If you play a lot of tennis, injuries might be interfering with your ability to play and enjoy the game.
This is Part 1 of a series on how stress can physically hurt us and prevent healing, and how relaxing and believing we can get better have been shown to heal injury and disease. A lot of this information comes from Lissa Rankin’s book, Mind Over Medicine, as well as a few other sources.
I want to preface this by saying that the post title (which comes from Rankin’s book title) is a bit misleading. I don’t mean to say that medicine, treatment, or surgery should be avoided. Rankin isn’t saying this either. The mental approach to healing and preventing illness and injury is complementary to these interventions.
In Part 1 I’ll be investigating the science of this concept, and in Part 2 I’ll cover ways we can implement the science to stay healthy on the court.
Update: Part 2 can be read here!
My first few years of tennis were plagued by injuries. I had some minor nagging pains like shin splints, lower back pain and a sore shoulder when I served too much, and a more serious chronic wrist injury that was eventually diagnosed as ECU tendinosis.
Last year, I wrote a tongue-in-cheek post about the typical way I deal with injuries. To summarize: I obsess about the injury, spending countless hours googling my symptoms. I visit practitioners of all types for treatments. I vow to do the at-home treatment plans but rarely do. Eventually the pain subsides and I go back to playing tennis until I’m once again sidelined.
When I wrote that post, I assumed that the main problem with my approach was the part where I didn’t follow through on treatment plans. I believed that my lack of “preventative maintenance” and failure to fix problems in early stages were what triggered injury, prevented healing and snowballed minor aches into bigger pains.
While I still believe these things contribute, after reading Mind Over Medicine by Lissa Rankin, M.D., I’m starting to think there could be another major factor at play: stress.
I don’t know about you, but when I get injured I get very stressed out about it. I imagine worst-case scenarios where I’ll never be able to play tennis again. I go over every movement, technique, routine, and meal, to see where I’m falling short in my training. I spend time and money at physiotherapy and chiropractors even though if I’m honest I never really think it will do any good.
In Mind Over Medicine, Rankin argues that these types of behaviours – anything that causes you stress – cause to your body to turn on the stress response and prevent it from doing what it can naturally do: heal itself.
I really do recommend reading the book if you’re interested – it’s an easy read but full of references to studies backing up her claims.
In this post I’m going to do my best to summarize the science of this concept (along with the help of some other resources), and then in my next post I’ll recommend ways to incorporate this knowledge to help heal and prevent tennis injuries.
The Physiology of Stress in the Body
The Fast Track
Our bodies have what’s called an autonomic nervous system (ANS) that operates without our knowing. It governs our involuntary processes like breathing, digestion, and pupil dilation.
The ANS has two branches: The sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).
When we perceive a threat (real or imagined), the SNS takes over. The body is now in sympathetic mode which results in a few automatic physiology changes and the adrenals are stimulated to release adrenaline for a quick burst of energy.
The Slow Track
The slow track is a chemical response. It responds to that same real or imagined threat that activated the SNS.
Basically, the hypothalamic-pituitary-adrenal gland axis (HPA axis) gets activated. A cascade of chemicals along this axis results in the adrenals producing cortisol, which helps your body produce a more sustained form of energy than adrenaline alone.
The combined action of the SNS and the HPA axis result in the following physiological changes in the body:
The reason I’ve been so interested in this response in the past is because of how it so negatively impacts my ability to play tennis. I find myself activating my stress response, typically before the match even starts as I anticipate all the things that could go wrong, and the physiological changes make it impossible to play my best tennis.
But after reading Mind Over Medicine, and similar material, I’m seeing how understanding the stress response, and it’s corresponding relaxation response, is crucial for learning how we can best heal and prevent injuries. This is where the relaxation response – which is the job of the PNS – comes in.
The Relaxation Response
The SNS is balanced by the PNS. If the SNS acts like a gas pedal on the stress response, then the PNS is the brake pedal. It’s responsible for calming the body down after the stress response and getting back business as usual. It’s also called “rest and digest,” or the relaxation response.
The relaxation response does the following:
- pulse and blood pressure drop
- blood redistributes around body
- digestion turns back on
- immune system turns back on
- stomach acid decreases
- adrenals stop producing adrenaline and cortisol
When the Stress Response Becomes a Problem
It’s perfectly normal to experience the stress response sometimes. If you’re facing real threat, like a burglar in your house or an encounter with a bear during a camping trip, your body’s stress response can help you.
The stress response becomes problematic in a couple of scenarios:
1. When the threat isn’t physical and isn’t helped by physiological changes.
This is how the stress response interferes in tennis performance. My body thinks that it’s facing imminent physical danger and prepares me to fight or flee. But the threat is actually to my emotional well-being (I’m afraid of losing a tennis match!), and this can’t be helped by the physiological changes that occur.
While this one could impact your health if you’re always getting stressed on the tennis court (you really don’t want the stress response turned on more than it actually needs to be), periodically becoming stressed during high-stakes tennis matches is normal and as long as you relax after the match it’s probably not affecting your health all that much.
Some stress in your life is actually a good thing (look up hormesis if you want to learn about this) and getting it through tennis, where there are so many other health benefits, is smart. The next one is the biggie.
2. When the stress is chronic, or, in other words, when the stress response is turned on much more often than required.
Just reading the list of physiological differences that we experience in the two states (stressed and relaxed) shows us the importance of being relaxed most of the time.
