If you’ve been in the clinic over the past 3 days you may know that I’m suffering from bursitis in my shoulder. A bursa is an ‘anatomical whoopee cushion’ that sits within some joints and prevents friction between structures. The suffix -itis means inflammation so bursitis is inflammation of the bursa. Using my injury as an example, this post looks at some of the effects of stress before and during injury or illness. At the end of the post, I outline some of the worries I’ve had during injury and how I coped with them.

There are a number of factors that added up to my development of shoulder bursitis including:
– Repetitive actions during massage and waterpolo
– A humerus (upper arm) bone that sits slightly forward in the shoulder socket following an injury in 2015
– Weakness in my mid/lower traps
 
These three factors are not new – I’ve swam regularly for years, have been massaging for nearly 2 years (including my massage training), and have been aware of and working on my mid trap weakness for a while. So why did the bursitis develop now?
 

Before the injury…

 

Looking back at the past couple of months and weeks, I have been feeling a little run down. 
  • I am taking a qualification to become a Pilates instructor. I’m loving teaching Pilates and find the coursework interesting, but having exams and deadlines again is stressful! 
  • I’ve had a few busy months in the clinic – again great and I love treating my clients, but deep tissue massage can be physically exhausting!
  • With summer coming around, my sleep has been lighter and shorter and I’ve been exercising more than usual without increasing my food intake. 

There is lots of research surrounding the interplays between stress and pain/illness/injury. Stress is the human response to a stimulus or “stressor” and can be physical or psychological. Lazarus and Folkman specifically define stress as a “relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her wellbeing.” The emphasis on “appraisal” highlights the subjective experience of stress. “Resources” relates to both internal (the body’s ability to cope- this may be subconscious) as well as external (e.g. social support, financial situation etc).

If you imagine a cup sitting below a dripping tap, each drop in the cup may be tiny, but at some point the cup will overflow. You can attribute the same principle to chronic stress and the body. Each little factor that your body perceives as stress can add up, and eventually something has to give!

Following this principle, the fuller your “cup of stress” is, the more at risk you are of illness or injury. This may be due to a number of factors including:

  • Fatigue or poor concentration meaning your technique slips during exercise
  • Tense muscles due to stress become more prone to injury and may restrict mobility
  • Stress may cause low mood or anxiety, which can alter your posture
  • Less consistent nutrition or eating foods with lower nutritional value due to stress
  • Acute stress (sudden fight or flight response) temporarily increases your immune response as an evolutionary mechanism to aid survival in the event that you are attacked by a predator. However, chronic stress actually reduces immune response.

 

During the injury…

 

As a massage therapist, I rely heavily on good physical health to be able to do my job. So, when my bursitis reared it’s ugly head on Saturday afternoon my stress levels were pretty high!! Despite knowing that (with the right treatment and home care) bursitis can clear up pretty quickly, my brain went wild with “what ifs”! I knew it was important to manage my stress levels at this time as you don’t have to look very far to find research that shows that stress slows tissue healing.

If you have had a massage with me, I may have talked to you about your stress levels and coping strategies. I feel that with our Britishness we are more likely to “just get on with it” rather than to talk about how we feel. However, complete vitality includes mental and emotional health too! I am not a psychologist, but pain and injury can be a huge deal for some people psychologically as well as physically. I like to give you the opportunity to talk about this during your treatment. I have decided to share a few personal worries that have affected me during my injury, and how I am dealing with them. I hope that you can relate!

 

If I can’t exercise or play my sport will I lose strength and conditioning?

 

Problem: As well as causing anxiety, this thought puts me at risk of returning to sport before my body is ready, which dramatically incases my chances of re-injury. A second bout of bursitis can require a much more lengthy recovery than the first!

What can I do? I’m changing my mindset and reminding myself that a short rest and recovery period will do my body good. I will have more time to spare that I would previously have used to train. I can now spend that time doing activities that promote recovery (rehabilitation and mobility exercises) or relaxation (and writing posts like this).

 

Not exercising might affect my mood!

 

Problem: Training has been a large part of my life and identity for many years now. Not being able to train may mean that I lose contact with friends that I know through sport. Lifting weights and swimming is also my main coping strategy for stress, so being unable to do that could impact stress levels!

What can I do? I can make a special effort to meet those friends outside of the gym or pool. I could seek social support for any worries rather than using the gym to cope. I can spend more time doing other relaxing activities that I enjoy such as baking and growing my watermelons. Massage has stress and anxiety reducing effects so I have also booked in for a few deep tissue massage treatments myself!

 

Will I gain weight whilst not exercising?

 

Problem: The body requires energy (calories) in order to heal an injury. Feeling that I am gaining weight could cause me to reduce the number of calories I am taking in – especially as it is summer! However, this could impact my healing time. Feeling that I’m gaining fat or losing definition could also affect my mood.

What can I do? I need to remind myself of the importance of fuelling my body with nutritious food and lots of water whilst I am recovering. I won’t need as many calories as I did whilst I was training regularly, but won’t need to drop by much. I am using the opportunity to try new recipes and loving filling my bowl with sweet and colourful fruits after dinner! I’m making a conscious effort to burn more “stealth calories” by parking further from my house or work and walking to do errands rather than driving.

 In summary, whilst stress is rarely the only factor in any injury, it is an important consideration.  The bursitis has allowed me to empathise with my clients, try different treatments and home care methods first hand, cook new recipes, spend more time on other hobbies, practice looking on the bright side, and even got me some sympathy from my big brother! It’s not all bad and having a positive outlook should decrease my healing time (or at the very least make it more bearable)!

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