Stress Management

Stress and its management in the community is a growing issue for many health practitioners.

Physiotherapists offer a number of stress management techniques and treatments which can help
to improve a patient's health and well-being, whether it be specially designed stress management
programs, exercise programs, massage, muscle relaxation or general fitness advice.

Role of physiotherapy

Physiotherapists use an initial assessment to clarify the nature of the problem and develop
strategies and treatment which are acceptable to the individual.

Treatment can take the form of individual consultation, group relaxation classes, relaxation audio
tapes or information sessions for the general public. As part of the treatment program,
physiotherapists offer close professional follow up with the patient to ensure a positive treatment
outcome.

Physiotherapists with a special interest in stress management can offer many different types of
relaxation therapy including guided imagery, progressive muscle relaxation, breathing techniques,
thought stopping, stretching, massage and general fitness advice.

Benefits of physiotherapy

Research continues to indicate a positive correlation between a person's ability to cope with
stressors and the likelihood of disease during their lifetime.

Physiotherapy can assist by:

reducing muscle tension;

increasing vitality and decreasing reported tiredness;

improving concentration span;

improving feeling of general well-being;

decreasing blood pressure;

reducing risk of cardiovascular disease;

improving attitude to work and leisure activity;

reducing pain states such as headache, chronic pain syndromes and work
related anxiety;

possibly decreasing dosage of psycho-active medication.

Finding a physiotherapist

Would you like the names of physiotherapists who have a special interest in Stress
Management? Call us on (03) 9527 7532 or contact us here.













Physiotherapy. 2010 Dec;96(4):303-10. doi:
10.1016/j.physio.2010.03.001.
Occupational stress and coping resources in
physiotherapists: a survey of physiotherapists in three general
hospitals.
Santos MC, Barros L, Carolino E.
Author information
Abstract
OBJECTIVES:
To identify occupational stressors and coping resources in a group of physiotherapists, and to
analyse interactions between subjective levels of stress, efficacy in stress resolution and coping
resources used by these professionals.
DESIGN:
A sample of 55 physiotherapists working in three general hospitals in Portugal completed the Coping
Resources Inventory for Stress, the Occupational Stressors Inventory and two subjective scales for
stress and stress resolution.
MAIN RESULTS:
Most physiotherapists perceived that they were moderately stressed (19/55, 35%) or stressed (20/55,
36%) due to work, and reported that their efficacy in stress resolution was moderate (25/54, 46%) or
efficient (23/54, 42%). Issues related to lack of professional autonomy, lack of organisation in the
hierarchical command chain, lack of professional and social recognition, disorganisation in task
distribution and interpersonal conflicts with superiors were identified as the main sources of stress.
The most frequently used coping resources were social support, stress monitoring, physical health
and structuring. Perceived efficacy in stress resolution was inversely related to perceived level of
occupational stress (r=-0.61, P<0.01). Significant correlations were found between several coping
resources and the perceived level of stress and efficacy in stress resolution. Associations between
problem solving, cognitive restructuring and stress monitoring and both low levels of perceived stress
and high levels of perceived efficacy were particularly strong.
IMPLICATIONS FOR PRACTICE:
The importance of identifying stressors and coping resources related to physiotherapists'
occupational stress, and the need for the development of specific training programmes to cope with
stress are supported.
Copyright 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
PMID:

21056165

[PubMed - indexed for MEDLINE]
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Summary
Occupational stress has been studied in a wide range of professional groups, yet very little research has
been conducted into the causes and effects of stress within the job of a physiotherapist. This study was
designed to investigate the incidence of occupational stress among newly qualified physiotherapists and
to identify possible sources of stress and personal coping strategies. In-depth interviews were conducted
with 11 young physiotherapists and their responses were used to design a questionnaire which was
completed by 43 newly qualified physiotherapists. Results indicated that the group studied perceived
physiotherapy as a moderately stressful occupation. Possible sources of stress for these subjects were
identified. Recommendations for minimising physiotherapists' work-related stress are discussed.
Key words
Occupational stress;
job satisfaction;
newly qualified physiotherapists
Copyright 1988 The Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Biography: Elaine Mottram trained at King's College Hospital, London. She gained general experience in
Kent, Nottingham, Manchester and Glasgow before training as a teacher of physiotherapy at The Queen's
College, Glasgow. She returned to clinical work as deputy superintendent at Aberdeen Royal Infirmary.
She then became superintendent physiotherapist at Ruchill Hospital in Glasgow and began the Diploma
in Management Studies course which she completed at Robert Gordon's Institute of Technology. Her
interests in the education of student physiotherapists and in development of staff are pursued in her
present post as superintendent physiotherapist at Aberdeen Royal Infirmary.
Rhona Flin completed both her honours degree and her doctorate in psychology at Aberdeen University.
She then worked as a research Fellow on a Home Office funded project examining techniques for
interviewing eyewitnesses, and now lectures in occupational psychology at Robert Gordon's Institute of
Technology, Business School. Her research interests include occupational stress and child witnesses.
She is an associate Fellow of the British Psychological Society.

