Ever wondered why stress can increase pain symptoms, or how your mental and physical health impact each other? Well here is a brief explanation to those points.
When experiencing anything stressful, the body reverts back to the evolutionary response of fight, flight or freeze. Such a response is advantageous in the short term, however, if held chronically, it can have both mental and physical ramifications which is becoming increasingly more serious and a somewhat epidemic due to modern day society. With longer working hours, growing career pressures, social media, higher inflation and monetary pressures, the body is exposed to much more frequent stressors which collectively, they can have detrimental consequences both directly and indirectly.
The Stress Response
(Copyright: Miss Kimberley Shone, Move Well Nottingham)
Taking the above diagram into consideration, it is easy to understand how stress can cause hormonal imbalances. Every person responds to stress in different ways including actions, emotions and impact due to individual nature and nurture aspects including genetics, attachments, and experiences. Thus, diagnosing symptoms of stress can be difficult as it affects each individual differently. However, as the stress response has not changed throughout evolution, the recognised symptoms are easy to detect, yet despite this, there is still great ignorance to stress and its impacts. Only relatively recently have Mental Health Divisions been able to support those affected by stress with the development of Cognitive Behaviour Therapy and Gestalt Therapy for example, yet these are only offered once the impact of stress has taken hold. Therefore, there is a great need to re-educate to enable people to deal with stress better so they are less likely to experience chronic stress and thus, be affected mentally and physically by stress.
Using the above diagram as insight, the respiratory system is one of the first aspects of the body to respond to stress. As mentioned, in short term this can be advantageous as it can allow an individual to respond quicker and more efficiently, yet chronically these hormonal changes can have widespread impact affected all aspects of the body. Noting further how past experiences influence future reactions to similar stimuli, which if it involved a traumatic and/or overwhelming experience, there is a likely chance that the individual will experience the same reaction which links with conditions such as Post Traumatic Stress Disorder. Therefore, learning ways to be more resilient to stress is vital for healthy mental and physical health, whether you are currently feeling stressed or not.
- Therapist Perspective
From a Manual Therapist perspective, it is important to be aware of the symptoms of stress, and assess each client because how they feel at the time of the appointment, will impact how they respond to treatment. Whether the individual booked the appointment due to injury, pain symptoms, recovery or maintenance, it is vital that you assess their breathing patterns (without the client knowing as they will change how they breathe upon mentioning). Why? Because if they are stressed, and such breathing patterns are not addressed, it will reduce the likelihood of the treatment having long term benefits, and rather the client is more likely to revert back to original patterns which can return original symptoms present before the appointment.
On the whole:
- By sympathetic and empathic
- Listen with care
- If necessary, recommend mental health support such as a reputable CBT practitioner for example. (I have a few such therapists within my network and make referrals when are where necessary, which has proven very complimentary to Soft Tissue Therapy treatments and thus, overall improvement)
- Be aware of the various breathing patterns and ways to help improve breathing patterns both in clinic and home care advice.
- Think global, and assess whether such breathing patterns are influencing posture and biomechanics and address where necessary.
BREATHING PATTERNS IN REST SHOULD INVOLVE THE DIAPHRAGM AND GUT, THUS THE GUT SHOULD MOVE OUT ON THE INWARD BREATH, AND BACK IN ON THE OUTWARD BREATH. ONLY WHEN REACTING TO A SUDDEN STIMULI SHOULD THE BREATHING INVOLVE MORE THORACIC CAVITY AND POTENTIALLY COLLAR BONES.
When beginning to retrain breathing patterns, it can be easier when horizontal due to reduced gravitational pressures. Nonetheless, try and be more aware of your breath in every day life and such awareness itself can help stress resilience.
Note: It is pretty ironic how paradoxical breathing involves inward movement on the inhale, and outward movement on the exhale, but such a breathing pattern increases risk of hypoxia and hypercapnia.
Tom Myers and James Earles collaborated to develop Anatomy Trains which increases understanding of anatomy and the impacts on physiology.
Tom Myers explains on their website:
"Just as an exercise to cement the students’ knowledge, I began stringing the muscles together through the fascia. This idea was initiated when Dr Jim Oschman gave me an article by Raymond Dart (the anthropologist and Alexander Technique student) linking the muscle in the trunk in a double-spiral arrangement... After a few teaching iterations, the whole project became so interesting that I started to systematize these connections. With the encouragement of my friend Annie Wyman, the full picture and implications of the lines started to become clear. I started to see the lines in assessing my clients, and then started building my structural bodywork sessions around these lines."
In application to breathing patterns in conjunction with overall anatomy and physiology, they offer great insight and I highly recommend their books and courses. They explain how a four legged creature has a diaphragm that moves obliquely to gravity, whereas the human respiratory diaphragm moves along the gravitational line. Thus, when vertical, the respiratory diaphragm moves up and down the central tendon creating healthy tensegrity throughout the spine, and positively influences posture and biomechanics.
