The Mind Body Connection

By Andy Schmalz, DO(MP), CAT(C)

We are often taught that the different issues in our body are the result of physical, emotional, or mental stresses. For physical injuries we look to some sort of therapist that focuses on stretching and strengthening to bring the physical structure back into a balance. Mental and emotional issues are treated with a therapist that has been trained in talk therapy and various rehabilitation techniques to help heal the initial trauma. The compartmentalization of these conditions has created a roadblock to healing for many individuals.

Instead of thinking of physical, emotional and mental health as being separate, they should be viewed as interrelated aspects along the same continuum. This can be thought of as similar to colours on the spectrum. Red, blue, yellow, or any other colour are not individual spectrums on their own colour palate, they are part of the same spectrum that transitions through all colours. In the same way that the inclusion of all colours combined produces white light, the total combination of physical, emotional, and mental spheres is required to produce holistic health.

To introduce this concept, let’s look at a simple injury like a sprained ankle. Imagine you’re a high school athlete competing for your school’s basketball team in the playoffs. You accidentally land on someone’s foot when descending from a jump and roll your ankle. You feel a couple of pops, a lot of pain right away and know it’s not good. You later discover that you will have to miss 4-6 weeks in rehabilitation if everything goes according to plan.

This is a very mechanical issue, right? There was no emotional stress that caused you to hurt your ankle so it should be a straight forward rehabilitation – manage the inflammation, begin range of motion exercise, slowly re-build the strength and continue from there. 4-6 weeks, right on schedule. But let’s take a look a little more closely at the whole scenario.

No injury is ever purely physical or purely emotional. They are opposite ends of the same spectrum. When you rolled your ankle, what were your feeling before and after the injury? You’re one of the better players on the team and there’s likely a feeling of letting your friends down, or possibly frustration because you had prepared hard for this year and now you’re going to miss the end of a short season. Maybe your coach isn’t supportive of the situation. Instead of reacting with empathy he/she responds with frustration that they have now lost one of their starters and the team’s chances of winning the championship have taken a hit. You will be able to feel that pressure during your healing process. And these thoughts don’t even include what might be happening at home – maybe your parents have been fighting lately and it has begun to create a lot of stress in your life. Maybe you’re having relationship issues with your boyfriend/girlfriend. Maybe there’s a loved one like a grandparent whose health is deteriorating.

The point is that ALL of these different stresses and emotions come into play during your healing process. Once again, the physical and emotional domains are opposite ends of the spectrum, and it’s important to have a rough idea where this injury falls within the spectrum to determine what type of treatment is required. This is not to say that every injury you experience needs to be assessed by a trained psychotherapist. Having a rough idea where an individual is in the spectrum helps to identify any barriers to healing as well as guide treatment. In this simple example of an ankle sprain it’s likely that the injury is much closer to the physical end of the spectrum with a small emotional component:

PHYSICAL___X_________________________EMOTIONAL

But if there are significant stressors at home or school, the spectrum would adjust:

PHYSICAL______________X______________EMOTIONAL

The difference between the two spectrums dictates what needs to be addressed in treatment. The physical rehabilitation of the injury does not change – control inflammation, then increase strength and range of motion as appropriate. But it’s possible the athlete in this scenario is carrying some stress that can slow the healing of the ankle. It may still heal on its own but the process will be more complete – and the care for the injured individual much more comprehensive – if the emotional stresses are identified and addressed. While this example is hypothetical, it’s well within the realm of possibility. Let’s look at a couple examples from clinic.

Example 1

A pre-teen girl (age 11) comes into clinic complaining of neck pain and headaches. Upon assessment the typical issues leading to neck pain are present – tension in the deep muscles of the neck, a change in breathing pattern (chest breathing), increased tension in the connective tissues of the abdomen, and weakness in the muscles of the mid back. The simple formula is to reverse these findings and the headaches should alleviate. However, in conversation during treatment the patient reveals that she has been experiencing difficulty all year long with a bully on the school bus that has been progressively getting worse. Her parents are aware of the issue but have not been fully informed about the severity and the young girl has not been forthcoming about the impact it is having on her. This simple disclosure has a significant impact on the healing process. The stress of worrying about a bully on a daily basis will create the tension in the abdomen (see effects of inflammation), change breathing patterns, and likely create the tension in the muscles of the neck as well. The approach to treatment at this point needs to change. The physical symptoms will resolve with the treatment of physical restrictions, but will return if the initial root issue is not addressed. The impact of the stress on the patient needs to be brought to his parent’s attention so they can address the issue appropriately – or the time and energy spent on neck rehabilitation will likely be redundant.

