We may all have felt it ourselves, or witnessed someone else, being physically affected by mental stress. Being a physiotherapist specialising in sport, I immediately think of the poor unfortunate penalty takers who will fulfil a life’s dream by appearing at the World Cup this summer. These world class athletes are genetically gifted in kicking a ball. They have honed their god given talent through thousands of hours of practice, yet often this ability to kick a ball with precision when they need to will evaporate as they step up to take a penalty in front of millions watching world wide. Similar scenes are bound to occur at Wimbledon, as the world's best tennis players fail in their attempts to execute the much practiced skill of a tennis serve. Then there’s the Olympic relay team that drops the baton.
We have all experienced this physical manifestation of mental stress; butterflies in the stomach before a first date, the heaviness in the arms and legs as we walk to an important meeting, the inability to sleep the night before an interview, the tightness at the back of your throat as you realise that you’ve made a mistake at work, the tension in the shoulders when you’re finishing up that report late at night.
To add to this, what if, rather than one, huge, anxiety making moment, stressors were sustained, divided into into tens, or hundreds or thousands of moments. What is the cumulative effect of all of these micro stressors on the body? A useful analogy is to imagine a seesaw. The load you place on one side has to match the other (we’re talking the elusive quest for balance), otherwise the see-saw will tip too much. Add too much stress, too quickly and one side will plummet down, but a sustained imbalance between loads will eventually have the same result. This can creep up on us and take us unawares as we have not necessarily been conscious of every one of these smaller and underlying stressors, or of just how much low mood and poor mental health is affecting us physically too.
We are learning more and more about how to treat the likes of depression once it arrives, but is there any way that we can pick up on warning signs as they manifest? If the answer is yes, can we then do anything to help to tip our seesaw back towards a more balanced and even keel?
Depression affects the bandwidth of the cables in the nervous system and brain that process emotion. It affects our sensitivity and emotional thresholds, resulting in some fundamental physical manifestations that we can feel and recognise. These include physical pain, muscular tension, problems with digestion , sleep and sex drive, to name just a few physical markers of poor mental health. Here’s what to be aware of...
As medical professionals we are continuing to learn about how physical and mental pain are intertwined. This can mean that we have a physical pain which can’t be specifically related to a traceable physical source, but rather to acute or chronic emotional stress. When a person comes to see us about a pain issue, we will take a verbal assessment and ask about the history of their pain. I am always struck by how often pain onset can coincide with a bereavement, a change at work or a relationship issue. Depression itself can lead to people feeling pain, which is commonly in the back, the abdomen or in the form of headaches.
On the other hand, people suffering with long term or chronic pain are often made miserable by it, leading to mental health issues, so it can be a vicious cycle. It’s often difficult to tell whether the pain can be attributed to a history of depression, or whether the pain in and of itself has made the patient depressed. We know that regardless of the way that pain and mental health issues have evolved, both mental and physical symptoms need to be treated to help the patient to heal.
Muscular tone, that is, how tense and tight your muscles feel, will change in response to your mental health. It’s not unusual to hear patients describe the fact that they carry a lot of tension in their shoulders. Research using electrical measurements of tension in muscles in the neck and shoulders has shown marked differences between people know to be suffering with anxiety versus mentally healthy control groups. People can also complain of a headache or migraine . There are associations with pain around the jaw, particularly if stress is leading you to grind your teeth together either during the day, or when you’re sleeping (you can ask your dentist or your partner for confirmation). Often patients will arrive speaking of symptoms which worsen over the course of the week, before settling down over the weekend. Holidays can sometimes see this painful stiffness in the shoulders aches and pains disappear all together!
Poor mental health can affect how our digestive tract functions, and impact on our appetite. Our appetite can be suppressed (eating less), but it can also make us hyperphagic (really hungry and craving sugar). We can feel bloated or have a tight knot in our stomach. The abdomen can feel painful, with especially tight areas being just below the breast bone where the ribs join. Some people can produce excess stomach acid, also known as reflux. It may be that you can put these symptoms down to some chaotic eating habits, or perhaps your eating habits are suffering as you are beginning to come under mental pressure.
Changes in sleep patterns are a sure way to recognise that you may be suffering with a mental health issue. Some people may find that it becomes more difficult to fall asleep, while others fall asleep with no problems, but wake up halfway through the night, finding it hard to get back to sleep until just before the alarm goes off. We know that sleep is a good indicator of if you are struggling mentally, and also that poor sleep is a major contributor to poor mental health. Synthetic means of getting you off to sleep such as sleeping pills or alcohol may feel like they are helping in the short term, but both affect the quality of your sleep and recovery negatively and have been linked to a higher chance of developing mental health issues.