When considering impact, this involves pressure in the human pelvic cavity to be strongly positive, reducing in the abdominal cavity and therefore, leaving the thoracic cavity in negative pressure with the respiratory diaphragm centrally placed in the zero point (1). Noting how poor posture and/or biomechanics can influence more dysfunctional breathing patterns as the poor lower limb biomechanics for example can increase pelvic pressures which causes the abdominal and thoracic cavities to incur greater pressures which impacts respiratory diaphgram function.
Fascial Connections of the Respiratory Diaphragm
Fascia is everywhere in the body, and there is increasing research to suggest that every living form has some kind of fascia, or at least anatomy that presents very similar characteristics to fascia. It has two main purposes:
1) Reduce friction: research has found that water (H20) aids fascial gliding to which an increase in Hyaluronic Acid can cause Macromolecular Crowding which reduces the presence of water.
2) Tensegrity with proprioception: as fascia surrounds everything from head to toe (not just the bottom of the foot), it helps hold the other anatomical parts to the skeleton, thus tensegrity. The definition of tensegrity being the tension in the integrity, and when applied means how well the body holds itself together, noting too little or too much tension are both dysfunctional. Regarding proprioception, it ultimately means feedback and how the body responds to stimuli, to which there are more proprioceptive properties in the fascia of limbs compared to the trunk due to increased movement abilities, noting the consistency of mechanoreceptors increases with proximity towards the joint.
Bordoni et al., (2013) identified four fascial planes involved with and connected to the respiratory diaphram at the retroperitoneal level:
1) Fascia Transversalis: Costal, lumbar and pubic iliac regions. Continues from endothoracic fascia, connecting to pleura, pericardium, and respiratory diaphram, and also deep and median cervical fascia involving phrenic nerve and occipital pharyngeal tubercle. Regarding connective tissue, they suggest connections to the pubis including epimysium of transversus abdominis, external oblique, and inguinal canal.
2) Interfascial Plane: Posterior aspect of the respiratory system to the aortic system including inferior vena cava, liver and kidneys. Connective tissues include psoas, quadratus lumborum, and phrenic-esophageal ligaments.
3) Thorocolumbar Fascia: Posterior sacral, thoracic and cervical regions. Connective tissue includes latissimus dorsi, trapezius, gluteus maximus (which also partially travels anteriorly towards the pelvic floor), external oblique, and the ligaments connecting ilium to sacrum. Bordoni et al., explain how the semispinalis muscles of the neck are predominantly activated at C2 level, yet when anomalous tensions are registered, the pressures become more widespread to C5 which has the potential to surround proximal aspects such as the phrenic nerve.
4) Lateral Raphe: From 12th rib to iliac crest, supporting the relationship between the respiratory diaphragm and quadratus lumborum. It is here that Bordoni et al., explain how they believe that the respiratory diaphragm predominanltly acts on L2 with the purpose to help stabilize the spinal column and regulate resulting forces.
Such research is supported by the likes of Wilke et al. (2016) who found that “lower limb stretching based on myofascial chains has been demonstrated to increase cervical range of motion (ROM) in the sagittal plane.” Therefore, not only does this help understanding regarding widespread pain and compensatory patterns, it also offers insight into the potentials of fascia both positively and negatively.
Imagine the connective tissue and fascial connections moving in harmony as you breathe through the gut in rest, and how stagnant, pulled and taught they can become once the breath moves towards more thoracic and clavicle breathing patterns.
Taking these connections into account, it helps to explain IBS symptoms when experiencing stress with dysfunctional breathing patterns albeit there needs to be further research to support this hypothesis. Nonetheless, it provides explanation as to how breathing patterns can impact posture and biomechanics, and vice versa.
The respiratory diaphragm is directly involved in the stress response, and depending on an individuals reaction to stressful stimuli, it can have negative consequences to mental and physical health. So practice restful breathing using your respiratory diaphragm optimally and efficiently, and consider your posture and biomechanics if you are finding it difficult. Furthermore, stay hydrated noting clean plain water is best, and lastly, enjoy the restful periods and be mindful in stressful times.
For therapists, be aware of the global ramifications of inefficient use of the respiratory diaphragm through dysfunctional breathing patterns, and how fascia influences the body including connections, functions, and alignment. Furthermore, be sympathetic and empathetic towards clients experiencing stressful symptoms and alter the treatment accordingly, addressing both the stress and reasons for seeking treatment, to which communicate your intentions and explain why to reassure the client.
Any questions or thinking of collaborating, please feel free to get in touch and Kim will respond as quickly as possible.
(1) Myers, T. and Earls, J., “Fascial release for structural balance” [Revised Edition] [book]
(2) Bordoni, B. and Zanier, E., 2013. Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 6, p.281-291. DOI: 10.2147/JMDH.S45443
Useful websites and links:
- https://bjsm.bmj.com/content/52/23/1497 : Zügel, Martina, et al. "Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement." Br J Sports Med 52.23 (2018): 1497-1497.
- Chaitow, Leon, Chris Gilbert, and Dinah Morrison. Recognizing and treating breathing disorders: a multidisciplinary approach. Elsevier Health Sciences, 2014.