“Does stress affect injury recovery?”

Stress is very common, and is often a way people respond to differing life situations and problems. What people often don’t realize is that stress can affect not only mental health, but also our physical health. There are numerous conditions that are linked with high stress levels, including cancer, diabetes and cardiovascular diseases (Guo & DiPietro, 2010).

Interestingly, stress has also been linked to poor wound and tissue healing (Guo & DiPietro, 2010; Vileikyte, 2007). Stress has been shown to deregulate the immune system, with increased brain (hypothalamus) and nervous system (autonomic nervous system) activity key role-players. Stress causes increased activity of adrenal and pituitary glands, leading to release of hormones such as cortisol, prolactin and catecholamines. Studies have shown these hormone changes increase our blood pressure, blood sugar and cholesterol levels, which can affect the healing process (see figure-2). Changes also occur to the chemicals around an injury site due to stress, leading to impaired immune function and delayed healing (Godbout & Glaser, 2006; Ross & Thomas, 2010). The psychological impact of stress can impact emotional states, leading to behaviours that negatively influence immune function; particularly affecting sleep, nutrition and exercise (Guo & DiPietro, 2010). All of these factors lead to poorer immune response and healing, thus delaying recovery.

Figure 2. Sourced from Ross & Thomas, 2010.

Figure 2. Sourced from Ross & Thomas, 2010.

 

Why is this important? The evidence detailed above shows that stress will negatively impact on an injury recovery, for example, delaying healing of a muscle tear. Therefore, it would make sense to utilize methods of reducing stress to help improve. This becomes a factor for individuals at all levels of sport and activity, with stress reduction an added way to further optimise recovery.

How can we reduce stress levels?

·        Exercise: Both aerobic and mindfulness-based have both shown stress relief benefits; reducing heart rate, blood pressure, blood sugar, hormone levels and improving local tissue healing (Ross & Thomas, 2010). Aerobic exercise can inclfude but is not limited to walking, running and cycling, whilst a good example of mindfulness-based exercise is yoga.

·        Deep breathing, relaxation and mindfulness type activities (e.g. meditation) have shown to be able to reduce stress levels (Chiesa & Serretti, 2009; Rainforth et al., 2007).

·        Sleep: Improvements in quality and amount of sleep assists in stress reduction, and is an important factor to consider.

·        These are only some factors associated with stress reduction, and it is important to consider that consultation with a Psychologist can also assist in reduction of stress.

 

Ky Wynne, DPT, APAM, BExSci

Physiotherapist at Lifecare Croydon Sports Medicine

References:

·        Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. The journal of alternative and complementary medicine, 15(5), 593-600.

·  Guo, S. A., & DiPietro, L. A. (2010). Factors affecting wound healing. Journal of dental research, 89(3), 219-229.

·        Rainforth, M. V., Schneider, R. H., Nidich, S. I., Gaylord-King, C., Salerno, J. W., & Anderson, J. W. (2007). Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Current hypertension reports, 9(6), 520-528.

·        Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: a review of comparison studies. The journal of alternative and complementary medicine, 16(1), 3-12.

·        Vileikyte, L. (2007). Stress and wound healing. Clinics in dermatology, 25(1), 49-55.