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  • Dr. Kelly Ashbeck

Stress, Not All in Your Shoulders

Have you ever said out loud (or to yourself) that you carry your stress in your shoulders? What does this mean exactly? I presume we mean that our upper back and neck hurt at times when we know we’re stressed. Or maybe we have headaches when we’re stressed. But still, what does that saying mean?


Stress can wreak havoc on our bodies, I think we can all agree with that. But why? Before we dive into the why, I have two pet peeves that I want to get off my shoulders:


  1. There are some clinicians that “won’t go there.” They won’t talk about stress and emotional health because it’s too touchy. Or “that’s not my place” or “I may be misunderstood with the implications.” I don’t buy any of these reasons. When we’re working with persistent pain, the hood must be opened up. If we as clinicians are not willing to admit that our emotional health plays into our physical health, we’re living under a rock. Emotional health is all around us. Frankly, WE deal with our own emotional health and its implications on OUR physical health. So there’s that!

  2. I have had more than one patient tell me they were told that they’re pain is all stress related, as if it’s that simple (both in explanation and solution). It’s really not that simple, but if we strive to understand our bodies and as clinicians we strive to empathize, we can learn a lot! And when we empathize and understand, our explanations don’t come off as so brash.


Stress is normal and part of life, so we should all have experiences in how it has affected our health and how we’ve dealt with it. But what does stress do to our bodies that causes this so-called havoc reek? Stress sets off our “fight or flight” mechanism of the autonomic nervous system. What happens when we’re in “fight or flight?” We tense up, and not just in and around our shoulders. Our heart rate elevates and our blood pressure increases. We also have hormonal changes. We release stress hormones such as cortisol, which is ultimately inflammatory. What does low level systemic inflammation do to our bodies? It trickles gasoline on our fires! It becomes a magnifier of sorts. Inflammation makes the nervous system sensitive and it amplifies signals both regionally throughout our body as well as up the spinal cord. Can you think of the last time you were “stressed out?” Stress has a feeling. We physiologically feel this fight or flight mechanism kicking in and frankly it doesn’t feel so great. Now spread that feeling over a long period of time. Uncontrolled and poorly managed stress is a persistent low level release of stress hormones. It is a persistent drip, drip of gasoline on your fires. Your back pain may become more prevalent and your headaches more frequent. It also affects your arthritic pains. So what can you do about your stress? It is normal after all!


The first thing we must do to adequately manage our stress is to be aware. Be aware that you are stressed in the first place. It is hard to make behavioral changes when we don’t know what the feeling is. Once we understand that we are stressed, we must understand our triggers. Do you have any triggers that consistently set off your fight or flight response? Knowing your triggers can help curb your stress response, minimizing its effect on you. Finally, breathe! Activities such as meditation can help your long game. It is a practice to help you re-anchor your thoughts and slow things down. That being said, lessons learned with meditation can help you in the short term as well. When you are triggered or starting to sense that slow gasoline trickle, be aware of your body’s response, anchor your thoughts on your breath and try to avoid the slippery slope. You may also concentrate your thoughts on your tension and work on relaxation. This simple (but not so easy) practice can really help unload your shoulders and start to put out some of those fires.


Are you or anybody you know dealing with persistent pain and need some help putting out those fires? Reach out via email or phone to set up an appointment.



Kelly Ashbeck, DPT, OCS


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