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Stress & Your Body

Stress & Your Body: Tense Brain = Tight Muscles

I usually don’t write on a more personal level, but it’s been a crazy, busy, few weeks in the Herdman household, and I started getting tension between my shoulder blades again.

Being the physiotherapist that I am, I decided to put myself under the microscope for analysis… Was it my posture? Did I pull a muscle? Did I lift something heavier than I was used to? Is there something wrong with my pillows?

Automatically, most people (myself included) want to reach for the biomechanical answer – the “something must be wrong” and if I fix it, my pain will go away. I applied heat, did several rounds of stretching and yoga poses for releasing my rhomboids, middle trapezius, and erector spinae muscle groups… But alas, no lasting success. I’d get relief for an hour or so, but the tension would just come right back.

Does this story sound familiar to you too?

Within the last decade or so, there’s been a revolution in the world of physiotherapy – away from the biomechanical approach. A new, big, popular, fancy term that’s being thrown around in the physiotherapy community these days is “Biopsychosocial” (1).

Let’s break this down:

  • Bio = Biology which includes a more mechanical approach to biological tissues (ie sprained ligament, strained muscle, compressed nerve, or inflammation and swelling)

  • Psycho = doesn’t mean crazy, but has to do with psychology (ie your attitudes, beliefs, fears, worries, anxiety, or stress)

  • Social = what kind of social support (or lack thereof) from friends/family/colleagues

But you may be thinking, “What? My attitude or friends can’t possibly change my pain!”

However, as Butler & Moseley state, “thoughts and beliefs are nerve impulses too”(2,3). They are just as real as the nerve/electrical impulses from danger sensors in your tissues. Your brain takes stock of all of it before deciding whether to create the not-so-fun sensation of pain and even how much pain you feel.

Each person is unique and has differing amounts of input from each category that may be contributing to their pain.

For example: Someone – let’s call him Todd - just sprained his ankle last week, but otherwise has good support from his family and a positive outlook (ie thinks “I know this’ll get better”). His Biopsychosocial diagram may look like this…

However, for someone else – let’s call him Tim – who also sprained his ankle, but his family lives far away, his boss is forcing him to go back to work, and he is struggling with anxiety and depression, his Biopsychosocial diagram may look like this…

Tim certainly isn’t faking it – he definitely sprained his ankle. The pain is NOT all in his head. But unfortunately, negative beliefs (eg thinking that “it’s never going to get better”) and a lack of or limited social support (from boss + family) further sensitize the brain and the danger neural pathways, making it more challenging to fully recover.

Which leads me back to me. What was going on with my Biopsychosocial diagram?

With the additional stressors over the past few weeks, the psychological aspect was definitely a major contributor to my biopsychosocial diagram. During university, I used to get a similar tension and tightness into my upper back all the time – thanks to the pressures of classes, exams, projects, and the endless studying required to keep on top of all of it.

It’s NORMAL to hold stress in your body. A tense brain can make a tense body. Some people carry their stress in their lower back, others get headaches, and some people (like me) hold their tension between their shoulder blades. By all means, definitely try applying heat or stretching, but don’t forget to address ALL of your factors. Ignoring the psychosocial aspects of your pain is like air-conditioning your house, but forgetting to close the windows.

For a holistic and biopsychosocial approach to your physiotherapy care, contact InReach Online Physio.

By: Susan Herdman, Registered Physiotherapist – Specializing in Upper Extremity and Hand Telerehabilitation.

Book a telephysio / online physio / virtual physio appointment with a registered physiotherapist in British Columbia. InReach Online Physio services communities in northern and rural BC, such as Masset, Queen Charlotte, Fraser Lake, Fort Nelson, Fort St James, Dease Lake, Fort St John, Dawson Creek, the Gulf Islands, and more!


  1. Gabor, Z. (2018 May 8). TrustMe Ed online lecture: “A Biopsychosocial Approach for Students and New Grads: A critical thinking and principles based approach”. Accessed June 2020:

  2. Butler D & Moseley L (2013). Explain Pain - Section 4: Thoughts and beliefs are nerve impulses too. NOI Group Publications. Adelaide, Australia. p 80-1

  3. Rabey M & Moloney N (2021 March 9). TrustMe Ed online lecture: “Translating Neuroscience into Clinical Practice”. Accessed June 2021:

Image from: Unsplash - Klara Kulikova (Mar 17/'21)

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