We’ve known for a long time that stress has an effect on healing. Hans Selye borrowed the term from mechanical engineering way back in 1936 and he originally saw stress as a uniformly bad thing. Somehow we have been left with this view of stress, and I’m going to suggest here that some stress is actually good for you – it’s all a question of how you respond to it.

Let’s begin with some examples of potential stressors:

Type of StressorExamples
PsychologicalRelationships, financial and health concerns, moving home, work, personal safety
MechanicalTrauma, surgery, occupational repetitive action, postural strain, excess body weight
ChemicalFood, air pollutants, allergy, tobacco, alcohol, drugs
MicrobialBacterial, viral, fungal


(expanded from Sammut and Searle-Barnes, 1998)

What happens when we get stressed

When we experience something stressful, physiological and behavioural responses are initiated by the brain. These responses include activation of the hypothalamic-pituitary-adrenal (HPA) axis, the autonomic nervous system and the metabolic, immune and cardiovascular systems.

However, if these systems are not switched off when the stressor passes, or if they become exhausted, our stress response systems become overloaded. The result is that our body systems are overexposed to glucocorticoids (such as cortisol) and catecholamines (such as adrenaline), and this leads to damage. Over a short period of time we can adapt and recover, but stress over a long period of time reduces the body’s capacity to heal.

There is an influence of chronic stress on biological ageing too (Harvanek et al. 2021). This can be measured via the length of telomeres, cellular structures which shorted as we age, or via so-called epigenetic “clocks” which look at the quality of your DNA.

Evidence for the impact of stress on healing

Many body systems seem to be affected by stress. Recent studies have found:

  • Dual states of pain and anxiety (Grachev et al. 2002, Apkarian et al. 2004).
  • Negative life events including bereavement or being the victim of a crime impair healing and even reduce your ability to benefit from exercise (Ruuska et al. 2012) and (Stults-Kolehmainen et al. 2014).
  • Being stressed over a longer period slows down that rate at which you heal by up to 60% (Alford 2006)
  • A link between being stressed and a reduction in running efficiency (Otter 2016)

Please get in touch with me via the Practice if you’d like a referenced list of further recently researched areas

So how do we go about reducing overwhelming stress?

This is a big question with no definitive answers. Certainly different people respond differently to similar situations. For many people it’s as much about the search for peaceful living as it is the avoidance of negativity. As an osteopath, I see many people whose bodies have adapted to excessive stressors using hunched and tense posture, but this just compounds the problem. Recent research is showing that posture is not always related directly to pain, and I do agree with that to some extent, but every day in practice I see that when dysfunction in the musculoskeletal system is resolved, a stressed person starts to feel less stressed. Osteopaths work to improve the balance between positive and negative stress in the body, improving function and reducing the impact of distress on the system as a whole.

Maybe some stress is good

Another view is that some stress is actually necessary for a person to thrive. ‘Good’ stress derives from daily tasks and the satisfaction of their successful completion, and leads to growth and increased function. Distress, on the other hand, occurs when a stressor tips an individual’s balance into exhaustion. Here’s a graph of the influence of stress on materials which you will instantly recognise. See that ultimate strength actually requires a significant amount of stress in the material world.

Stress vs Strain


So the key is to achieve stability in the face of a constantly changing environment. This is known as allostasis and it’s what we’re all striving for on a day to day basis. If we take the view that some stress is a good thing, as Robert Sapolsky argues (author of the famous Why Zebras Don’t Get Ulcers), we can start to think about it differently. Cortisol gets a lot of bad press, but it’s one of the chemicals that maintains a healthy blood pressure, so we need some of it to get through the day. Viktor Frankl suggested that it’s our perception of the things that happen to us, not the things themselves that matters.

It’s also worth remembering that for some people stress runs at a more profound level, and in these cases it’s best to speak to a psychologist. Unpacking deeper issues takes time but it is well worth the journey.

I’ll leave you with the delightful scribblings of Dr Mike Evans.

Selected bibliography

Alford, L. (2006) ‘Psychoneuroimmunology for physiotherapists’, Physiotherapy, 92(3)

Apkarian, A. V. et al. (2004) ‘Chronic back pain is associated with decreased prefrontal and thalamic gray matter density’, The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 24(46)

Grachev, I. D., Fredrickson, B. E. and Apkarian, A. V. (2002) ‘Brain chemistry reflects dual states of pain and anxiety in chronic low back pain’, Journal of Neural Transmission (Vienna, Austria: 1996), 109(10)

Guo, G. et al. (2009) ‘Psychological stress enhances the colonization of the stomach by Helicobacter pylori in the BALB/c mouse’, Stress (Amsterdam, Netherlands), 12(6)

Harvanek, Z. M., Fogelman, N., Xu, K., & Sinha, R. (2021). Psychological and biological resilience modulates the effects of stress on epigenetic aging. Translational psychiatry, 11(1), 601.

Johnstone, S. E. and Baylin, S. B. (2010) ‘Stress and the epigenetic landscape: a link to the pathobiology of human diseases?’, Nature Reviews. Genetics, 11(11)

Kiecolt-Glaser, J. K. et al. (2002) ‘Psychoneuroimmunology and psychosomatic medicine: back to the future’, Psychosomatic Medicine, 64(1)

McEwen, B. S. (1998) ‘Protective and damaging effects of stress mediators’, The New England Journal of Medicine, 338(3)

McEwen, B. S. (2007) ‘Physiology and neurobiology of stress and adaptation: central role of the brain’, Physiological Reviews, 87(3)

Otter, R. T. A. et al. (2016) ‘A Negative Life Event Impairs Psychosocial Stress, Recovery and Running Economy of Runners’, International Journal of Sports Medicine, 37(3)

Rizzolo, D. and Sedrak, M. (2010) ‘Stress management: helping patients to find effective coping strategies’, JAAPA: Official Journal of the American Academy of Physician Assistants, 23(9)

Ruuska, P. S. et al. (2012) ‘Self-Rated Mental Stress and Exercise Training Response in Healthy Subjects’, Frontiers in Physiology, 3

Sammut, E. and Searle-Barnes, P. (1998) Osteopathic Diagnosis. Nelson Thornes

Sapolsky, R. M. (2000) ‘How Do Glucocorticoids Influence Stress Responses? Integrating Permissive, Suppressive, Stimulatory, and Preparative Actions’, Endocrine Reviews, 21(1)

Sapolsky, R. M. (2015) ‘Stress and the brain: individual variability and the inverted-U’, Nature Neuroscience, 18(10)

Selye, H. (1936) ‘A Syndrome Produced by Diverse Nocuous Agents’, Nature, 138

Selye, H. (1975) ‘Confusion and controversy in the stress field’, Journal of Human Stress, 1(2)

Stults-Kolehmainen, M. A., Bartholomew, J. B. and Sinha, R. (2014) ‘Chronic psychological stress impairs recovery of muscular function and somatic sensations over a 96-hour period’, Journal of Strength and Conditioning Research, 28(7)

Viner, R. (1999) ‘Putting Stress in Life: Hans Selye and the Making of Stress Theory’, Social Studies of Science, 29(3)

Welberg, L. A. and Seckl, J. R. (2001) ‘Prenatal stress, glucocorticoids and the programming of the brain’, Journal of Neuroendocrinology, 13(2)