Example 2

Many of us carry low-level stress on a constant basis. We have simply been doing it for so long that we do not realize that it is actually affecting us. But the physiological effects of inflammation and the blood flow changes associated with stress can take a significant toll on us that we do not realize until there is a breakdown in the physical body. In this example you are a parent working full time with a couple of kids. You try to take care of your body but your responsibilities to your children take up much of your time. You are so tired at the end of each day that you can barely make it up to bed. Instead, you pass out on the couch most nights. You do get out for walks with the kids and eat the best you can, but the busy-ness of young children consumes most of your life…soccer practices, music lessons, birthdays, family commitments, etc. Sound familiar?

Life flies by, work gets busier and responsibilities increase. The kids are older but there are some minor troubles at school that worry you. Your parents have started to experience some health difficulties and need some help at home. Each of these commitments has also placed a strain on your marriage that simply wasn’t there 10 years ago.

Then one day you pick up your daughter after a particularly bad day at work – the same way you do every day when you get home from work. She’s only 45 pounds and you have lifted her many times before. But this time your back spasms and you experience extreme pain that brings you to your knees. You immediately know you’ve “blown out your back” and are able to see your doctor the next day. You’re told it’s a muscle strain and that you didn’t lift properly and that’s why you’ve hurt your back. NO WAY!!

Let’s take a close look at what has actually happened. Years of wear and tear and progressive increase in stress have decreased the mobility of your body. The lack of flexibility has finally reached a point where your spine cannot accommodate the things you’ve always been able to do, like pick up your daughter. The bad day at work is the proverbial straw that breaks the camel’s back. Your system was at a point where it could no longer accommodate any more change. The small change in blood flow to the muscles due to the cumulative stresses combined with one more stress lead to the muscle spasms.

What does this mean for your treatment? The back will likely heal no matter where you do your rehabilitation. If it’s really bad you might need to try a couple different practitioners before you feel back to normal. Stretch the muscles of the low back, release the tight connective tissues on the abdomen, strengthen the core, and things should resolve in a typical fashion. But here’s the problem – you have done nothing to address the root causes of the back injury. You have approached your rehabilitation as a purely physical phenomenon and therefore you have not completed your rehabilitation. Unfortunately, you will likely injure your back again in time.

What else could you do to completely heal your injured back? You can’t necessarily control the events in life that cause your stress, but you can manage how you react to stress using appropriate techniques. Managing stress is a multifactorial approach (view article Managing Your Stress) that should be part of our everyday lives. If there is a significant strain on you personally because of your parent’s health or relationship you may benefit from talking to a trained psychotherapist that would compliment the physical side of your rehabilitation. Meditation, breathing techniques, regular physical exercise, yoga/flexibility work and potential modifications to your diet all come into play when trying to heal something fully instead of simply managing symptoms for another couple of years.

Example 3

It is important to remember that the physical and emotional connection is a two-way street. The first two examples showed how emotional stresses can either create an injury or slow it’s healing. But issues that seem to be purely emotional can also create a physical imprint. Anxiety is a perfect example. Anxiety is like a little breeze that can quickly turn into a tornado that takes over your brain and body. The emotion is often created by a perception based on a root fear that leads to worry and distress. And like many things in the brain, the more it is experienced the easier it seems to become to trigger an anxiety attack. But what we forget is that there is a physical imprint left in the body that seems to form a physical pattern – and once that pattern is established it feeds into the continued development of anxiety. In essence the physical imprint helps to perpetuate and lower the body’s threshold for anxiety.

When we experience anxiety, breathing patterns change – the breath becomes shorter and we no longer activate the thoracic diaphragm to breathe properly. Instead we use the upper chest muscles and neck muscles attaching to the upper ribs to lift the ribcage and create the breath. This results in increased tension in the thoracic diaphragm, neck and upper back that may affect nerve and blood supply to the head potentially creating headaches. There also seems to be a consistent pattern of tension in the centre of the upper abdomen just below the ribs that can lead to abdominal discomfort. It may be the inflammation in the body from the anxiety or some sort of other pathway but some of the stress from anxiety collects in this solar plexus area that seems to make the emotion of anxiety easier to experience.

As these physical changes culminate, they restrict proper breathing and seem to feed into the development of subsequent attacks. Releasing the physical imprints of the anxiety attacks seems to help the body manage anxiety. It is important to note that this is in no way a substitution for counseling. Instead it is approaching the body from a holistic point of view. Treating only the brain for anxiety will help to decrease the anxiety attacks one may experience, but it will not reverse the physical effects the attacks have.

As you can see in these examples, a physical injury is never just a physical injury. Conversely, an emotional issue will always have a physical imprint. To heal the body, mind and spirit a multi-faceted approach is required. It is up to you to determine the right formula for your healing, as you are the one responsible for your own health. At Awakening Health, our goal is provide you with the information and tools available to achieve the balance in life that we are all seeking.