Is your stress your Achilles heel?

by Gus de la Querra

You’re struggling with this irritating reoccurring pain in your Achilles tendon. It’s been persistent for the last few months and although at times it seems to be getting better, constant inflammation is the order of the day, causing regular flare-ups, stopping you in your tracks.

Maybe you’re currently experiencing a certain amount of stress? Stress in small amounts has been shown to create optimal levels of alertness, behavioural and cognitive performance (1), but we all know how excessive stressors of any kind can play havoc with our biology.

So, what does this have to do with our ongoing Achilles tendon pain, or any other recurring injury?

Don’t shoot the messenger.

The answer lies in Cortisol – a hormone (a glucocorticoid) produced by our adrenal glands during a stress response.

Often seen as the enemy, cortisol is actually our friend.

Thanks to cortisol, we’re able to wake up and get out of bed in the morning. It regulates many basic functions such as brain and nervous system energy (2), metabolism, salt and water retention levels, and blood sugar levels. In fact, cortisone is anti-inflammatory – it prevents the widespread tissue and nerve damage associated with inflammation (3).

However, a drastic shift occurs under scenarios of excessive or chronic stress as it requires vast amounts of energy, and this is where getting injured during such a period is not ideal timing. Chronic stress might even set you up for injury and throw a proverbial spanner in the works whilst trying to heal.

You see, chronic elevated levels of cortisol lead to tissue damage as cortisol acts to break down collagen (the most abundant protein and building block of fascia) into amino acids which are turned into glucose through a process called gluconeogenesis by the liver for use as energy.

When it comes to tissue healing, cortisol can inhibit fibroblast growth (4) (5) and decrease the amount of collagen your body can produce (6).

The bottom line – chronic stress can lead to tissue breakdown, inhibit healing, leading to ongoing/recurring injuries.

Time to rethink?

Is it time to re-evaluate your current treatment plan if this is you, or if you’re a practitioner – for some of your clients? Facilitating the healing process in some cases might just require more than a mere change in the application of different manual techniques.

It might just require the most difficult technique of them all – “101 ways to de-stress!”

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Acknowledgements

Dr Stewart Gillespie for his insights into this topic.
www.functionalmedicineservices.com

Research Links:

• Kirby et al. Acute stress enhances adult rat hippocampal neurogenesis and activation of newborn neurons via secreted astrocytic FGF2.
• Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25:1–35. 
• Kara E. Hannibal, Mark D Bishop. Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation
• William B. Pratt, The Mechanism of Glucocorticoid Effects in Fibroblasts
• A Ramalingam , A Hirai, E A Thompson, Glucocorticoid inhibition of fibroblast proliferation and regulation of the cyclin kinase inhibitor p21Cip1
• A Oikarinen, Effect of cortisol acetate on collagen biosynthesis.