Stress is likely to have some degree of influence on every client you work with; it can also be a factor in your health and happiness as a therapist. It is essential that every massage therapist understand stress in order to recognize its impact on various conditions and diseases, on general health, and on a person’s sense of wellness.

Stress Defined
In the broadest sense, stress is defined as any event that threatens homeostasis and causes the body to adapt. This might include any change in external temperature, water intake, physical exertion, dietary changes, or even positive excitement like that experienced at a sporting event. Physiologists point out that while the reaction of the body to cold temperatures is different from its reaction to fighting an infection or to an event that causes anxiety and fear, in one respect, all of these types of stress are the same—they all cause an increased secretion of cortisol by the adrenal cortex. Therefore, physiologists define stress as any event that causes increased cortisol secretion.1

Most people think of stress as the resulting factor when an event triggers the fight-or-flight response. The fight-or-flight response is a full-body reaction mediated by the sympathetic nervous system as an inborn, automatic reflex to any perceived danger. It has protected mankind throughout evolutionary history by rapidly preparing the body to respond to a life-threatening event (e.g., an animal attack). The problem is that the body can’t differentiate between a hypothetical threat that might be caused by something like an unpaid bill, and a genuine threat where immediate action is required to survive.

It is possible for the fight-or-flight response to be triggered multiple times in a day by non-life-threatening events such as sitting in traffic, being late for a job interview, worries about finances, or relationship issues. Furthermore, people are socialized to behave a certain way. You might get the full-body adrenaline rush of the fight-or-flight response when a coworker challenges your opinion, but you would be unlikely to act on it by running away or beating him up. Instead, you suppress your physical and emotional responses with muscular, mental, and emotional tension to avoid the embarrassment of acting in a socially unacceptable way.

Stress that triggers the fight-or-flight response can be further categorized based on its origin or duration. The cause of stress can be mental (e.g., negative speculation about the reaction of your boss to a client complaint), emotional (e.g., grief over the death of a loved one), or physical (e.g., pain from a soft-tissue injury). It can be short-lived (e.g., you mistake your father standing in a darkened kitchen for an intruder) or chronic (e.g., you are under constant pressure at work and do your best each day to suppress it).

Chronic Stress and Implications for Health
Chronic stress is a situation in which persistent stressors repeatedly trigger the fight-or-flight response leading to the prolonged elevation of stress hormones, especially cortisol and epinephrine (adrenaline), in the bloodstream. These hormones, when not used in a real emergency, wear down the body’s systems. In this situation, sometimes referred to as adrenaline and cortisol poisoning, they become destructive to the body and can lead to stress-related disorders like high blood pressure, heart disease, ulcers, impaired immunity, and even psychological changes such as increased aggression or defensive behavior.

For example, cortisol can cause the body to digest its own proteins, leading to decreased immunity, sleep disturbances, and an increase of substance P (related to the sensation of pain). After a threat has passed, epinephrine that has not been reabsorbed produces a shaky, nauseous, pumped-up feeling. In situations of chronic stress, epinephrine causes overstimulation of the autonomic nervous system and adrenal exhaustion associated with fatigue and mental weariness.

It is possible that the weakest areas of the body—either from injury or genetic predisposition—show wear and dysfunction from chronic stress first. A body under constant stress becomes more susceptible to infections and disease. People adapt quickly to challenging situations and may not recognize that symptoms such as insomnia, chronic tension headaches, or heartburn are related to stress.

Massage therapists often deal with habitual tension patterns in muscles. Bracing physically against nonphysical threats may very well be at the root of a good deal of physical tension. One researcher speculates that with cancer, the body would normally eliminate a mutant cell, but if the system is dysfunctional because of a hormonal imbalance due to stress, the cell may take hold and develop into a tumor.2

Stress and Massage
We already know that massage activates the parasympathetic nervous system, which balances out the sympathetic nervous system and helps the body to unwind and recuperate once danger has passed. The parasympathetic nervous system slows the body’s heart rate and is associated with relaxed breathing patterns. It stimulates the formation and release of urine and the activity of the digestive system so that the body can nourish and detoxify itself. This response is important for reducing all types of stress and allowing the body’s chemistry to normalize.

Massage also helps with this task: it lowers cortisol, has a balancing action on the adrenal glands,3 has been shown to reduce epinephrine levels and quench the fight-or-flight response in patients about to undergo surgery,4 and normalizes levels of epinephrine and other chemicals in depressed adolescent mothers.5 Massage is a key stress-management tool that helps the body return to normal homeostasis and optimal function. As an MT, it’s important to understand the effects of massage on stress, so that you can educate your clients as well.

