By Senior Physiotherapist Michael Callan.

We all get stressed. Whether it’s a tough day at work, a tough exam coming up, a visit from the in-laws, increased interest rates or a difficult day with the kids. Sometimes stress contributes to pain and distress, but sometimes it doesn’t. It’s a normal to have stresses, and we actually develop helpful coping strategies when we’re exposed to a moderate amount of stress. But high amounts of stress are a common contributing factor in developing musculoskeletal pain. Let’s dive into stress, what it does to our bodies, how it can sometimes be a contributing factor in some of the common problems we experience, and some of the options for managing it.

What happens to our bodies when we’re overly stressed?

For starters, when we experience stress our body turns on its fight or flight mode. Our breathing changes, our heart rate increases, we sweat. Multiple locations in the brain release different chemicals and hormones that prepare our bodies for imminent danger1. Some of these chemicals and hormones change our metabolism, blood pressure, immune system and inflammation1. A change in immune function and increased inflammatory chemicals can directly act on our tissues, nerve endings, spinal cord and brain to make things more sensitive, or easier to fire. So when we’re stressed, our bodies are a bit more ready to be set off.

Increased stress is also strongly associated with increased muscle activity and tension in our bodies2. When our body feels threatened, it often increases the amount our muscles fire at rest and during normal activities, and when we are stressed our body feels threatened.  It is very common for us to change our movement or adopt protective postures in response to stress and pain2,3, which involve increased muscle tension.

So where does stress fit into common ailments?

Increased stress is often a contributing factor for most musculoskeletal disorders and is a common contributing factor in a new episode of neck pain and low back pain4.

Increased tension of the muscles in our neck and shoulder blades can cause the nerve endings in those muscles to fire up to our brain and become a source of pain. These muscles can be locally sore or refer pain up to our head or behind our eyes. Muscles in our neck and shoulder blade attach to our spines, and increased muscle tension causes increased compressive loading on the spine4. This can sensitize and irritate bones, joints and nerves in our neck, which can cause localised pain or referred pain to the head known as cervicogenic headache4. Increased muscle tension and compressive loading on our neck can also restrict our movement, making it more difficult to turn our head or look up and down. Increased stress and emotional distress is also a primary contributing factor in tension headaches5.

In low back pain, increased stress is a common contributing factor2,3.  Stress can cause increased muscle activity in the muscles around our back and trunk. This can cause these muscles to locally become sore and also cause increased compressive loading on our low back. Increased cortisol and inflammatory chemicals released during high stress chemically sensitise our tissues and nerve endings, making it much more likely for our body to experience pain.

High amounts of muscle tension in the low back can also drastically alter how we move. High amounts of muscle tension in our trunk and back is strongly associated with low back pain2,3 and can make the spine move in a rigid way. Lifting with high trunk muscle activity greatly increases tension on the spine and is strongly correlated to developing back pain with lifting tasks6.

How do I know if stress is a contributing factor to my pain problem?

Look for a link, as stress isn’t always a contributing factor. It’s always important to take note or a keep diary for your pain problem and look for patterns. In terms of stress, take note if a more stressful day increases symptoms and if symptoms are lessened on a less stressful day.

If stress is a contributing factor to my pain problem, what should I do about it?

There are many different options for managing stress. Some work better for some and not as well for others. Some options are passive (someone does it for you) and others are active (you take charge yourself). Some options include:

  • Breathing, mindfulness and relaxation exercises
  • Regular exercise
  • Good sleep
  • Yoga
  • Manual therapy/massage
  • Heat
  • Engaging in fun social activities
  • Speaking to a Clinical Psychologist about problems leading to stress and how to address them

If you think stress is a contributing factor for a problem you are having, our Physiotherapists can discuss it with you, where it fits into your problem, and what options are appropriate for you!

Michael Callan is a Musculoskeletal Physiotherapist. He has twelve years experience in clinical practice, has supervised postgraduate university students and conducted research in neuropathic pain.


If you would like to make a physiotherapy appointment and get some basic advice in regards to stress, please call the clinic on 9756 7424 or book online  for an initial assessment. .

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We have a same day cancellation policy where a $50 fee will be charged for missed or cancelled appointments. Please call 9756 7424 or email to reschedule or cancel Thank you for your understanding.

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  1. Haykin, H and Rolls, A (2021). The neuroimmune response during stress: A physiological perspective. Immunity 54, September 14, 2021; Elsevier.
  2. O’Sullivan, Peter (2016). Unraveling the Complexity of Low Back Pain. J Orthop Sports Phys Ther; 46(11): 932-937.
  3. Mitchell, Beales, Slater & O’Sullivan (2014). Contemporary management of musculoskeletal pain disorders. Published through Curtin University of Technology.
  4. Jull G, Sterling M, Falla D, Treleaven J, and O’Leary S (2008). Whiplash, Headache, and Neck Pain. 145 -152. Elsevier.
  5. International Headache Society (2013). International Classification of Headache Disorders, 3rd Edition. Cephalalgia 33(9) 629-808.
  6. O’Keefe, Mary (2017). 10 Myths about back pain. Irish Independent, 2 January 2017.