Multi-system Involvement
In the previous post we observed the role of the nervous system in the pain experience. To recap, receptors send signals via nerves to the brain, and the brain gives these signals context. The type of signal and the surrounding context can result in feelings of pain.
The nervous system is not the only system that contributes to the pain experience. The immune system acts as a first line communicator and a mender in the presence of tissue damage, and the endocrine system acts as a fire brigade and a mediator.
In this blog, we will follow the injury journey of an active adult. Julie is a runner, and she is training for a marathon. She recently increased her milage, and she began to feel pain in her heel and Achilles tendon.
Immune System and Injury
The immune system is a network of organs and cells that defend the body against infectious organisms and aid in the healing response. When the body sustains an injury, substances released from the injured tissue and surrounding tissues trigger an immune response. In this context, immune cells facilitate inflammation, message local cells to rebuild, and clean up debris from the injury.
During her last long run, Julie strained her calf. A muscle strain involves disruption of the muscle cells and surrounding connective tissue. Cellular debris from the injured site and chemicals that are released from the irritated muscle attract immune cells to the area of injury. Immune cells remove damaged muscle tissue, stimulate growth of new cells and connective tissue, and perpetuate an inflammatory response.
What Is Inflammation
Inflammation has been described as a chemical soup. It is composed of multiple messenger molecules that can cause fever, swelling, and hypersensitivity. These molecules can also incite increased nerve signaling, further immune cell congregation, and activate a stress response. Inflammation is meant to promote healing while cuing the body to protect the affected area.
The symptoms that Julie feels from her calf strain are primarily from the acute inflammatory response in her muscle. She notices redness, warmth, swelling, sensitivity to touch, and radiating pains that shoot into her heel and Achilles tendon. Symptoms like sensitivity and radiating pains give her intrinsic cues to protect her calf while warmth and swelling indicate increased healing activity and resource delivery to the area.
Stress and the Endocrine System
The endocrine system responds directly to stress by releasing adrenaline and cortisol to prime the body for a response. Adrenaline is a fast-acting transmitter that increases heart rate, energy availability, alertness, and blood flow. It is responsible for our immediate fight or flight response, and its actions are meant to prepare the body for a quick response to stressful stimuli. Cortisol has similar effects, and it also helps regulate our immune system.
Julie is currently in an acute inflammatory phase of healing. As the inflammation in her calf builds, messengers begin to activate cortisol production. Cortisol dampens the immune system and mitigates the inflammatory response. This chemical cycle indicates a normal course of healing. Unfortunately, Julie has been underprioritizing rest during her training and life rhythms, and she is exposed to high levels of stress. Cortisol is also released as the body encounters stressful situations. When confronted with constant stress, the natural stress response can become dysregulated. For Julie, she is exposed to stress during her training, and her stress level remains elevated due to exposure to distressing life events. In her case, the constant exposure to stress has made her body less sensitive to an appropriate cortisol response. As she is recovering from a calf strain, this also means that she is less able to mitigate the inflammatory response in her calf as she is healing. Disastrously, Julie is determined. She has an upcoming marathon that she will not miss. She continues to train through her symptoms. This perpetuates the effects of the inflammatory response such as pain, swelling, and warmth beyond the time frame when she is physically healed. She has now entered the realm of chronic stress, chronic inflammation, and chronic pain.
We Can Help
At this point, Julie is in a bad place, but there is still hope for healing, recovery, and continued racing. At STAT Wellness, we offer functional medicine, health coaching, nutrition counseling, physical therapy, small and large group fitness, and personal training. Julie can benefit hugely from functional medicine and physical therapy. First and foremost, if Julie understands the effects of stress and inflammation on healing and recovery, she can be more informed and proactive in her own training and injury management. The providers at STAT wellness can help bridge this knowledge gap. Further, as Julie encounters injury, our physical therapists can design a staged program to guide her back to running while respecting the normal healing response. Finally, when Julie finds herself on a complex pain journey from overtraining and life stressors, we can tag team across multiple disciplines such as functional medicine, health coaching, and physical therapy to address underwhelming cortisol levels, unmitigated inflammation, and chronic sensitivity. Have you ever found yourself in a place like Julie? Book a visit or a FREE 15-minute introductory call with one of our amazing providers HERE!
