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Posted in Injury Prevention, News, Running.

March 13th, 2017

How Stress Is Contributing to Your Running Injuries

By Raechel Bugner DPT, FAFS

Your alarm goes off at 5 a.m., startling you from the half-awake state you’ve been tossing and turning in all night. You take a quick shower, scramble around your apartment grabbing everything you need for the day and head out to battle through the rest of New York City on your morning commute.

As you rush into the office, you notice two new meetings have been added to your schedule, and you wonder how you’ll ever have time to meet tomorrow’s project deadline if you’re sitting through meetings all day. You do some quick math in your head and realize you’ll likely be in the office until well past dinner tonight and, if your project presentation goes poorly tomorrow, you probably won’t be taking that vacation you’ve been planning with your family next week. Meanwhile, you have a half marathon coming up in a few weeks, and you can’t figure out how you’re going to be able to finish it with this nagging knee pain you’ve developed.

Any of this sound familiar?

This hectic, workaholic, stressful lifestyle is quickly becoming the norm for most Americans. According to a 2014 Gallup poll, the majority of full-time employees are working 47 hours per week, and 4 in 10 Americans are working in excess of 50 hours each week. In New York City, this way of life is even more pronounced. Known for its over-the-top-stressful jobs that have employees working 12+ hour days, New Yorkers work an average of 49 hours per week — more than the next 29 largest cities in the country.

And as if we weren’t all working hard enough, we are also notoriously bad at taking the few vacations days that our jobs allot us. According to a 2015 article by Forbes, full-time employees in the U.S. receive an average of 15 days off per year but use just 11 of these days. Contrast that to full-time employees in European countries who are mandated a minimum of 20 paid vacation days a year but average 28 days of R and R.

It probably comes as no surprise that multiple studies have noted a link between number of hours worked (a lot), number of vacation days used (not many) and high levels of stress. A report conducted by Oxford Economics emphasized this association and established that individuals who refrained from using vacation time tended to have higher levels of stress than those who vacationed regularly.

Just as New York City is well known for housing busy work-aholics, it has also become home to a large and ever expanding running community. Each November over 50,000 athletes line the Verrazano Bridge for the start of the New York City Marathon, and the city also plays host to two of the country’s largest half marathons each spring.

Step into Central Park on a spring evening, and it’s teeming with runners, many of whom belong to one of the city’s 75+ running groups, donned in their team singlets. Ask many of these runners why they enjoy their sport so much and the majority will respond, “it helps me de-stress” — not surprising considering they live in such a high-stress city.

When we think about stress, oftentimes we consider the emotional toll it can take on us, but we frequently forget about its physical consequences. A study by Harvard Health discovered that 25% of Americans express high levels of stress in their lives, and 50% report moderate stress levels; this means that 75% of Americans experience some level of stress regularly. Harvard Health went on to describe the physiologic effects of the stress response, noting that this response was originally designed to activate the fight or flight mechanism to prepare the human body to run from a predator or fight back against a physical threat.

When a stressor is present, a signal is sent through a series of neural and hormonal commands to elevate heart rate, increase blood pressure and respiratory rate and ramp up the release of glucose into the bloodstream to prepare the body to combat the stressor. The hormone Cortisol is also released into the bloodstream to increase appetite and glucose production and decrease immune response (so we have more energy devoted to fend off the threat).

In addition to physiologically preparing the body to confront the stressor, the “fight or flight” response causes increased muscular tension in skeletal muscles to prepare them for quick activation should they need to engage a predator. These processes were ideal for the neolithic age when stressors were commonly a physical danger; unfortunately our bodies don’t understand the difference between the lion chasing us down for dinner and the important deadline we have at work tomorrow.

While there is a real need for the physiologic and physical preparedness that would allow us to outrun a lion, there is no use for this same response to confront tomorrow’s project deadline, or the bills that we have to pay, or the dysfunctional relationship that we’re in.

What makes this stress response such an issue for many Americans is that the stressors we encounter at work, throughout our commute or at home are chronic stressors that exist every day of every week; they don’t disappear after we outrun the lion. The “fight or flight” stress response that increases heart rate, blood pressure, etc., is meant to last only a short period of time, during which you either out run your predator or fight it off.

In today’s society, we are exposed to stressors that are present for much longer periods of time. This means that our muscles are in a constant state of activation or increased tone, and our immune systems are often in a weakened state. Over time, when our muscles remain in an active state with increased tone, they become shortened or tight; add this physiologic stress response to the fact that you’re likely sitting at those stressful jobs most of the day, and you have a recipe for a running injury.

Sitting on its own can shorten and tighten important muscle groups (such has your hip flexors in the front of your thigh or the muscles in the front of your chest), but when compounded with the increased muscle tone present under chronic levels of stress, the issue becomes magnified. Tightness in the hip flexor group will inhibit normal running mechanics by preventing full hip extension — something that’s needed in order to efficiently load the glutes and allow for effective push off.

