How Stress & Anxiety Affect Physical Pain

By Karen Morgan, DPT


For the past two Octobers, Angelica’s back “gave out.” As a personal trainer at a local gym, this flummoxed her. I treated her for each episode, but it was during the second episode that I thought to ask what sources of anxiety or stress could be feeding her pain.

Tears arose. “I am just trying to keep everything together.” Code for “I don’t want to look like a whiner and won’t admit how hard my life really is.”

When she was 10, her father abandoned the family and returned to Guatemala, leaving her mom to care for two young children. Angelica, the responsible big sister, cared for her younger brother while her mom worked hard to put food on the table. Angelica cared for her schizophrenic sibling, learning to read his behaviors, and adapting hers to settle down his. As a 24-year-old, she struggled with living on her own, but still checking in with her family, while going to school and working full time. Simultaneously, a dormant faith was lifting its sleepy head with her. “I was raised in a sort-of- Christian home. But now, I really want to know Jesus.” Deep hunger and thirst infused those words, even as she shouldered conflict, responsibilities, confusion, and worry. It made sense her back was responding as a kind of mirror of her chaotic stress.

I told her gently “It is like your back is telling you, ‘The stress and anxiety is just too much. Send me help. In all the ways.’”

Hello, Stress & Anxiety 

Stress and anxiety kick the nervous system into action by releasing stress hormones. These chemicals elevate our heart rate, blood pressure, blood sugars, vertigo, gut problems and muscle tension, and contribute to our experience of pain. Unattended, our worries will make us physically miserable, and yet many of us don’t realize it. And if we did, we wouldn’t know what to do.

What to Do When Stress and Anxiety Show Up

1. Acknowledge while suspending judgment. Ask what is bothering, and why. Pay attention. Break the worries or fears into smaller pieces, and without judgment.

Same goes for responding to pain or fatigue. Pay attention to the symptom(s) without judgment and respond calmly and deliberately.

Recent literature in the neuroscience of pain and chronic fatigue reveals the brain constantly processes what is going on in our bodies and can become overly concerned about previous injuries, behaving like an overly concerned parent. Through its language of pain or fatigue, it will remind us that we need to be careful. The messaging is mild at first and drop-to-the-knees if we don’t listen. It’s not always accurate in its assessment of danger, but we do well to stop and give it the information it needs:  “address the threat.”

Translated, respond kindly and deliberately, treating it like it’s your bestie. Stroke the area lightly.  This soothes the nervous system, while telling the brain, “We’ve got this.” In turn, the brain will calm its response, if temporarily.

2. Deep Breathing. We tend to breathe shallowly when we’re worried. This upper chest breathing sends tension to our shoulders, neck, and head. If we breathe deeply in through the nose and blow out through pursed lips like we are blowing out birthday candles, we get more air, and we tend to relax.

Likewise, when our bodies hurt, we tend to hold our breath, further driving up the pain.  Breathing deeply distracts us from our pain and reduces muscle tension.

3. Move. To move through their anxiety, I encourage my patients to make an action plan: what simple things can I control and do? Then do it.  And alongside the action I suggest a simple prayer,  “Lord, You’ve got this and You’ve got me. Help me. Guide me.” 

And for the body, I encourage what feels counterintuitive:  move the area, and get the muscles contracting.

The Rest of the Story

With the first twinge of pain, Angelica addressed the area like it was a wounded child, and then spoke comfort to it, while stroking the area and working at activating key core muscles.  It took practice not to react with fear and discouragement. The crowning release of her freedom was speaking the truth of Psalm 71 over it.  “Be my rock of refuge, to which I can always go; give the command to save me, for you are my rock and my fortress…my lips will shout for joy when I sing praise to you—I whom you have delivered.”    

I believe speaking courage to her body and spirit put into motion the healing mechanism God has built into every body.

About the writer: As a Doctor of Physical Therapy, Karen has been connecting the dots between physical, mental and spiritual health with her patients for over 30 years. Living in the Pacific Northwest, she is a bevie (loves water, tea, coffee, wine and beer), a  foodie, and geeks out on both.  You’ll find her running on a trail with her husband, curled up with a good book beside him, or puttering around in her overgrown garden. Follow her work at , on IG, or  FB

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