Dr. Brian Cole is a nationally acclaimed orthopedic surgeon and sports-medicine doctor who cohosts the popular radio show Sports Medicine Weekly. Whether you want to know about bunions, better sleep, or running your first marathon without getting hurt, Dr. Cole can offer an expert’s take. Eric Haunschild, his research assistant, also contributes to this column. Have a question? Email AskADoctor@outsideim.com. The doctor is in.
I’ve noticed that when I’m stressed out, I get pressure headaches. When it’s really bad, I get chest tightness and feel fatigued—even nine hours of sleep isn’t enough. What does anxiety do to my body, and why?
Stress has long been identified as a trigger for the pressure-like headaches you describe, as well as migraines. People who suffer from severe headaches or migraines are three times more likely to report anxiety than those without headaches. Despite this association, the exact reason why stress creates headaches is still unclear. One theory is that muscle tightness in the neck and head, which can reflexively increase with stress, results in dull tension headaches.
In addition to headaches, stress and anxiety can trigger a number of symptoms, including chest tightness and fatigue, abdominal pain, indigestion, dizziness, and nausea. Why we get these symptoms is complicated, but the theory is that they originate in a part of the brain called the amygdala, which coordinates our fight-or-flight response. Once activated, the amygdala starts a chain reaction within the brain: it tells the hypothalamus to release something called the corticotropin-releasing hormone (CRH), which then triggers the pituitary gland to release the adrenocorticotropic hormone (ACTH). ACTH enters the bloodstream, where it prompts adrenal glands to release our stress hormone, cortisol. Cortisol produces direct effects across the body that are believed to play a significant role in the symptoms you describe.
What’s happening inside my muscles when I get a cramp?
Put simply, a cramp is a sudden contraction of a muscle that is involuntary and uncomfortable, and it can last from just a few seconds to minutes. This happens when the nerves responsible for controlling a particular muscle begin firing repeatedly at high rates, resulting in a strong and sustained contraction.
Our central nerves—located in the brain and spinal cord—control the motor nerves that make our muscles engage. To initiate movement, a motor nerve sends electrical impulses to the muscle, releasing calcium and activating the proteins that physically result in muscle contraction.
While the mechanism of a cramp within a muscle is simple, its underlying causes are broad. More common exercise-induced cramps can result from rapid shifts in electrolytes, dehydration, or an accumulation of metabolites (the by-products of our muscles breaking down fuel), all of which happen during strenuous physical activity. Various nutrient deficiencies, neurological diseases, metabolic disorders, medications, and inherited diseases can all cause cramps. The reasons behind certain other cramps—like nocturnal leg cramps—are still a mystery.
Generally, cramps resolve without any need for medical attention. For those with recurring cramps, properly rehydrating with electrolytes and stretching prior to exercise are usually enough to decrease their rate of occurrence. If you experience recurrent cramping associated with weakness or severe and persistent pain, you should seek medical evaluation to identify and treat the underlying cause.
I can’t help but slouch in front of my computer, but it’s killing my neck and shoulders. Could I be doing permanent damage? What can I do to help correct my posture and alleviate pain?
According to a Nielsen Total Audience Report, the average American spends more than 11 hours a day looking at a screen—which doesn’t leave lot of time for moving around. You’re more prone to poor posture when you’re sitting, because you lose the natural curve of the upper and lower spine when you plop into a chair, and staring down at a phone or a computer doesn’t help, either. That bad posture strains the neck, spine, hips, and shoulders.
Usually, poor posture starts with muscular imbalance: your core stabilizing muscles (like the deep muscles of the trunk or the muscles of the pelvic floor) might be too weak, or simply disengaged, which makes you slouch and leads those muscles to further atrophy. In a kyphotic posture, which is associated with a rounded upper back, certain muscles, like your pecs and your lats, compensate and shorten, while other muscles, like the ones in your back, stretch out and disengage. If you’re a chronic sloucher, you’ll find that your mobility gradually decreases and your muscles and joints may ache.
Thankfully, targeted exercise and physical therapy can help improve your posture and alleviate pain. Several trials of regimented exercise programs administered to subjects with bad posture demonstrated significant improvements in shoulder, middle, and lower-back pain. There are a number of exercises that target the mobility and strength of the muscles most affected by poor posture. These exercises, such as squeezing your shoulder blades together (to increase proprioception and strength of the trapezoids and rhomboids) or slowly nodding your head up and down (to assist in maintaining range of motion), along with a concerted effort to minimize the time you spend sitting down or in poor posture, are often enough to provide pain relief. You might try setting a recurring alarm on your phone during the workday that reminds you to stop slouching, or opt for a standing desk. A physical therapist can also help design a postural-strengthening program tailored to your individual needs.