This course is designed as an introduction to learning ways to manage your stress levels and to teach you some basic relaxation techniques. We will go over some of the different causes of stress and what their effects or symptoms are so you can recognize them.

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Stress:

Causes of stress:

Lots to do – not enough hours in the day
Lots of demands on you – work, family, committees
Lack of sleep – both causes stress and is an effect of high stress
Poor nutrition/illness – having sugar spikes, sugar lows, inadequate resources, too much caffeine – all exacerbate or make you more susceptible to stress
Changes of living situation – pregnancy, moving, changing jobs, divorce, death of a family member, etc. How do you view change?

Symptoms of chronic stress include:

mild symptoms:
headaches
increased susceptibility to colds
increased aches and pains

more severe symptoms:
depression
obsessive-compulsive or anxiety disorders
heart disease
hyperthyroidism
obesity
ulcers

Symptoms of sleep deprivation include:
tiredness
irritability/edginess
inability to tolerate stress
problems concentrating or memory problems
behavior, learning, and/or social problems
frequent infections
blurred vision
vague discomfort
alterations in appetite
activity intolerance
depression
decreased productivity
breathing disorders
heart disease
musculoskeletal problems (myofascitis)

Having vague symptoms from sleep deprivation and/or chronic stress does not mean your symptoms are all in your head!

There are numerous strategies to help reduce stress.

• Make time for yourself – at least 15 minutes/day
• Exercise – at least a half hour per day
• Prioritize your commitments
• Don’t over-commit yourself, just say no
• Take more control over your life – don’t be as reactionary
• Get good sleep – every night
• Organization/avoid clutter

Exercise:

When you are stressed, your muscles naturally contract and stay contracted. Two primary things happen when your muscles have sustained contractions: 1) this sustained contraction ultimately reduces the amount of fresh blood supply (oxygen), builds up lactic acid in the muscles, and you begin to just “ache”. 2) when a muscle fiber contracts, it slides inside a sheath. When the muscle stays in contraction, you begin to build up adhesions between the muscle sheaths not allowing it to slide normally – thus producing muscle knots and trigger points (see Trigger Point in the back of these notes).

Short exercises of even mild activity (even stretching) will help you to relax. More intense workouts will thoroughly allow your musculature to relax by repetitively (rather than sustained) contracting, will help increase blood supply (nutrients), to flush out toxins/waste build up, and to help breakdown some adhesions.

Some of the best exercises include:

• walking – swinging your arms, does not have to be at a fast pace to be beneficial
• swimming
• stretching
• yoga
• core strengthening
• low impact aerobics
• using free weights, weight machines
• bicycling

• 1. An exercise to help you identify tight muscles and then to relax them: Sitting or lying down. Tighten up your toes/feet, then your legs, then your buttocks/stomach, then your hands, then your arms/shoulders, then your jaw. Hold for a count of three. Slowly relax each muscle group in the reverse order. As an alternative, you can just work on your hands, arms, shoulders, neck, and face.
  2. An exercise you can do at your desk to relax your shoulders and neck: Shrug your shoulders up and hold it for a count of three. Relax your shoulders to neutral, then push your shoulders down and hold it for a count of three.
  3. For jaw clenching/ teeth grinding: Position for your jaw when under stress: Place your fingertips over your TMJ (jaw joints), clench your teeth. Relax your jaw, so that your lips are still closed, but your teeth do not meet each other.

Sleep:

• You should get between 7 – 10 hours of good sleep per night – waking up every 2 hours even though you are sleeping 7 hours is NOT good quality sleep
• develop good sleep routine habits: don’t drink a lot of fluids or have caffeine before bedtime, have a quiet, dark room – consider no television
• Have a bedroom that you enjoy sleeping in
• Make sure you have a good mattress and pillow/s
• If you have been chronically sleep deprived, you might consider a sleep vacation
• If you have back problems, sleep on your sides with pillows large enough to fit between your shoulders and your head
• If you have neck problems, sleep on your back with a smaller height pillow

Relaxation

To relax for some means immersing oneself in something that you like, such as in a hobby (gardening, knitting, painting, model trains, reading). By absorbing yourself in a hobby, you give your brain a chance to NOT be focused on all the other things going on in your life and really your brain gets to relax or take a break. Thus when you come back to your daily life, your brain is not so “overloaded” continually with the same things. You will be able to think a little clearer.

Ways to help you relax (definition: become less tense, rest, or take one’s ease)

Hobby
Laughter
Music
Exercise
Sleep/nap
Friends
Time for yourself
Breathing
Meditation
Massage

Breathing:

When we get stressed we have a tendency to start breathing very shallowly. Put your hands around the bottom portion of your rib cage. Breathe normally and see how far your hands spread out with inhalation. When you breathe shallowly, you are not getting enough fresh oxygen into your lungs and you are not exhaling enough of your exhaust. You need to start changing that shallow pattern of breathing for a deeper breathing pattern.

When you feel stressed, and want a quick technique to help you relax:

1. 1. Sit or stand up straight. Take a deep slow breath, lifting your chest; hold your breath for a count of three and then exhale completely and hold for a count of three. Do this three times slowly. Do not hyperventilate. I teach this breathing and exhaling through your nose.
2. 2. For a meditative breathing exercise: Sit comfortably on the floor or chair (sitting tall), or lay down. Concentrate and count your number of breaths to 5, then start back at 1. Just continue concentrating on your numbering breathes. Do this for 5 minutes.

