As a Trauma-Informed Physiotherapist who works with people experiencing persistent pain, many of my clients show up to sessions with nervous systems that are in an activated stress response (fight/flight/freeze). In fact, many people spend much of their lives in an activated state, and may or may not realize that it's even happening, or know how to achieve a more settled state. A dysregulated nervous system is a common presentation in people with persistent pain.
Particularly if you've had pain for a long time, whether you've been diagnosed with a chronic pain condition or your pain cannot be explained medically, it could be helpful to have a look at what state your nervous system is in and how it is responding to your day-to-day stimuli.
How might you identify if your nervous system is activated?
Here are some things you might notice about yourself when you are in a stress response (these are also signs that I look for in my clients while we are in sessions):
Fidgeting, twiddling fingers, bouncing leg up and down, etc.
Clenching of jaw
Clenching of fists
Body positioned with toes down and heels up (stance for preparing to run away)
Body positioned with legs and/or arms crossed (protective stance)
Tense, difficulty relaxing
Tightness in chest
Increased speed or intensity of heartbeat
Shallow/quickened breathing or holding of the breath
Increased tension in muscles
Pale or flushed skin
Body temperature changes (hot or cold)
Heaviness of limbs
Feeling agitated, restless, irritated or a sense of impending doom
Feeling numb (physically or emotionally)
Difficulty concentrating, even feeling sleepy
Feeling easily triggered, even by small stressors
As a practitioner, if I notice any of the following conditions showing up on the intake form or during the assessment, it might direct me toward learning more about the client's nervous system and the role that might play in their symptoms/experiences:
History of trauma
Anxiety, Depression or Post-traumatic Stress Disorder (PTSD)
Diagnosis of Fibromyalgia, Irritable Bowel Syndrome, Restless Leg Syndrome, Temporomandibular Joint (TMJ) Dysfunction or Chronic Fatigue
Widespread body pain (usually muscle pain/tension, may include tingling/numbness)
Inconsistent body pain (one day the back hurts, the next day the neck hurts, etc.)
Pain that is directly affected by level of stress
Medically unexplainable symptoms (tests and imaging results are inconclusive)
Consistently low energy/exhaustion
High level of stress
Lastly, our nervous systems are always perceiving, interpreting and responding to external stimuli, including other people. It is common that a person might experience changes in their own body in response to an interaction with another person, whether that results in higher or lower activation. So in sessions, I also use the information that I gather from my own body to give me clues to the state of my client's nervous system. (This interaction of nervous systems is also the reason why I always try to maintain a calm and relaxed state in my own body while with my clients, because I know they can feel my energy.)
To learn more about the relationship of the nervous system and persistent pain, and how I incorporate nervous system regulation into my work with clients, check out my article entitled: "Struggling with persistent pain? The solution may lie in your nervous system."
As always, I am happy to respond to any questions you may have, so feel free reach out. :)
With love and understanding,
Joanna Hermano is a Trauma-Informed Physiotherapist and Somatic Experiencing® Practitioner-in-Training with a special interest in persistent pain.