Injured or Struggling to Recover? Stress Can’t be Ignored


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Given we are past the one-year mark of a global pandemic, stress is not hard to find. Take the pandemic away, and we still have jobs, family life, politics, and sports (I can attest as a Dolphins fan) to heighten our stress.

There is a reason stress is referred to as the silent killer. Stress does more than deteriorate health over a long period of time, however. It has an immediate effect on our ability to heal. But hope is not lost.

There are many research-backed strategies that can be employed to address these effects. They aren’t just theoretical. I have seen them work well in my clinics.


The relationship between stress and our health

As a physical therapist, I assess stress levels with each patient. Without it, my timelines for recovery would be marginal guesses at best. The road to recovery for any type of injury becomes a steeper climb as stress piles on.

Studies assessing wound healing models and outcomes show there is an average correlation of 0.42 between psychological stress and wound healing. That value is a moderate correlation, indicating a relationship is present.

So what does this mean for you?

Recovery for exercise and strenuous activity, such as a heavy manual labor job, is impaired by stress. If you are plateauing in the gym, struggling to recover between workouts, or dragging at work, stress may be the culprit.

If you suffer any type of injury — an ankle sprain while hiking, a hamstring strain while playing softball intramurals, or whiplash from an auto accident — stress will delay your recovery time. The standard recovery times you find online — 3 days to 6 weeks for sprains and strains depending on the severity and grade rating — are averages. They also relate to ideal healing environments.

Individual characteristics such as age, gender, comorbidities, cardiovascular fitness, nutritional status, injury history, sleep hygiene, recovery expectations, and psychological stress all affect healing time.

Let’s focus on stress, why it is important, and what you can do about it.


Psychological stress has many drivers

Psychological stress comes in many forms, all of which can delay wound healing. People with depressive symptoms are 3.6 times more likely to experience delayed wound healing relative to controls. During examination week, dental students took 40% longer to heal from an experimental wound than when they were on vacation. Even stressful careers, such as being a caregiver, can delay wound healing by 24%.

This does not mean if you have a stressful career, are pursuing graduate school, or suffer from depression you are doomed to a life of poor healing capacity, rather, these studies provide valuable information that can be used to make actionable plans.


How to use this information

You can approach the information on two fronts. The first is acknowledging the delay the current situation will cause. If you are injured, plan accordingly with your doctor and physical therapist. Develop realistic expectations.

Second, address the risk factors you can modify. There are many activities and strategies you can use to modify stress. Pursue the strategies that work best for you.

For example, positive behaviors related to social support have been shown to improve wound repair. One study demonstrated self-disclosure, acceptance of a partner, relationship-enhancing statements, and humor within a marriage lead to faster wound healing compared to people in marriages that lack those positive behaviors.

Research shows a lack of exercise can slow would healing rates. Conversely, regular physical exercise can both reduce psychological stress and reverse its negative impacts, improving cardiovascular function, reducing depression and anxiety, and providing a means of social support. Exercise is challenging, however, and many barriers exist for some people, including time restraints and lack of equipment. Instead of using exercise as a method to combat stress, other coping behaviors are often sought.

Many coping behaviors, unfortunately, exacerbate the problem by creating a compound effect.

It is common for people experiencing high levels of stress to turn to alcohol, tobacco, and comfort foods while reducing positive health behaviors such as exercise. Heavy alcohol use and smoking delay cell migration and collagen deposition — two vital processes to begin healing and repair of injuries. Poor sleep impeded growth hormone production, which is needed to stimulate the growth of new tissue.

There is no one-size-fits-all approach to handling stress, but there are many options. The key is to take a long-term approach, not seek short-term “fixes” repeatedly. If you suffer an injury and seek medical care, be sure to share with your physician or physical therapist factors that may influence recovery. This includes major medical procedures, such as surgery.

Many studies show behavioral stress management interventions before surgery may improve postoperative outcomes, including fewer medical complications and shorter hospital stays. So regardless of the severity of an injury or the potential procedure, prioritize methods to reduce stress levels.