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I wrote last time about how diseases of the mind and body are really not separate diseases and how psychologists may be missing diagnosis like anemia and hypothyroidism that look like mental illness and how doctors may be missing psychosocial factors like relational stress and trauma that lead to conditions like autoimmunity. The term in science used to describe this interconnectedness is psychoneuroimmunology.
As I sat this morning doing my morning routine I realized physical therapists need to be added to the conversation - the group of practitioners that interfaces with the "neuro" part of psychoneuroimmunology - the nervous/musculoskeletal system!
I have been seeing a PT for the last few weeks for ongoing wrist pain associated with pectoralis minor muscle tension and hip pain associated with psoas muscle tension that both started around the time of my Hashimotos diagnosis. It spurred me to wonder if the disease state of Hashimotos has lead to habitual muscle engagement patterns that are causing the musculoskeletal pain of my wrist and hip.
In the disease state of Hashimotos, the immune system within the body attacks and begins to destroy its own thyroid gland because it mistakenly believes it to be a foreign invader that threatens the body’s survival.
As the immune system attacks the thyroid gland – stored thyroid hormone spills out into the blood stream. This spilling of excess thyroid hormone increases metabolism, increases heart rate, increases blood pressure and increases body temperature. These symptoms are signs of an increase in sympathetic nervous system activation and are interpreted by the mind as a state of anxiety. This is an example of how immune system activation influences the nervous system which in turn influences how the the psyche feels.
Evolutionarily when the body experienced this state, the organism was most likely in a threatening environment that resulted in activation of the nervous system responsible for mobilizing the organism to flee the threat. Another response to threat is to protect the most vulnerable areas of the body - the guts and the heart by curling up into a ball.
So how does anxiety in the psyche influence the nervous system and how the body moves through the lens of a PT?
I’m in quite theoretical territory and perhaps I’m simply telling my own story and embodied experience with the potential that my response to threat and anxiety is not unique. Globally speaking, when an organism senses a threat, it engages muscles on the front of the body to close and protect itself and stops engaging muscles on the back side of the body that vulnerably open the organism to the world.
In the case of hip pain, I learned from my physical therapist that I am over engaging the psoas muscle which brings the knees up into the chest to cover the abdominal region containing the guts and viscera. I am under utilizing the gluteus muscles and muscles on the posterior that open the hip. This combination is leading to the hip pain I experience day to day.
I also learned from my PT that I have chronically tight pectoral muscles, which are causing my chest to close and protect my heart. The closing of the chest also pinches the brachial plexus, the nerve supply that travels down to the wrist joint – which is causing the numbness, tingling and pain that I experience while on a computer.
Are these "injuries" random occurrences or are they nervous system responses to a perceived threat coming from autoimmunity and anxiety? Is this another example of how one "disease" is touching all the systems of the organism as captured by the term psychoneuroimmunology?
Calling all physical therapist – have you seen this pattern in your patients with anxiety or thyroid disease? What other patterns of self protection are your noticing with your patients?
Calling all people with Hashimotos – are you visiting physical therapists with your own version of how anxiety is being expressed in your bodies moving system?