Introduction

We can all agree that we have experienced an injury at some point in our lives, right? You would have also noticed that our body does a meticulous job at allowing us to recover back to normal. There are times however when our body cannot heal properly and, given the complexity, there can be a number of factors at play. It may come as a surprise – but one of these culprits is chronic stress.

You may be wondering what chronic stress means. This is defined as a situation that the stressor (i.e. a human being) cannot resolve, which leads to a long period of stress. This can be overwhelming and mentally exhausting for anyone and it doesn’t just affect your mood – it can also have a detrimental impact on your quality of life and mental health.¹ 

So why is it important for us to manage our stress when we have an injury? Let’s find out an answer to this question.

What happens when you get a wound?

First, we need to talk about what happens in your body from the time you get a wound to full recovery. This is how it works:

• Stopping the bleeding: As soon as a cut appears, your body will cause the wound to clot using small blood components called platelets. This allows the wound to close, preventing further damage² 
• Cleaning the wounded area: You will notice that your wound becomes red, inflamed and possibly releases some discharge. This is because your immune system is sending an abundance of immune cells to help in removing debris such as dead cells and bacteria² 
• Tissue Repair: A wound shows visible damage to your body. This needs to be fixed! And so, the immune system will send crucial components to rebuild the tissue lining. You may have heard of the ‘happy hormone’ serotonin.Well, your cells around the wound also need this to be happy. Serotonin allows more immune system components through the cells to help fix the damage² 
• Final Touches: After about a week, your body will begin to lay down the scaffolding to tissue which builds strength. One important structure involved in tissue re-building is collagen.³ After around three weeks, the remodelling phase will begin which is when you may notice the formation of a scar. The scar can take many weeks to heal fully but this will not reach the same strength as the previous healthy tissue² 

Sounds like a smooth process, right? Well, it should be – but there’s a catch. Chronic stress can throw a spanner in the works!

What exactly is chronic stress?

Chronic stress is not like the temporary stress that you might experience before an important exam or in a conflict. Chronic stress is long-term and there are various situations that may cause you to experience it, whether that be financial, health or work-related factors.

This means your body is in a constant state of ‘fight-or-flight’ which can have surprising effects on repairing a wound. Let’s explore why.

How does chronic stress affect wound healing?

Imagine it somewhat like a day at work. You have workers being delegated tasks to complete (blood clotting, inflammation and tissue repair) by the boss (your brain). Now imagine the boss is constantly shouting tasks and orders with changing priorities. The workers now become confused at what needs to be done first and work slows down. Your immune system relies heavily on order and organisation, with clear signals required, and so this example is very similar to how wound healing relies on a stable mind.⁴ 

Here are a few ways stress interferes with wound healing:

• Weakens your immune system: Chronic stress takes a toll on your immune system which means it becomes less effective at fighting infection.⁵ This is because stress reduces the number of crucial immune cells – responsible for the removal of bacteria and viruses – as well as repairing tissue. Think of this as a concert having less security: people (infections) are therefore more likely to sneak in⁶ 
• Slows blood flow: Stress causes your blood vessels to tighten which is triggered by certain hormones like noradrenaline.⁷ This in turn reduces blood flow to your tissue and, more importantly, your wound. Healing requires an adequate oxygen supply to the damaged site. With reduced oxygen to the wound, the time it takes to heal will increase⁸
• Inflammation is disrupted: Inflammation is a critical function in our body to help heal any damage. In some instances, chronic stress can cause the pathway of immune system activation to overreact, which leads to chronic inflammation and an increased risk of autoimmune disease.⁶ At other times, stress might prevent the proper inflammatory response altogether, leaving the wound vulnerable. Either way, it’s a recipe for slower healing
• Cortisol surge: Remember we mentioned how collagen helps rebuild tissue? Well, another hormone released in a period of stress is cortisol, which suppresses collagen. Without enough collagen, wound healing isn’t as quick or as strong^9,10 
• Poor Lifestyle Choices: Stress can have many effects on us. Do you skip meals, struggle to sleep and hate the idea of exercising, when you are stressed? All of these behaviours can snowball into your body being unable to repair itself¹¹ 

Why does this matter?

Have you ever noticed how people under a lot of stress, whether from caregiving, work overload, or personal issues, seem to take longer to bounce back from an injury or surgery? The research backs this up. A study of over a hundred patients demonstrated how high blood pressure (a factor associated with stress) prolongs wound recovery after a hip operation.¹² Another study showed that patients who experienced more stress after an operation for gallstones had longer hospital stays and patients who were more optimistic after heart surgery were less likely to be rehospitalised.¹³ Individuals with high-stress levels tend to have more complications after surgery and overall longer recovery times.¹⁴

When a wound takes longer to heal, it can make you feel frustrated or anxious which in turn leads to more stress.¹⁵ This vicious cycle can therefore lead to further complications, such as wound infections.¹⁴ 

Can managing stress help wounds to heal faster?

So, what can you do if you’re dealing with chronic stress and a wound that won’t seem to heal? While it’s impossible to completely eliminate all the stressors from your life, managing stress better can make a difference to how quickly your body recovers.

Here are a few strategies to help keep stress in check and give your body the best chance of recovery:

1. Practice relaxation techniques: Activities like deep breathing, meditation, or yoga can help calm your mind and body, reducing the harmful effects of stress. These practices are like hitting the ‘reset’ button, helping lower stress hormones and letting your immune system do its job^6,11 
2. Stay active: Regular exercise might feel like the last thing you want to do when stressed. But it’s one of the best ways to relieve tension and improve blood flow, which is essential for healing. Even small changes can help, such as taking the stairs rather than the escalators. Exercise doesn’t just improve circulation – it contributes to improved mood, sleep, and energy^16-17 
3. Eat well: Stress often leads to poor eating habits, and vice versa, but making an effort to eat a balanced diet with plenty of vitamins, proteins, and healthy fats can speed up recovery. Foods high in sugar and caffeinated or alcoholic drinks are associated with stress, with a tendency to disrupt your sleep¹⁷ 
4. Get enough sleep: When you’re stressed, sleep can feel like the last thing you want or need, but it’s crucial for healing.¹⁸ Sleep is when your body goes into repair mode, so aim for a good rest at night to allow your body to recover.¹⁹ This may be easier said than done, but you can check out the NHS website for further help and guidance
5. Talk to someone: Sometimes, stress can become overwhelming. Talking to a friend, family member, or even a therapist, can help relieve some of the pressure¹⁷ 

Summary

Chronic stress has a significant impact on the ability for wound healing. When a wound occurs, a multi-step process is initiated involving blood clotting, immune response, tissue repair and scar formation. While this is ordinarily a smooth process, it can be knocked if you are experiencing chronic stress.

Chronic stress is defined as long-term, unresolved stress which compromises the immune system and in turn affects our ability to fight infection. Stress-related hormones, such as cortisol, also reduce important healing factors like collagen. This causes impaired tissue repair and prolongs healing altogether. Poor lifestyle choices are linked to stress and therefore improving sleep, diet and exercise, as well as trying different relaxation techniques, can help reduce stress in the long run. 

So why is it important for us to manage stress? This is now a much simpler question. We need to manage stress to prevent becoming overwhelmed and to help the healing process. If we take chronic stress seriously, we can aim to change our lifestyle and ultimately improve wound recovery.