Mental Stress and the Impact on Physiologic Healing

As we approach the holidays, we’re often reminded of how stress-inducing the season can be. Between juggling vacations, finances, work schedules, and family engagements, what should be a relaxing time to spend with family can often morph into a stress filled 8-weeks. This scenario creates a unique situation, where the concept of holiday and time away paradoxically results in increased stress. As someone whose been involved in the workers’ compensation system and treating injured workers, this paradox resonates with me, as it’s one we often see within the worker’s compensation system: The system designed to help them paradoxically works against them.¹¹

In this month’s blog, we’ll discuss how stress negatively impacts healing and delays return to work. We’ll also discuss what employers, case managers, adjusters, and payors can do to support injured workers and promote timely claim resolution.

The Physiology of Stress and Healing

When we think about healing, the focus is typically on cellular repair, inflammation management, and physical rehabilitation. Healing, however, isn’t just about what happens at the injury site. It’s an intricate process managed by the body’s entire system, and stress can disrupt this process at multiple stages.
The body’s response to stress is primarily regulated by the hypothalamic-pituitary-adrenal (HPA) axis, a system responsible for managing the release of cortisol, adrenaline, and other stress-related hormones.

In moments of acute stress—think of the “fight or flight” response—these hormones increase heart rate, elevate blood pressure, and improve energy availability. This is helpful in short bursts, but when stress becomes chronic, cortisol remains elevated, impairing processes essential to healing, such as immune function, tissue repair, and sleep quality.¹

Additionally, chronic stress can hinder neurochemical balance in the brain, leading to higher levels of inflammatory cytokines. This inflammation can interfere with the body’s normal healing response, prolonging the time it takes to recover from physical injuries.¹ Moreover, elevated cortisol levels over time can cause muscle wasting, bone density loss, and even insulin resistance—all factors that further delay recovery.

How Mental Stress Affects Healing Processes

Stress impacts the body’s natural processes for repair, particularly through the following mechanisms:

1. Inflammation

When cortisol is chronically elevated due to stress, it can paradoxically increase inflammation, which is counterproductive for injury recovery. Normally, inflammation helps contain injury and initiates healing, but prolonged inflammation can prevent tissue repair and lead to conditions such as chronic pain syndromes.

2. Immune Suppression

The immune system is fundamental to recovery, as it helps fend off infection, clears damaged cells, and regulates tissue repair. Chronic stress, however, suppresses immune function, increasing susceptibility to infections and slowing wound healing. This leaves workers vulnerable to infection-related setbacks that can extend time off work.

3. Sleep Disruption

Healing processes like cell regeneration and tissue repair are accelerated during deep sleep. However, chronic stress often leads to poor sleep quality, interrupting these critical restorative stages. Poor sleep can result in decreased immune function, slower physical recovery, and increased pain sensitivity, all of which can delay return-to-work timelines.²

4. Pain Perception and Sensitivity

Stress can amplify the experience of pain, a phenomenon known as pain catastrophizing. This effect can turn what would be a minor, manageable pain into a major, overwhelming obstacle.¹ Workers experiencing heightened stress due to injury may be slower to engage in necessary physical therapy and rehabilitation, creating additional hurdles for recovery.

5. Reduced Blood Flow

Stress causes vasoconstriction, or the narrowing of blood vessels, reducing blood flow to the extremities. For injured workers, this means less oxygen and nutrient delivery to the injured area, hindering tissue repair and extending healing time.³

Mental Stress in the Context of Workers’ Compensation Claims

Workers’ compensation claims can be a significant source of stress in and of themselves. Financial insecurity, fear of job loss, distrust of the claims process, and the stigma associated with being “injured” or “unfit for work” all contribute to psychological strain. This stress compounds preexisting issues, creating a feedback loop that impedes recovery.

In many cases, workers navigating compensation claims may feel uncertain about their future. Studies have shown that individuals who experience financial or work-related stress have higher rates of chronic pain, slower recovery, and longer claim durations compared to those with less stress.^{4, 5, 6}

1. Financial and Employment Concerns

Workers’ compensation often provides only partial income replacement, which can increase financial strain. This financial burden becomes a major source of stress, particularly for those with families or other dependents. The stress related to financial insecurity can exacerbate the physical symptoms of injury and slow down the healing process. This has significant implications for extending claim duration.