In terms of the stress response, I’ve always focused on the changes that affect my play when I become stressed. How the blood moves from my small to my large muscles which diminishes my fine motor skills and throws off my timing. How the adrenaline makes me feel jittery, like I’ve just chugged a massive cup of coffee, and my strokes don’t feel fluid.
I’ve always kind of ignored the others on the list – like immune function and digestion – since these don’t really affect my play.
But they certainly do affect my ability to stay healthy, which is another key factor in tennis!
As Rankin says in her newer book, The Fear Cure,
You’re not designed to be frightened often. Period… Your body wasn’t built to withstand the effects of chronic fear and stress. And yet, if you’re like most people, your body is running on overdrive much of the time, fearing imagined threats, such as financial loss, the demise of a relationship, a threat to your stability, a perceived health threat, or a loved one’s death – fears that most of the time never actually come true. This leads to a vicious cycle. You fear getting sick, aging, or dying, and yet the fear can literally make you sick, age you, and kill you.
Chemical Effects of Chronic Stress
Aside from the lists above of what happens when the SNS is chronically activated, the chemical effects of the stress response like chronically elevated cortisol in the body are known to be very unhealthy and can lead to things like weight gain, cardiovascular disease and immune system depression.
The effects of chronic stress are a hot topic right now in the health world. We’re hearing everywhere that we need to limit stress to avoid serious health problems.
But while the effects of chronic stress on our overall health are no doubt serious, and we definitely want to avoid them as regular people as well as tennis players, I think that Mind Over Matter opened my eyes to the possibility that we can use the concept that stress hurts us and relaxation heals us to help us both avoid and heal tennis injuries.
Evidence that people can heal themselves or contribute to their healing
The majority of Mind Over Medicine is spent presenting evidence of how situations that cause people to feel things like happy, calm, supported, cared for, and a belief they will get better have been shown to increase healing. A major way that this has been shown to be true is through the placebo effect – where patients get better in clinical trials even when they don’t get the treatment being tested.
Sometimes just the act of going to the doctor can induce the relaxation response which can decrease inflammation and pain. This is familiar to me – I finally get in to see my physio and my symptoms magically disappear or greatly reduce when I show up. This somehow seems frustrating since it makes diagnosis harder, but maybe the act of going to an appointment with someone I trust to have answers and treatment has actually contributed to my healing!
Rankin also discusses how alternative therapies like acupuncture and Reiki are often thought of as “quackery” since they’ve been shown to have no benefit over sham treatments (where the treatment is designed to appear valid to the patient but isn’t valid).
But what Rankin believes we should be focusing on is that both the sham and the actual treatments make the patients better! This indicates that there’s something about the experience of the treatment that’s healing the patient or affecting his or her perception of pain. This could be belief that it will work, the nurturing environment of the treatment, the relaxation that happens during treatment, or the caring touch of the practitioner.
Unfortunately, the opposite happens too. When people are stressed, often as a result of the very treatments they seek, they often don’t get better. Rankin mentions “medical hexing,” which can occur when patients hear from their doctors that they’re untreatable. They can become programmed with subconscious negative beliefs that induce stress responses and prevent them from getting into the relaxed state they need to be in to heal themselves.
My Story – Wrist Injury Healing through Yoga?
I wrote a series of posts awhile ago about how I was able to play tennis pain-free after severe wrist pain – which was finally diagnosed by MRI as ECU tendinosis – plagued me for years. Last winter, I had been considering taking a full year off of tennis since I was so frustrated by the cycle I was in of resting, feeling better, and then having the pain return as soon as I played tennis again.
And then I started doing Bikram yoga last spring, and my pain virtually vanished. I went from playing tennis, painfully, about once a week, to playing pain-free 6 days a week all season long. I was so interested in figuring out how I was able to seemingly heal myself so that maybe others could benefit from my experience.
I didn’t believe that yoga alone explained the elimination of my pain. Basically I credited a combination of factors and one of them was the physical postures of Bikram yoga gently stretching my forearms and performing a type of traction on my wrist.
But now that I understand this concept of rest and digest and how this state can help injuries heal, or even just how it can reduce the perception of pain, I’m wondering if a major factor was actually that I now spend big chunks of time (about 90 minutes, 4 days a week) in the perfect state for my body to heal.
And all the yoga and meditation I’m doing at Bikram no doubt helps me manage my stress levels outside of the studio as well, thus helping me stay in parasympathetic mode more of the time.
- We have two branches of our autonomic (involuntary) nervous system: Sympathetic and parasympathetic.
- The sympathetic system is activated in response to stress. Ideally this would only happen when we’re experiencing a true threat to our physical bodies that would be helped by “fight or flight.” But unfortunately this gets activated much more than it should, and in this mode our bodies shut down their preventative maintenance and repair systems.
- The parasympathetic system is the default mode when we’re not stressed. In this mode, our bodies repair and strengthen themselves. The more time we spend here, the healthier we’ll be.
- There’s plenty of evidence of how sickness and healing are affected by the system that’s in control (sympathetic or parasympathetic)
- As tennis players, we should be aware of this and do our best to stay in parasympathetic mode as much as possible to heal and prevent injury. More on this in part 2.
Perhaps this post has convinced you that there’s some science backing the idea that stress hurts us and relaxation heals us. We can use this knowledge to help us stay healthy on the tennis court, and in Part 2 I’ll be investigating specific ways we can do this.
I’d love your feedback. Have you read Mind Over Medicine or similar material? If you think I’m misinterpreting any of the science, please let me know – I’m doing this to learn!