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Informa
Br J Ind Med 1990;47:20-28 doi:10.1136/oem.47.1.20
Research Article
Stress at work and mental health status among female
hospital workers.
1. M Estryn-Behar,
2. M Kaminski,
3. E Peigne,
4. N Bonnet,
5. E Vaichere,
6. C Gozlan,
7. S Azoulay,
8. M Giorgi
+Author Affiliations
1. Mission Etudes et Information Sant-Travail, Ergonomie Htel-Dieu, Paris, France.
Abstract
Relations between working conditions and mental health status of female hospital workers were studied in a sample
of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff,
mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the
afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational
health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were
considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of
antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four
indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and
strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of
occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of
children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all
other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased
significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association
between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in
interventions aimed at improving the working conditions of hospital workers.
Summary
Back problems can be caused by injury, inflammation, tension or spasm, and may affect muscles, ligaments, cartilage or bone.
Arthritis, muscle strain, osteoporosis, sciatica and stress are other common causes. Treatment can include exercise, massage and
medication. Staying active is an important part of managing back pain.

Back pain is a very common back problem. It is usually not due to any serious disease. Most episodes of back pain get better
quickly. Simple analgesics (pain-relieving medication) and a change of activity are generally all that is needed.

About half of all people who get back pain will have further episodes. The first step to managing back pain is to rule out the
possibility of any medical problem, such as infection or fracture (although these are rarely the cause).
Structure of the back

Your back is a complex structure that provides support for your pelvis, legs, ribcage, arms and skull. The spine is
made up of bones called vertebrae that are stacked together to form a loose S-shaped column.

Each vertebra is cushioned by spongy tissue or cartilage called intervertebral discs. These discs act as shock
absorbers and give the spine its flexibility. They have a flat structure with a jelly-like centre. Vertebrae are joined by
pairs of small joints known as facet joints. A mesh of connective tissue called ligaments holds the spine together.

Complex layers of muscle provide structural support and allow movement. The spinal cord runs through the centre of
the vertebral stack and connects the brain to the rest of the body.


Types of back problems

There are many different back problems, all of which can cause back pain, such as:
Soft tissue injuries like sprains and strains
Disc problems
Postural stress
Sciatica
Structural problems
Disease
Fracture.


Causes of back pain

There are many possible causes of back pain and it is often difficult to work out which structure is the cause. Any
structure in the back has the potential to cause pain if it is affected by injury or disease. Most people with back pain
do not have any significant damage to their spine. The pain comes from the muscles, ligaments and joints.

Some common causes of back pain include:
Arthritis osteoarthritis and ankylosing spondylitis are two forms of arthritis linked to back pain
Muscle and ligament strains if your back is out of condition or if you have pre-existing problems, you are more
vulnerable to soft tissue injuries such as sprains (stretching or tearing ligaments) and strains (injuring muscles or tendons).
Stretching a ligament or muscle too far or too quickly can result in a tear of the tissue. Excessive force and repetitive use
may also damage muscles
Osteoporosis is a disease characterised by loss of bone density and strength. The vertebrae can become so porous and
brittle that they break easily. Pain is due to a fracture of the vertebrae
Sciatica develops when the nerve that runs from the lower back into the leg is compressed by a bulging intervertebral
disc, causing pain
Stress one of the side effects of stress is increased muscle tension. This can lead to fatigue, stiffness and localised pain.
Constantly tight muscles can create imbalances in a persons posture that may cause misalignment of the spine
Structural problems lifelong bad posture, osteoporosis and genetic conditions (such as kyphosis, a curving of the upper
back (sometimes called hunchback), and scoliosis, which produces a sideways curve) can cause pain by putting added
stress on the structures of the spinal column.

