In this post we discuss allostatic load and its effect on chronic injury rehab. We also look at strategies to aid recovery.
What is allostatic load?
Allostatic load is a measure of the wear and tear on the body as a result of long-term exposure to stressors.
The term was first introduced by neuroendocrinologist Bruce McEwen and psychologist Eliot Stellar in 1993.
McEwen described allostatic load as the price people pay for adapting to stress. It is thought to contribute to the development of a range of negative health outcomes including chronic pain.
Stressed or stressed out?
It’s important to first mention that a certain amount of stress is crucial for a healthy, productive life. Whilst it may have a bad reputation, stress helps us in a number of ways. It improves cognitive function for example, can direct behaviour in a positive way and it stimulates your immune system. It’s also a critical part of children’s development.
Issues tend to arise when stress is:
a) frequently experienced
b) there’s a lack of adaptation to repeated stressors
c) there’s an inability to shut off the stress response after a stressor is terminated
These stressors can come in a variety of forms and are generally referred to as life events. Unhealthy relationships for example, money worries and unhappy work environments can all contribute to allostatic load.
The evolutionary purpose of the stress response is to enable action. Once you’ve avoided the lion you’re able to relax and recuperate. In cases of chronic stress the lion keeps appearing and so the response is ongoing.
This may have a number of consequences for our long term health and of particular relevance to this post, chronic stress is associated with ongoing or chronic pain.
Chronic pain
Chronic pain is classified as pain lasting longer than 3 months after the resolution or in the absence of injury. It’s associated with restrictions in mobility and activities of daily living, increased levels of anxiety and depression and a reduced quality of life.
Whilst chronic stress and chronic pain commonly appear simultaneously, their relationship is complex. In many ways it can be compared to the chicken and the egg riddle.
The appearance of ongoing pain can understandably create stress. Whilst chronic stress has been shown to contribute to chronic pain.
What’s clear is that in either case, you the organism is struggling to adapt to the challenges you are facing.
Measuring allostatic load
Whilst there is no gold standard test to apply, allostatic load can be measured via secondary markers such as blood pressure, heart rate variability, total cholesterol (TC), high-density-lipoprotein (HDL), glycosylated hemoglobin (HbA1c) and waist-to-hip ratio (WHR).
Primary markers include dehydroepiandrosterone sulfate (DHEA-S), as well as urinary epinephrine, norepinephrine, and cortisol.
What does allostatic overload feel like?
Whilst objective measures can be useful in assessing allostatic load, sometimes its effects are obvious.
Poor quality sleep, depressed mood, anxiety and mood swings can all be signs that chronic stress is having an impact on your body.
Try the following measures to reduce allostatic load and improve your chances of feeling better, sooner.
Strategies to reduce allostatic load
Exercise
Exercise is generally recommended to reduce allostatic load. You may however be in a position where exercise is the very thing you’d like to do but can’t due to ongoing injury problems.
This is a situation I come across frequently. Many people intuitively use exercise as a way to cope with chronic stress. The more stressed they feel, the harder they exercise in an attempt to gain relief.
Here’s the problem though, exercise is yet another form of stress. Studies have shown dancers are more likely to become injured during periods of elevated psychological stress. Whilst collegiate swimmers are more susceptible to illness under heavy training loads.
It’s not that exercise won’t help, it’s more that it needs to be applied judiciously.
My bias is to use resistance training to improve the tolerance of the muscular system for the activities you’d like to return to.
Resistance training has also been shown to improve feelings of resilience and reduce anxiety. Both can be helpful in changing the internal story you have about your body and what you think it’s capable of.
Mindfulness practice
Let’s try an experiment. Close your eyes and think of a recent conversation that didn’t go as you would’ve liked. Perhaps it involved a disagreement, or maybe you weren’t happy with how you handled it.
Got one? OK play that conversation again in your mind. What do you notice?
Is your heart beating a little faster? Are some of those feelings of anger or embarrassment resurfacing?
Interesting isn’t it?
Thoughts become biochemical realities in our bodies. If we’re not vigilant our minds will take us on these journeys throughout the day with negative consequence for our health.
Being aware of this phenomenon is the first step towards reducing its impact.
A regular mindfulness practice can help with this. There are plenty of apps you can use to get started. Waking Up is certainly the best I’ve found.
Spend time with your friends
We are social creatures who require human contact to help us thrive. Although socialising might be the last thing you feel like doing when you’re under stress, spending time with friends can help. Sharing a problem can often reduce its threat level. Listening to other people’s problems can also be effective.
Get out into nature
Lastly spending time in nature has been shown to significantly reduce cortisol levels. This study found 20-30 minutes immersed in a natural setting such as a park 3 x per week had the biggest impact on stress reduction.
Summary
Whilst it might seem obvious that injury doesn’t occur in a vacuum, factors such as allostatic load are rarely taken into consideration in injury rehab programmes.
This might be even more relevant if you’re still experiencing issues long after your injury is likely to have healed.