Because it impacts on the success of my physio treatments, I often check to see if patients have, what I like to call, an over-sensitive nervous system. This is when your system is in a state of stress or, in other words, the sympathetic part of your nervous system ( the fight or flight response) is activated , even when you are at rest.
THE BASICS OF THE NERVOUS SYSTEM
Here’s the background to this…..
Our nervous system consists of our central nervous system (CNS, which consists of the brain and spinal cord) and peripheral nervous system (all the other nerves in our body). Nerves are basically electrical cables that conduct electrical impulses to and from the CNS, which is the control centre of your body. Your nerves power up everything: every move we make, every change in blood pressure or temperature, every single action in response to our environment. But it’s a 2-way street. They only power up actions in response to a stimulus. The nerves in your skin, muscles and organs send messages UPwards to the brain, to inform it of the local environment ( am I cold? Am I in pain? Is there danger?). THEN, in response to this, the CNS decides on a course of action, depending on whether you are safe or not.
SYMPATHETIC AND PARASYMPATHETIC (SAFE OR UNSAFE)
Effectively, the CNS decides whether to activate the sympathetic or parasympathetic parts of the nervous system. The sympathetic is our ‘fight or flight’ when we are in perceived danger: our muscles tense up preparing for action, our heart rate and blood pressure raise, getting us ready to move out of danger, pupils narrow in focus, skin goes clammy to divert blood to the muscles/lungs/heart – all of this in a split second.
Or when our brain perceives us to be safe, it activates the parasympathetic system, our ‘rest and relax’ response: our muscles relax, pupils widen, heart rate/breathing rate/blood pressure all lower, blood is diverted to the digestive organs – think of someone on the loo, reading the newspaper and laughing at the cartoon section. The parasympathetic should also be active when we are asleep, allowing us to rest, heal injuries and clear our waste.
Think of a dimmer switch: the CNS is our control panel and it operates a dimmer-switch and therefore ramps up or down our response.
In a healthy individual, there is frequent and quick movement between the two ; you easily ramp up to the sympathetic state but quickly return to baseline. Heart-rate variability is one way of looking at this ability to ramp up and down effectively ( some of the fancier smart devices like WHOOP! measure this).
When this DOESN’T happen, then the stress response can be active even when you are at rest : a sign of a body is acting like it is in danger even when it is not. This is what leads to an over-excitable or over-sensitive nervous system, which in turn leads to poor healing, poor sleep, chronic pain and a whole host of other health problems.
CAUSES OF TOO MUCH SYMPATHETIC ACTIVITY IN OUR NERVES
There are many causes, but here are a few known ones:
- First of all, let’s get you off the hook: there are definite genetic aspects to having a sensitive nervous system. There’s a fair chance that a susceptibility is somewhere in the genes – your system is just more prone to excitability.
- Sustained long-term stress is a biggie. Stress is NOT in our mind, it is felt and activated in our body and is a biochemical event. Stress hormones like cortisol keep the body in the sympathetic state, and long term secretion of stress hormones makes it harder to get OUT of the sympathetic state.
- Sustained emotional states, such as excitement, over-working, anxiety, sadness all activate our sympathetic response.
- Injuries and accidents activate our stress response.
- Alcohol and (here’s an interesting one) foods
- Yes, there is more and more evidence that the gut biome ( the quality and range of bacteria in your gut) modulates activity in our brain and our nervous system. This is going to be huge in a few years, and I’m currently exploring this for myself! ( More to follow at a later stage)
- Previous significant trauma sensitizes your nervous system, long beyond the trauma has occurred. If you are interested in this, you’ve got to read THE BODY KEEPS THE SCORE, one of the best evidence-based book out there on trauma. Such a great read.
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WHAT’S ALL THIS GOT TO DO WITH PHYSIOTHERAPY
Well, an overactive sympathetic (stress) state in your body is evident in your body . It makes the pain from injuries last much longer, it leads to tense/overactive muscles and it is a massive factor in chronic pain states and fibromyalgia. Chasing the pain is never very effective: there is limited use in trying to treat a sore neck or back or shoulder, if you are dealing with a sensitive nervous system. Instead, the treatment has to be targeted at the nervous system itself. I have often a really hard time selling this concept to patients!! Anyone who has gone from pillar to post with one pain or the other, please listen up!
THIS IS WHAT I LOOK FOR
1) Raised resting respiratory rate ( how many breaths you take at rest). I usually check this out when the person is lying down and is unaware of what I am observing ( sneaky, I know !). Twelve breaths per minute is considered somewhere around the norm, I often count over 20 per minute in my patients who are stressed. If you want to do this at home, ask someone to count for you when you are unaware of it, and always at rest ( not after exercise).
2) A poor breathing pattern: stressed people tend to breathe in the top part of the lungs, where none of the oxygen exchange happens. All the parasympathetic activation happens in the lower part of the lungs. For more on this, read my blog on breathing here.
3) Tense neck or back muscles – particularly if they are always tight and not a one-off occurrence due to an injury
4) Anyone who has had pain for a long period of time – pain causes a stress response, particularly if it has been ongoing for some time. Not to mention the distress and change-to-your-life that it causes.
5) Sometimes I’ll look at resting heart rate
6) If they have a smart system that measure heart-rate variability, I’ll get them to watch that too.
HERE IS WHAT I ASK ABOUT
1) Racing thoughts ( a sign of anxiety)
2) Constant analysing of the pain, frequently trying new things to help but not seeing them through ( anxiety)
3) Sleep being disturbed by thoughts ( anxiety, system too heightened to sleep soundly)
4) Distress or helplessness/lack of control about the pain. Feeling lack of control over your situation is a huge stressor and adds to EVEN MORE stress chemicals in the body.
5) Previous significant trauma in their life
6) Episodes of racing heart
7) Recent significant life events ( moving house, getting divorced, death of a loved one)
8) Any significant sensitivities to food – if certain foods are leading to an inflammatory or stress response in the body, then this affects your nervous system.
WHAT CAN PHYSIOTHERAPY DO?
As physios, there are some things that we can offer, instead of chasing the pain. These treatments are aimed at stimulating the parasympathetic part of the nervous system. Quite simply, if you can stack up the amount of time you spend in the parasympathetic part of your system, you reduce the activity of the sympathetic. It’s not a quick fix, it’s a long gradual plan at reducing the sensitivity of your system.
1) Breathing exercises ( see my breathing video on how to do relaxed breathing.
2) Somatics (SEE my somatics page here for more info). I've also a few blogs on it, so go to my somatics blogs here
3) Yoga
4) Advice on relaxation techniques and meditation sites . Read my Relaxation post here.
5) I usually advise people to see their GP, in case some medication would be helpful. People are so tetchy about taking medication for anything to do with their ‘nerves’, feeling that they must to be totally mad before they go there. I did, and I don’t regret it. What’s REALLY the difference between taking pharmaceuticals for you heart or kidneys, and taking it for your brain?? They are all parts of our body, get over it.
6) Sometimes, I get them to look up treatments like tapping for vagus nerve activation ( Google it!), it’s not my area but I know that it is there and some people find it useful.
7) I usually get them to investigate the possibilities of treating their gut biome, for added effect.
All these things activate the parasympathetic part of the nervous system. The more ‘exercises’ you do for your parasympathetic system, then the more time you spend in the parasympathetic state. Over time, your reactivity reduces and you are not as ‘nervy’ as before. Makes sense, right? Treating your nervous system as opposed to chasing pain is the newest trend in pain medicine and it’s a good one. And remember, Rome wasn’t built in a day.
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