Notes
1. A. Vander, J. Sherman, and D. Luciano, Human Physiology: The Mechanisms of Body Function, 5th ed. (New York: McGraw-Hill, 1990).
2. P. Nuernberger, Freedom from Stress: A Holistic Approach (Honesdale, PA: The Himalayan Institute Press, 1981).
3. N. Bost and M. Wallis, “The Effectiveness of a 15-Minute Weekly Massage in Reducing Physical and Psychological Stress in Nurses,” Australian Journal of Advanced Nursing 23, no. 4 (July–August 2006): 28–33; M. C. Fogaca et al., “Salivary Cortisol as an Indicator of Adrenocortical Function in Healthy Infants, Using Massage Therapy,” Sao Paulo Medical Journal 123, no. 5 (September 2005): 215–8.
4. M. S. Kim et al., “Effects of Hand Massage on Anxiety in Cataract Surgery Using Local Anesthesia,” Journal of Cataract & Refractive Surgery 27, no. 6 (June 2001): 884–90.
5. T. Field et al., “Targeting Adolescent Mothers with Depressive Symptoms for Early Intervention,” Adolescence 35, no. 138 (Summer 2000): 381–414.

Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012), from which this article was adapted, and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2006). She can be reached at anne@abmp.com.

Sidebar: How stress affects the body

So many glands and organs are affected by the autonomic nervous system that stress affects every body system on some level. For example:

Cardiovascular system: Stress contributes to a sustained elevation of blood pressure, as well as triggering or aggravating cardiovascular pathologies like angina, coronary heart disease, and ischemic cardiopathy, among others.

Digestive system: Brief bouts of stress (e.g., a presentation at work) may cause short digestive system reactions such as a stomachache, nausea, or diarrhea. Colitis, gastritis, irritable bowel syndrome, and stomach and duodenal ulcers are closely associated with chronic stress.

Endocrine system: Stress can cause imbalances in powerful hormones that help regulate many body functions. The adrenal glands can go through three different phases as they attempt to deal with chronic stress. In the first stage (adrenal adaptation), the adrenals increase the production of stress hormones, resulting in digestive issues, jitteriness, weight gain, menstrual problems, and sleep disturbances. In the second stage (adrenal maladaptation), the adrenal glands slow down, resulting in fatigue, loss of sexual drive, fluid retention, and hair loss. The third stage (adrenal exhaustion) is associated with conditions like fibromyalgia, severe constipation, depression, memory loss, joint pain, and panic attacks. Thyroid disorders are also closely linked to stress.

Integumentary system: Skin disorders like psoriasis and atopic dermatitis are worsened by stress. Some forms of hair loss are linked to stress. Neurodermatitis is a skin disorder that causes severe itching of the skin and is likely caused by an overactive sympathetic nervous system and the subsequent imbalance in the endocrine system related to stress.

Lymphatic and immune system: Stress makes people more susceptible to catching common illnesses and can impair the body’s inflammatory response. Conditions involving excessive inflammation, like allergic, autoimmune, cardiovascular, infectious, and rheumatologic illnesses, are exacerbated by stress. People experiencing chronic stress recover more slowly from a wide variety of diseases and conditions.  

Musculoskeletal system: Muscle tension is increased when the body is under stress, and this may lead to chronic tension patterns and postural imbalances. Conditions like temporal mandibular joint disorder may be caused or worsened by stress.

Nervous system: Anxiety is a normal response to stress, but if stress is prolonged, a number of disorders can develop such as panic disorder, posttraumatic stress disorder, and social anxiety disorder. Stress also plays a role in depression and mood disorders.

Reproductive system: The fight-or-flight response inhibits the release of gonadotrophin-releasing hormone (GnRH), which directs reproduction and sexual behavior. Cortisol inhibits the release of the luteinizing hormone, which stimulates ovulation and sperm release, and hinders the production of male and female sex hormones like testosterone, estrogen, and progesterone. Stress levels influence infertility, menstrual disorders, and sexual disorders.

Respiratory system: Asthma symptoms worsen under increased levels of stress.

Urinary system: While urinary retention (problems emptying the bladder) has many possible causes, one of them is stress. Stress can also worsen conditions including interstitial cystitis (painful bladder syndrome) where the bladder wall becomes irritated and inflamed.

Sidebar:Conditions and Diseases Related to Stress

Disease that results from stress is the consequence of very complex interactions of psychological, constitutional, genetic, and environmental factors. The pattern is unique to each person. The body is capable of adaptation and a return to homeostasis if the stressor is removed or lessened. If the stressor continues to be active, however, adaptation and resistance lead to a state of exhaustion and the body becomes highly vulnerable to disease. Some common conditions that are associated with stress include:

• Alcoholism
• Anxiety attacks
• Asthma
• Chronic fatigue syndrome
• Colds and flu
• Depression
• Drug abuse
• Dystonia
• Eating disorders
• Eczema
• Heart disease
• High blood pressure
• Insomnia
• Insulin resistance
• Menstrual disorders
• Migraine headaches
• Panic disorder
• Peptic ulcers
• Posttraumatic stress disorder
• Postpartum depression
• Rosacea
• Teeth grinding (bruxism)
• Temporomandibular joint disorder (TMJ)
• Tension headaches
• Urinary retention or incontinence

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