escape to safety, or even provide motivation or focus to perform a task. But just like inflammation, if this stress response lasts over long periods of time it starts to work against us. Chronic stress can have negative effects on physical and mental health, including contributing to pain, chronic inflammation, and other health problems. It can also interfere with our ability to function effectively in our daily lives and lead to burnout.

Stress is a major contributor to chronic inflammation by disrupting the delicate balance of the immune system. Have you ever noticed that you sometimes get sick after final exams or after working on a stressful work project? This is not a coincidence; after a bout of prolonged stress our immune systems stop working efficiently. During acute stress, our body releases hormones like adrenaline to help us get through our public speaking event or to help us quickly slam the brakes to avoid hitting another car. But if the stress response sticks around despite life threatening stimuli no longer being present, this not only impedes our mood but also negatively affects our immune system and inflammatory response. 

There are many ways in which chronic stress and inflammation are interconnected. First, stress hormones like cortisol activate the immune system and promote the release of cytokines, small proteins that regulate inflammation. Chronic stress can lead to sustained levels of cortisol, which can increase inflammation and damage tissue over time. Second, stress affects our gut microbiome, which plays a critical role in immune system function. Stress can disrupt the balance of bacteria in the gut, leading to an overgrowth of harmful bacteria and a decrease in beneficial bacteria leading to inflammation throughout the body. Third, stress impacts how the body responds to oxidative stress. Oxidative stress occurs when there is an imbalance between free radicals and antioxidants in the body. This imbalance can lead to chronic inflammation causing tissue and cell damage. And last, stress can also affect the quality of our sleep. You’ve probably felt this if you’ve ever woken in the middle of the night with racing thoughts. And from our previous post, sleep plays a critical role in regulating inflammation. Sleep deprivation can increase levels of cytokines, leading to increased chronic inflammation. 

Although there are many stressful aspects of life that we are incapable of eliminating, there are many ways we can manage or adjust our response to stress to keep the negative effects on our body at bay. Stress management takes time and repeated effort but can have a drastic impact on your quality of life, including reducing your musculoskeletal pain! Here is a list of suggested things to do to help manage chronic stress:

1. Practice relaxation techniques: Meditation, deep breathing exercises, or yoga can help to reduce stress and cortisol levels and promote a sense of calm. Cortisol is a hormone that is released in response to stress; high cortisol that is secondary to chronic stress can contribute to chronic inflammation and pain. Check out this video instruction on diaphragmatic breathing. Diaphragmatic breathing has been shown to have numerous benefits for reducing stress and anxiety.
2. Exercise regularly: As physical therapists, we probably sound like a broken record encouraging exercise at this point. But in addition to other benefits, regular physical activity can also help to reduce stress and improve mood. Aim to get at least 150 minutes of moderate-intensity exercise per week – even better if it is something you find fun and enjoyable! 
3. Get enough and higher quality sleep: Adequate sleep is important for managing stress. Try to get 7-8 hours of sleep each night and establish a regular sleep routine. Stress can disrupt sleep patterns, leading to a cycle of increased stress and pain. Managing stress through relaxation techniques and other stress-reducing activities can help to improve sleep quality and reduce pain and inflammation. 
4. Eat a healthy diet: Eating a balanced diet for your specific body needs (which may include fruits, vegetables, whole grains, and lean protein) can help to support a healthy immune system and reduce stress levels. More to come on this in future blog posts!
5. Connect with others: Remember you are not alone when it comes to experiencing stress. All of us experience some type of stress at some point in our lives, and spending time and connecting with friends and family can help to reduce stress levels and provide a sense of support.
6. Take breaks and practice self-care: Take regular breaks throughout the day to engage in activities that you enjoy, such as reading, taking a walk, or listening to music.
7. Seek professional support: If you are experiencing high levels of stress, consider talking to a mental health professional who can provide support and guidance on how to more adaptively manage your stress response.

In summary, experiencing stress is a completely normal part of life. It is essential to recognize stress in order to manage it as effectively as possible. By doing so we can avoid negative consequences like chronic inflammation, and improve our mental and physical wellbeing. At Beacon Physical Therapy, we are here to support you as a whole person. We know that chronic stress and inflammation can impact your recovery. Please reach out so we can help support you!

SOURCES:

1. Glaser, R., & Kiecolt-Glaser, J. K. (2005). Stress-induced immune dysfunction: implications for health. Nature Reviews Immunology, 5(3), 243-251. https://doi.org/10.1038/nri1571
2. Dhabhar, F. S. (2014). Effects of stress on immune function: the good, the bad, and the beautiful. Immunologic research, 58(2-3), 193-210. https://doi.org/10.1007/s12026-014-8517-0
3. Armaiz-Pena, G. N., Cole, S. W., Lutgendorf, S. K., Sood, A. K. (2013). Neuroendocrine modulation of cancer progression. Brain, behavior, and immunity, 30 Suppl, S26-S31. https://doi.org/10.1016/j.bbi.2012.07.006
4. Richtel M. An Elegant Defense : The Extraordinary New Science of the Immune System : A Tale in Four Lives. William Morrow Paperbacks; 2020.