More persistent back pain may be associated with arthritis of the facet joints and degeneration of the discs.
However, people with this condition may not experience any pain.


Lifestyle factors contribute to back pain

Most cases of back pain are exacerbated by lifestyle factors including:
Lack of exercise
Being overweight or obese
Sitting for long periods
Poor posture
Stress
Bad work practices.


Preventing back pain

In most cases, back pain can be prevented by making a few lifestyle changes. Some suggestions include:
Exercise regularly this is important to improve posture and increase muscle support of the spine. Aim for 30 minutes of
moderate physical activity every day. This can be broken into shorter blocks of exercise if you prefer
Lift and carry safely if you are picking up a heavy load, squat down, hold the object as close to your body as practical
and lift by using your legs (keeping your back straight). Get some help from another person or use equipment (such as a
trolley) if the load is too heavy to manage comfortably on your own
Maintain a healthy body weight being overweight or obese puts extra strain on your back
Be aware of your posture consider your posture, particularly in seated positions such as when driving or sitting at a desk
for long periods of time. Dont slump, keep your back upright and use support where necessary (such as a lumbar support
cushion or footstool)
Take regular breaks when driving, standing or sitting for long periods of time, take a break at least every hour. This will
help change the position of your joints and loosen your muscles. Include a short walk and a few stretches as part of your
break
Relax learn some relaxation techniques to reduce stress levels and related muscle tension. Try massage, heat or cold
packs and gentle exercise. Seek advice from a physiotherapist
Change your mattress surfaces that are too soft or too hard can aggravate a sore back. Avoid sleeping on your stomach.


Seeking help for back pain

In many cases of back pain, the first and most important treatment is to keep active and resume normal activities
work, sport and recreation as soon as possible. The majority of back injuries will improve by themselves. However,
there are times when it is important to see your doctor to check there are no medical problems that may be
contributing to the pain.

See your doctor if you have back pain and any of the following warning signs:
Severe pain that gets worse instead of better over time
You are unwell with back pain or have a fever
Difficulty passing or controlling urine
Numbness around your anus or genitals
Numbness, pain, pins-and-needles or weakness in your legs
Unsteadiness on your feet.


Initial treatment of back pain

In the first couple of weeks after the onset of an episode of back pain, treatment will focus on reducing pain and
maintaining movement. Treatment options include:
Rest this may mean temporarily reducing activity such as sport and heavy lifting
Exercise seek advice from a health professional, such as a physiotherapist or exercise physiologist, who can prescribe an
individual exercise program for you. Exercise may include stretching, mobility and strengthening exercises that target the
muscles stabilising and supporting the back.
Medication pain-relieving and muscle-relaxant medication may be prescribed temporarily by your doctor
Heat and cold therapy hot and cold packs applied to the area of pain may be helpful in relieving pain temporarily
Manual therapy a qualified professional may use massage, manipulation or acupuncture.
Education and counselling can be helpful to encourage you to resume normal activities, emphasising that most people
with back pain get better, and teaching active pain-coping strategies.
Surgery in severe cases, when the condition does not respond to other treatments and where doctors can tell which
structure is causing pain, surgery may be an option. The techniques used depend on the condition. For example, surgery for
a ruptured disc involves removing the fragments that may be pressing on nerves.


Managing long-term back pain

Back pain can be an ongoing problem for many people. About half of the people who get back pain will experience it
again. It is important to strengthen and condition your back, and be aware of your posture, even after the pain has
subsided.

Talk to your physiotherapist, osteopath, exercise physiologist or other health professional about what exercises you
can do on an ongoing basis to maintain the health of your back and for your general wellbeing. Recommended
activities may include walking, swimming and cycling. It is important that you learn about back pain and play an active
role in your own treatment.


Where to get help
Your doctor
Australian Physiotherapy Association Tel. 1 300 306 622
Australian Osteopathic Association Tel. 1800 467 836
Exercise physiologist


Things to remember
Back pain is a common problem.
Back pain most often comes from muscles, ligaments and joints. It can be caused by injury, inflammation, tension, spasm
or muscle imbalance.
Staying active plays an important role in management and prevention of back problems. Remember, your back is designed
to move.
Seek advice from a doctor if any warning signs exist.
You might also be interested in:
Back pain - disc problems.
Osteopathy.
Osteoporosis.
Physiotherapy.
Sciatica.
Scoliosis.