Have you ever noticed when you're stressed your pain feels worse or when you're in pain your stress levels go up? That's not just a coincidence, it is a real biological response.

Pain and stress are closely linked and once they start reinforcing each other it can be incredibly hard to break the cycle. So whether you're struggling with back pain, migraines, joint issues or even conditions like fibromyalgia, stress can make everything worse. I'm Roberta Bass and I am a women's health physiotherapist, menopause mentor and control practitioner and that mind-body connection is something that I am really passionate about. And so today we are going to explore how stress and pain feed into each other, why it happens and most importantly what we can do to start breaking free from that cycle.

So when we experience stress our body reacts in a very primal way. It prepares to fight, flee or freeze. Think if you're a caveman and there was a saber-toothed tiger running towards you. This is known as the fight or flight response and it happens automatically. So the brain sends out danger signals. There's a tiger. This then triggers the release of cortisol and adrenaline. Muscles tense up so that we can prepare for action, whether that's to fight or run away. Our heart rate increases, our breathing becomes shallower. Our blood flow is diverted from digestion and other non-essential functions to our vital muscles, our heart, getting everything ready.

So this response is useful if we had a saber-toothed tiger in front of us and we needed to run away or stay and fight. Not necessarily the best idea, but when our stress becomes chronic, the body stays in this heightened state for too long and that's the problem because muscles then can stay tense for too long and then they start to ache, joints then become stiff and inflammation rises, all of which can lead to more pain.

So thinking first of all about our muscles, that chronic stress leads to this muscle tension. When muscles never fully relax, it leads to this tightness, it can restrict movement and ultimately can cause pain. So this is especially common in the neck, shoulders, jaw, lower back and I see it a lot in the pelvic floor, which can lead to pain, but also can cause problems such as incontinence, prolapses and things like that. Imagine if you've been sitting at a desk for a long time, you're stressed at work, you often start to get neck ache or backache. Or if you've been stressed and our jaw muscles, kind of your clenching, your jaw, that also can cause problems with your TMJ and generally aches and pains when everything's too tight.

Our stress also fuels inflammation. So long-term cortisol disrupts the body's ability to regulate our inflammation. This is not good for many different things, but it increases our pain sensitivity. Certainly worsens conditions like arthritis and fibromyalgia. Inflammation isn't just about pain, it causes lots of other issues as well. If you are feeling constantly stiff, sore and achy, stress might actually be playing a bigger role than you realise.

Another big way that stress worsens pain is that it affects our sleep. So when we are stressed, our body is staying on that high alert. That means it's going to be harder for us to fall asleep, stay asleep, or at least getting into that deep restorative stage of sleep that can help with healing. And sleep is when the body repairs itself.

Every day when we're moving around we have little micro traumas, so small amounts of tissue damage from exercise or daily wear and tear. Normally when we sleep, our body heals those little micro traumas so allows us to wake up feeling refreshed and recovered. However, if we're not getting good sleep then we're not repairing properly. Over time this leads to increased inflammation, muscle tightness and a higher chance of chronic pain. Poor sleep also lowers our pain tolerance. So your body perceives pain worse than it actually is. You can imagine this. So if you wake up and you've not had much sleep, everything feels worse. And so we're less able to cope with pain, but also it makes the body more sensitive. Our pain then can disrupt our sleep, and then that just keeps this cycle going. And if we're not getting the sleep, then it can increase our stress and then that increases our pain. So it's just this vicious cycle.

So how do we stop the stress from making the pain worse? There are several ways and one of the key things is teaching the body and the brain that it's safe so it can stop overreacting to normal sensations. So we want to try and work on our stress management. I've done a whole episode on stress. If you look, go back and look at the ones about sleep and stress, that's going to help you to improve pain as well.

But just a few things you could try is doing some breathing exercises, doing some deep breathing. Abdominal breathing is great. That's shown to reduce our cortisol levels and reduce our stress response. Things like guided relaxation or mindfulness can help reset the nervous system and lower tension, particularly if you think about relaxing the body as you go and do things like body scans or gradual relaxation or tightening and relaxing of each of the muscles. There's various things. Check out YouTube. There'll be all sorts of things you could do to do a body scan and relax.

You could try some journaling, writing down any thoughts or stresses, things that you need to deal with. Even just doing a to-do list can help get things out of your mind and help reduce that overwhelm. Spending time out in nature helps to reduce your cortisol levels and is great for improving mood. Also, we're getting a bit of exercise, which is always good. Social connections, so talking to somebody, joining groups, doing activities with groups, doing exercise with groups, that can help reduce your stress levels. Having a creative outlet, activities like painting or music. Singing is great for stress relief as well.

Exercise is key not only for your stress management, but also for relieving the pain. Strength training helps support the joints, preventing further strain. If you've got particular problems, say a bad back or a bad hip, it's always worth going to get it assessed to see whether there are certain muscles that are weak or some that are too tight and getting specific exercises. Doing some general flexibility work and stretches can help to relieve any tightness in the muscles. Doing some Pilates or core stability work helps with back pain, helps with pelvic pain and any other joint issues because we need that strong foundation to work with.

Getting out, just doing some walking or other gentle movements helps to break the stress-pain cycle. And it's important that you start with movements that you're able to do. Don't push yourself through pain. As soon as you are pushing it too far, the brain then perceives that pain is doing damage and then it's going to make it worse. If you start with short steps thinking that you can do movements that aren't pushing you into that painful range or it's just a bit uncomfortable and then build on it, then the brain and the body learn that these movements are not causing any damage.

If stress, poor sleep or chronic pain is holding you back, then with a mixture of physiotherapy, maybe even some Pilates and some movement, and then looking also at maybe the control method, this can help reset those patterns.

So my challenge this week for you again is to pick one thing. Each time we're going to say one thing to change. Maybe that is taking a few deep breaths to try and calm your nervous system. Maybe picking some gentle exercise or going for a walk, doing some stretches. Maybe it's paying attention to how you talk about your pain or how you feel about your pain. Are you expecting all movement to be painful?

Pain is complex, but the good news is you can help your brain and your body to change. There are things that you can do. You don't have to be stuck in the cycle forever. And if pain and stress are holding you back, then visit my website and you can learn about all the different things that we can do.

Hopefully, you found this episode helpful. If you've got any questions, feel free to reach out on social media and let me know if there's anything you want me to cover in future podcasts. But for now, take care and I will see you next time.