Similarly, tightness in the muscles across the front of your chest and upper back will limit proper arm swing and trunk rotation during your runs; the rotation of your trunk while you run often drives the motion that is needed down the chain at the hip, knee or ankle, and it also plays a role in glute activation. Limitations in these muscle groups that contribute to suboptimal running mechanics will often lead to common running injuries: low back pain, hip strains and runner’s knee, to name a few.

So: those runners in Central Park who use the sport as a means of “de-stressing” should consider a few things:

Running Shouldn’t Be Your Only Outlet for Stress Relief
The first issue with using running to cope with stress is that we are often doing a lot of it. We aren’t just running a few miles a few times a week, we are running a lot of miles every day because we don’t know how else to cope with the daily stressors in our lives. Running everyday with little or no rest actually has the opposite effect; it causes increased physical demand on our bodies that only exacerbates the stress response. With little or no rest, we don’t give our bodies the opportunity they need to repair themselves, and an irritation that may otherwise have healed easily with a day or two of rest might turn into a season-ending injury.

Remember too that chronic stress causes increased levels of the hormone cortisol in the blood. With high levels of cortisol there is weakening in the body’s immune response, which also helps to repair damaged tissues. Again, this means that what might normally be a minor ache or pain from a hard workout may not have the opportunity to properly heal.

The second concern with using running as your sole form of stress relief goes back to the issues about mechanics; if your muscles are chronically in an active, shortened state, your running mechanics will inevitably be affected in a negative way that may contribute to injury. Fortunately there are three great ways to start managing stress in a healthy way, before you hit the pavement.

#1: Just Breathe!
Breathing has long been associated with the meditative benefits of yoga, but there is an actual physiologic benefit to controlled breathing as well. Slow, controlled, deep breathing can actually alter the pH of the blood stream to help bring the body out of the “fight or flight” state and back to homeostasis (or a normal resting state), triggering a decrease in heart rate and blood pressure.

This type of purposeful breathing and altered blood pH also stimulates the parasympathetic nervous system (the part of the nervous system that controls our resting state and digestive system) to help calm us down. With activation of the parasympathetic nervous system, a decrease in tone of skeletal muscles is triggered giving our muscles a much needed chance to relax.

This type of breathing can even be practiced during a run to help muscles stay loose. Try focusing on actively exhaling air from lungs by engaging your core to pull your ribs towards your pelvis as you slowly breathe out; inhale gently through your nose. It may take some practice initially, but the benefits will pay off in your next race!

#2: Meditate!
Mention to someone that you’re stressed out and often times the first thing they’ll say is, “You should try a yoga class!” This is because many yoga classes incorporate meditation and mindfulness as part of the practice. A Harvard study found that people who regularly meditated were better able to manage their anxieties and stress than those who did not.

The theory is that meditating regularly teaches the person to effectively manage distracting or stressful thoughts by giving their mind something to focus on. Although yoga offers a form of guided meditation, you don’t need to participate in a yoga class to reap the meditative benefits. Meditation can be as simple as taking five minutes each morning to channel your thoughts and bring your mind to focus on the present moment instead of thinking about the hundreds of other distracting thoughts that often crowd your brain and contribute to stress.

Picking a word or phrase as a mantra to repeat as you meditate can help focus your thoughts; any time you feel your mind start to wander, repeat your mantra and re-channel your focus to the present moment. Bonus: focus on your breathing instead of on a mantra and reap the combined benefits of breathing and mediation!

#3: Get More ZZZ’s!
Sleep and stress have a somewhat complicated relationship. The Huffington Post recently published an article describing the sleep/stress relationship: high levels of stress are linked to high incidence of insomnia, but lack of sleep increases our perception of how stressful an event may be.

Basically, sleep and stress are inversely related in a feedback loop. The more stressed you are, the harder it is to sleep; the less you sleep, the more stressed you become.

According to the American Psychological Association, it is recommended that adults sleep at least 7-9 hours per night. Those who sleep greater than 8 hours per night report decreased levels of stress; however, most adults are only catching 6.7 hours of shut eye at a time. Because the relationship between sleep and stress is so complex, there’s more to consider than just jumping into bed a few hours earlier.

Refining our meditation and breathing skills to help focus our thoughts and slow our heart rate before bedtime can help us find the “off switch” to the never-ending stream of thoughts that keep us awake at night. Initiating a bedtime routine can also help set the tone for a good night’s sleep. Try turning off your phone and refrain from checking emails in the hours before bed; instead, pick up a good book, or practice a sudoku to help unwind and then spend a few minutes meditating before closing your eyes.

The next time you’re feeling stressed at work or you notice yourself struggling to squeeze a run in between meetings, remember the negative consequences that those high levels of stress can have on your body as you run and take a deep breath.

Raechel Bugner joined the Finish Line PT staff in 2014 and is recognized as a Fellow of Applied Functional Science (FAFS) through the internationally acclaimed Gray Institute. A competitive gymnast in high school, Raechel started running in college and has run three marathons and numerous half-marathons.

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