This blog wrote itself as I was bumbling around my kitchen at 5:30 a.m. today, tears streaming down my face while I fumbled for Advil and coffee. Inspiration moves in mysterious ways! More about this ugly scene in a minute. Away we go:

I’ve been in independent practice for more than 3 years now, and I’ve watched a fascinating pattern unfold–around holidays and vacation times, the times when I thought things would be slow, my client volume increases exponentially. People who recovered from an injury months ago are back. People who were on their way to discharge have managed to set themselves back a few weeks. People come in with random, diffuse, insidious onset pain that keeps them up at night. What’s the deal? I’ve been a PT for 15 years now, this ain’t my first rodeo, and I am going to put my hypothesis out there. I have no randomized, double blind clinical trials to support my idea, only years and years of working with people in pain, so here it is: Stress travels to and affects the weakest area of your body.

This is not to say that it’s all in your head. I am talking about a very physical response to stress. We’ve all heard about the “fight or flight” response that gives a mother the power to lift a car to free her child in an emergency. In a stressful situation, your sympathetic nervous system is activated and stimulates the release of the neurotransmitter norepinephrine, which increases your heart and respiration rate, slows down your GI system, shunts blood to your muscles and tenses them to prepare them for action, and increases circulating levels of cortisol, the so-called “stress hormone” to break down fat stores and give you an energy boost.

This works great when you need to save a life. When you are running around for days or weeks at a time with your nervous system in a partially or fully facilitated state, your body starts to wear out. Prolonged muscle tension in various areas of your body contributes to muscle spasm, uneven pulls and malalignment of joints. Prolonged elevated levels of cortisol breaks down healthy tissue, also predisposing us to injury, and also shuts down the immune system, GI system, and memory. Hello? No wonder so many of us are brain dead this week. Plus being in that hyperfacilitated state just fatigues us. How long can you run around, heart racing, lungs blasting, muscles ready to spring into action, before you are exhausted? Eventually it just tires you out.

So I don’t think it’s a huge jump from here to there to say that if you have an area of the body that is predisposed to injury, whether that’s your neck and shoulders, your low back, your GI system, your lungs, or your knee, these effects of prolonged stress will sooner or later show up in these already weakened tissues.

The week before the holidays, many of us feel overloaded. We are out of the normal routine. We are running around trying to accomplish way too much on top of what we normally do. The things people come in and confess to me are astounding–climbing trees to hang up Christmas lights, shoveling a quarter mile of snow, or moving a woodpile from one side of the house to another are a few examples I’ve heard recently. We are doing things that we don’t normally do. Family pressures, financial stress, too many requests for assistance, and the pressure to have everything perfect all contribute to nervous system hyperfaciliation and has our neurons firing overtime.

So here’s my ugly little story, to show you that I, too, am not perfect and don’t follow my own advice at times: I got stressed and out of my routine. December is particularly busy for us because two of our children also celebrate birthdays in the weeks before Christmas. So we had that. As I mentioned above, I also have been so fortunate and blessed to have my practice very busy this month. I was feeling overloaded early yesterday morning and blew off Masters swim to prepare for a busy day. I didn’t get to accomplish nearly enough, in my mind, and last night came up with a brilliant idea: Hey, I just won’t sleep! I’ll get up at 2 am, work, hit a nearby fitness class at 6:15 am, and continue on with the day.

Needless to say, this plan backfired big time. I thought I’d do a little holiday cleaning (yes, I know this story is insane), and at 2:45 am lifted up the couch to look for a missing toy part. Bang! Strained my shoulder, but that didn’t stop me. Continued on to the laundry, then gift wrapping, then paperwork and around 4:45 am thought I’d power nap for a little while and then hit the class. Opened my eyes at 5:30, tried to stand up and wow! My back was out! One of the upsides of being a PT is that I am in a position to immediately identify and address an injury, so I’m already feeling much better, thank you, but my ridiculous story highlights the kind of crazy stuff that we do around the holidays in the quest to get it all done. Would I do this normally? Not on your life.

So, what can we do? Here are a few suggestions:

  1. Carve out a little time for yourself. I know it’s hard, and feels wrong and selfish when there’s so much to be done! But we need a little down time to chill and reset our brain and nervous system. Think of it as injury prevention and a gift to your family, because you will be less stressed, less tired, and have more energy.
  2. Exercise, but don’t overdo it. I have to laugh when people say, “I don’t have time to exercise.” Yeah, like you’re busier than I am. This is a big, fat excuse. You prioritized something else over exercise, just like I did yesterday. BUT: When your body has been in this crazed, hyperfacilitated state and you aren’t feeling like yourself, keep it gentle. Those who have worked with me know how grouchy I can get when you come in complaining but haven’t done your exercises at all. I do, however, grant a little amnesty during crazy times of the year. I think that people who are really struggling with all this stress may benefit more from relaxing exercise during very busy times of the year–stretching, yoga, easy walks–than from much more vigorous exercise, which may put them at a higher risk for injury. And if you are exhausted and your body is telling you “no” to your daily run for a couple of days, listen to your body. You’ll get back into the routine soon.
  3. Breathe. I’ve seen a number of cases of thoracic and rib pain recently and I’ve come to the conclusion that people aren’t breathing! I’m guilty of this myself. I think I ran 2 laps around the high school track last week without taking a breath. Try some slow, deep breathing for 5 minutes, twice a day to mobilize your ribs, slow your respiration rate, quiet your sympathetic nervous system, oxygenate your muscles and take a break.
  4. Keep a sense of humor. After work yesterday I did a couple of errands around town and ran into people I know everywhere. We were all frantically running around the same places, and we would catch each other’s eyes and just crack up at how crazy we all were feeling! Humor makes any situation tolerable. And it also has been demonstrated in studies to decrease circulating cortisol levels.
  5. Try to get some rest. If you can’t get to bed a little earlier, try to fit in a little rest somewhere in your day. Late in the day I frequently set the timer on the stove for 10 minutes, announce to the kids that I’m taking a power nap and to only wake me if the house is burning down, and then crash out on the couch for 10 minutes. It works wonders. It gives me energy for the evening. I highly recommend it.

Remember that the world will not end if something does not get done. My BFF Nancy Nowalk and I like to quote “The Grinch” to each other at this time of year for perspective: “He hadn’t stopped Christmas from coming, it came! Somehow or other it came just the same!” Hang in there, everyone! xo

–Kathleen Doehla, M.S. P.T.