Meditation

Meditation is a practice of concentrated focus upon a sound, smell, object, visualization, the breath, movement, or attention itself in order to increase awareness of the present moment, reduce stress, promote relaxation, and enhance personal and spiritual growth.

Mediation can be very simple. Start with just 5 minutes at a time and work up to 15 – 20 minutes a day. Try not to do this right before bedtime; you will get more benefit if you are wide-awake. To help relax you, your room should be quiet or with soft music (preferably without lyrics), or at least have a minimal amount of distractions.

1. 1. Either sit or lay down. Concentrate on one thing – your breathing, listening to raindrops, listening to birds, etc. It is emptying your mind of everything else.
2. 2. You can also just concentrate on your body. How does your left foot feel?, then your right?, then your left calf, etc. all the way up to your face and head. Do not judge the feelings (good versus bad), but rather does it feel soft, vibrant, tight, relaxed.
3. 3. Mindful eating – If you reach for food when you’re under stress or gulp your meals down in a rush, try eating mindfully. Sit down at the table and focus your full attention on the meal (no TV, newspapers, or eating on the run). Eat slowly, taking the time to fully enjoy and concentrate on each bite. Especially good at the dinner table.

Massage

There are four basic types of massage:

• effleurage – light stroking, like Swedish massage
• petrissage – deeper stoking
• tapotement – percussion
• friction – Rolfing, breaks down adhesions

We will concentrate on effleurage and some petrisage. General rule if it hurts, but feels good you can do it. If on the other hand it just hurts - stop doing it.

Since most people’s stress is carried in their face, neck and/or their shoulders, those are the three places that are very easy to start with.

1. 1. Your face: Start with your two middle fingers at the bridge of your nose. Go up to the top of your forehead and then across to your temples. Repeat 5 times. Go back to the bridge of the nose, and do small circular motions at the bridge (both directions). Then move to the temples where you will use 2 – 3 fingers to gently massage in a circular motion. Then move down to your TMJ joints, continuing to massage lightly in circular motions. Continue down along your jaw line. Then move to your cheek bones along side of your nose. Again using small circular motion. As you do this, concentrate on feeling the muscles of your face and relaxing them. Feel the blood supply in your face.
2. 2. Your Head: From your face, move your fingertips up to just behind your ear (mastoid bone). Slide your fingertips along the mastoid bone and along the base of the skull. From there take your fingers up to the top of the head like your are giving yourself a dry shampoo. If you find small tender points, just lightly massage them. Again feel blood supply in your muscles, and whether they are tight or not.
3. 3. Your Shoulders: Take your opposite hand and grab your shoulder. Give a gentle squeeze. Take both hands along your neck from the skull to the top of the shoulders with gentle circular motions. When you get to the base of the neck, gently pull forward with your hands. You can then start to gently massage the tops of your shoulders. You can also use a hand held massager (I like Panasonic) to do your shoulders and back of the head.
4. 4. Your hands: I recommend you do your hands in general. Using your thumb, slowly run it along from the wrist down to the tip of each finger, slightly stretching the finger. Then pull each finger gently. Use your opposite thumb to make small circular motions throughout your palm, especially the thenar and hypothenar eminences.

Laughter: Is one of the best medicines.

“The old saying that ‘laughter is the best medicine,’ definitely appears to be true when it comes to protecting your heart,” says Michael Miller, M.D., director of the Center for Preventive Cardiology at the University of Maryland Medical Center and a professor of medicine at the University of Maryland School of Medicine. “We don’t know yet why laughing protects the heart, but we know that mental stress is associated with impairment of the endothelium, the protective barrier lining our blood vessels. This can cause a series of inflammatory reactions that lead to fat and cholesterol build-up in the coronary arteries and ultimately to a heart attack.” University of Maryland Medical Center.

Music:

Research has shown that music has a profound effect on your body and psyche. In fact, there’s a growing field of health care known as Music Therapy, which uses music to heal. Those who practice music therapy are finding a benefit in using music to help cancer patients, children with ADD, and others, and even hospitals are beginning to use music and music therapy to help with pain management, to help ward off depression, to promote movement, to calm patients, to ease muscle tension, and for many other benefits that music and music therapy can bring. This is not surprising, as music affects the body and mind in many powerful ways. The following are some of effects of music, which help to explain the effectiveness of music therapy: Elizabeth Scott, MS 11/07/07

Caffeine:

Here are some examples of caffeine content in common foods:

8 oz. Coffee brewed—-135 mg 8 oz. Coffee instant—–95 mg 8 oz. Coffee decaf——-5 mg 8 oz. Lipton Tea———40 mg Vivarin, 1 tablet———-200 mg Excedrin, 2 tablets—–130 mg 1 Hershey Bar————10mg

12 oz. Mountain Dew–55 mg 12 oz. Surge—————51 mg 12 oz. Diet Coke———47 mg 12 oz. Coke—————-45 mg 12 oz. Pepsi—————37 mg 12 oz. Dr. Pepper——-41 mg

Trigger Points:

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms. (Am Fam Physician 2002;65:653-60. Copyright© 2002 American Academy of Family Physicians.)

DAVID J. ALVAREZ, D.O., and PAMELA G. ROCKWELL, D.O., University of Michigan Medical School, Ann Arbor, Michigan