Sex drive and libido
People who are suffering with depression may notice a reduction in their interest in sex. Sex is a powerful mood booster and therefore a lack of sex drive can exacerbate this negative cycle of feeling depressed. This can be difficult, especially if your personal relationships are already being affected by stress.
A plan for feeling better physically and mentally
We already know that physical exercise and strength training have positive effects in terms of relieving pain and helping to lift depression . As far back as the 1950s, German psychiatrists published articles extolling the virtues of ‘ambulatory therapy’, or walking, for depressed patients. Exercise releases hormones and endorphins that help to keep the brain functioning optimally, and the well documented happy buzz that comes after exercising is just that- a little endorphin rush. Disciplines such as pilates, yoga and tai chi also incorporate elements of mindfulness , helping to soothe our fired nervous systems. Carefully spaced over a week to coincide with when you know you will be low, they can help to combat and reverse these early signs of mental health issues. Exercise will also help with peristalsis, or the movement of food through the gut, providing you don’t do it just before or just after eating. Finally, we know that exercise, when performed at the right time also improves sleep quality and sex drive, in turn improving the outlook for mental health problems.
Diet and eating habits
Is it possible to make eating a part of your day that is relaxing rather than stressful? Can you ring-fence time, to make sure you are not only getting a balanced nutritional intake, but the time to eat it at and enjoy it?
Simple steps such as trying to eat at regular times through the day can help. Eating at your desk should be avoided wherever possible, as the combined effects of posture, distraction and stress mean that you’re unlikely to digest your lunch too well! Reducing or avoiding foods that act as stimulants to both the mind and the stomach such as excessive caffeine , sugar and alcohol will be beneficial. Eating healthily , or at least avoiding any ‘trigger’ foods at certain times will also improve sleep quality and boost libido.
Soft tissue treatment and acupuncture
Soft tissue release over areas where you carry muscular tension will be highly beneficial to already tight muscles. Fascial release around the jaw, shoulders, neck and mid and lower back can restore movement and reduce pain. There is also the well known benefit of simple human touch psychologically for us humans. Specific massage around the diaphragm and rib muscles will help with digestive problems as well as releasing known focus points for fascial tension.
Acupuncture can help to release tension over the treatment area and is known to be beneficial for stress and depression. In accordance with the theory behind traditional Chinese medicine, the meridians, or energy lines, that are treated can target the visceral issues they are named after. For example the stomach and small intestine meridians pass over areas of tension such as the jaw and upper shoulders.
A fundamental way of improving your chances of a good night’s sleep can be reducing screen time late at night. Using your phone as an alarm clock is common now, but it means that that 11pm message or email will be the last thing your see at night, or the first thing you see in the morning. Buy a bedside alarm clock and read ‘real’ books before bed rather than using an electronic screen for bedtime reading.
That said, there are many methods of monitoring and tracking sleep via wearable technology and apps, and one of the best ways to assess not only the duration of sleep, but its quality, is via heart rate variability. Heart rate variability measures not only the rate of your heartbeat, but the difference in time between heartbeats. A better HRV indicates better recovery, less stress and a more even hormonal balance. It’s for this reason that we offer full lifestyle assessments using HRV monitoring in clinic to help professional sports men and women and clients to manage their stress and recovery effectively.
Muscular tension, pain, and the digestive system will all be affected negatively by a hunched posture. While nobody should be sat or stood bolt up right, maintaining a poor posture will often make you sore. Simply changing position regularly will reduce this, but a full ergonomic assessment of your desk space is highly recommended. Look at how many screens you have and whether they’re positioned centrally in front of you. Consider how far you need to reach to your keyboard and whether your feet comfortably reach to the ground.
Try to get up and move regularly through the day, setting reminders if you need to or using technology such as Little Nudge , an ‘exercise as medicine app’ that’s proven to help with mental and physical recovery from illness or injury and encourages healthy habits. Exercise in general will also help to strengthen postural muscles, with pilates being particularly helpful for people with long standing postural issue, therefore benefiting body and mind.
Steady your seesaw
Take a step back and consider whether any of these issues or patterns are cropping up in your life. Most people can sustain a high mental load for a period of time, yet if your seesaw is not tipped back to an even level intermittently, no one is immune from developing mental health issues. Almost all of the solutions mentioned here revolve around making time for yourself, or doing something positive for yourself. This isn’t selfish- it’s essential. Prevention is always preferable to cure, so if you can address problems before you burnout mentally and physically, that’s brilliant, but if you’re in the midst of an episode of poor mental health, even the smallest change could make a big difference to how you feel in yourself.
For more information and support regarding mental health issues visit the Mind website
Make an appointment with Tom at Pure Sports Medicine