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“Research shows there is a link between stress, anxiety, trauma and how it is manifested in the body with symptoms such as chronic pain. The physiotherapist management of pain has adjusted in recent years in line with research which advocates a more holistic approach towards delivery of physiotherapy which integrates mindfulness, relaxation and CBT style management. I’m really looking forward to supporting people through this programme and keen to see how local people affected by the conflict can benefit.” Francis McMonagle, Trauma and Orthopaedic Outpatients Department, Mater Hospital.

Physiotherapy at Bridge of Hope

Bridge of Hope’s physiotherapy programme is delivered by specialist musculoskeletal physiotherapist Francis McMonagle, Trauma and Orthopaedic outpatients department, Mater Hospital. Those eligible for support include those individuals physically or psychologically impacted by the conflict who are experiencing symptoms such as chronic pain. Individuals can self-refer or be referred in by a health professional, family member, friend or community organisation. This service operates from Bridge of Hope’s clinic at 16 Alliance Avenue. Telephone 028 9543 8707.

What is Physiotherapy? Physiotherapy is one way of addressing the physical effects of stress or trauma held in the body. The body’s response to stress shows itself in many ways:


During the stress response blood flow is directed away from the skin and other organs to fuel the stress response in the muscles. Under emergency conditions this allows for faster reaction to the perceived “threat”. Under chronic conditions this continually deprives the skin of necessary blood flow and therefore nutrients and the skin ages faster. Stress can also aggravate skin conditions such as Psoriasis or rashes and histamine released during the stress response can give rise to itching and general discomfort.


Just like the skin, blood flow is directed away from the intestines during the stress response. When people are chronically stressed, it can affect the motility of the gastrointestinal system, which can lead to constipation, diarrhoea, indigestion, reflux or bloating. IBS is very commonly associated with and aggravated by stress.

Weight Gain

Stress can cause the body to crave sugary carbohydrates or chocolate (due to the increased Serotonin levels these foods temporarily provide. Over time indulging in such foods on a regular basis can lead to weight gain. The stress hormone cortisol can also promote the storage of excess abdominal fat.


In the acute stress response the muscles are primed for “fight or flight” by increasing their tension levels through the above mechanism.This is helpful if you need to fight off an attacker or flee from a vicious dog but can become a problem with chronic stress.  That constant tension can aggravate existing muscular or surrounding joint conditions, or cause pain all on its own, eg Fibromyalgia. The neck, shoulder and lower back are the most common locations for this excessive muscle tension and excess tension in the neck muscles can be a common cause of headaches.


As part of the acute stress response, blood pressure starts to rise and the heart rate tends to speed up to fuel the body to respond to the “threat”. Under acute conditions this is helpful and reverses quickly when the threat subsides but over time with chronic stress these changes can become structural and irreversible leading to chronically elevated blood pressure and heart beat irregularities e.g. Palpitations. Unchecked chronic stress is linked to an increased risk of heart disease, heart attacks and strokes.


During sleep, the relaxed parasympathetic system is in control and the active sympathetic nervous system gets very quiet. But when you’re acutely stressed, the sympathetic nervous system doesn’t want to shut itself down leading to disturbed sleep. Chronically disturbed sleep has been linked with hormone imbalances and has been proposed as a factor in the development of Fibromyalgia.

Immune system

Because the body is diverting resources to the systems required for immediate survival, the immune system can become suppressed. And not only does that make you susceptible to new viruses (one study found that people who recently experienced a major stressful life event were more likely to catch a cold), but it can also activate existing infections and viruses. Stress can affect the regulation of inflammation, and increased inflammation can, in turn, exacerbate conditions such as asthma, IBS and arthritis.


The body needs more oxygen to fuel the fight or flight response, which can cause our breathing to become more rapidly and shallow. If sustained, this can lead to shortness of breath and in severe cases Panic attacks. Consciously taking deep breaths can have the opposite effect by activating the calming parasympathetic nervous system.

How can Physiotherapy help?  Chronic pain and some even some of the above physical manifestations of Stress/Trauma can be effectively managed through a multi-disciplinary treatment program including Physiotherapy. Your Physiotherapy treatment will be tailored to your individual needs following a detailed assessment of your presenting problems.


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