2. Fear and Stigma in the Workplace

Many injured workers worry about how their injury will impact their reputation and job security. They might feel stigmatized, fearing colleagues or employers perceive them as “weak” or “unable to contribute.” This adds an emotional strain that can make them feel isolated or even guilty about their injury. ¹⁰ In such cases, the added psychological load may increase susceptibility to conditions like depression or anxiety⁷, which can further impair physical healing.

3. Navigating the Bureaucratic Process

The workers’ compensation claims process is often lengthy and complicated. Between paperwork, regular appointments, and administrative hurdles, workers may feel overwhelmed, helpless, or frustrated. Each new form, delay, or phone call can compound stress, impacting the worker’s motivation to engage in rehabilitative care.

4. Potential Legal Concerns

Workers’ compensation disputes may escalate into legal cases, especially if there is any question regarding the validity of the claim or fault of the injury. For many individuals, this legal tension adds another layer of chronic stress, creating a persistent source of worry that contributes to sleep issues, mental health challenges, and delayed healing.

Solutions for Employers, Case Managers, Adjusters, and Insurers

Given these impacts, it’s essential for employers and insurers to address stress management as part of the workers’ compensation process. Some strategies include:

Early Intervention Programs

Mental health screenings and support for stress management as early as the initial injury assessment could prevent or mitigate stress-related complications⁶. These programs could include access to counseling, stress management resources, or workshops that focus on resilience and coping mechanisms.

Clear Communication and Process Transparency

Simplifying and explaining the workers’ compensation process helps to reduce uncertainty and ease the emotional toll on injured workers.^8,9 Clear communication from insurers and case managers can prevent misunderstandings that lead to stress, frustration, and feelings of alienation.

Return-to-Work Programs with Psychological Support

Phased return-to-work programs that include psychological support can help reduce stress associated with reintegration into the workplace. These programs, coupled with empathy from employers and other key stakeholders, can help mitigate stigma and foster a positive environment for recovery, all while improving return to work rates.¹⁰

Conclusion

Mental stress is a powerful force that can significantly delay physical healing and extend the duration of workers’ compensation claims. For injured workers, stress arises not just from the injury itself but also from financial worries, the fear of stigma, and the complexity of the claims process. This stress exacerbates the body’s physiologic response, creating a cycle of delayed recovery and prolonged claims. By recognizing the impact of mental stress on physical healing and taking proactive steps to address it, employers, adjusters, case managers, insurers, and policymakers can improve outcomes for injured workers and reduce overall claims costs. Embracing a holistic approach to healing that includes mental health support may be the key to helping workers recover fully and efficiently, ultimately benefiting both the individual and the system as a whole.

To learn more about how Upstream Rehabilitation and our family of brands can assist with Workers’ Compensation and how physical therapy plays an effective role in helping injured workers return to work, contact our Workers’ Compensation team today!
Resources

1. Butler D, Moseley L. Explain Pain. Second Edition – April 2013.
2. Walker, Mathew. Why We Sleep – Unlocking the Power of Sleep and Dreams. New York, Scribner, 2017.
3. Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin North Am. 2011 Feb;31(1):81-93.
4. Gallagher RM, Williams RA, Skelly J, Haugh LD, Rauh V, Milhous R, Frymoyer J. Workers’ Compensation and return-to-work in low back pain. Pain. 1995 May;61(2):299-307.
5. Collie A, Sheehan L, Lane TJ, Gray S, Grant G. Injured worker experiences of insurance claim processes and return to work: a national, cross-sectional study. BMC Public Health. 2019 Jul 10;19(1):927.
6. Netterstrøm B, Friebel L, Ladegaard Y. Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: results from a randomised, wait-list controlled trial. Psychother Psychosom. 2013;82(3):177-86.
7. Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Clinical depression is a strong predictor of poor lumbar fusion outcomes among workers’ compensation subjects. Spine (Phila Pa 1976). 2015 May 15;40(10):748-56
8. https://www.crawco.com/resources/how-empathetic-claim-management-helps-avoid-large-jury-awards-and-nuclear-verdicts
9. https://www.texasmutual.com/blog/posts/2018/12/the-key-to-compassion-what-your-employee-is-really-thinking-when-they-are-injured-on-the-job
10. Pedersen, K.K.W., Langagergaard, V., Jensen, O.K. et al. Two-Year Follow-Up on Return to Work in a Randomised Controlled Trial Comparing Brief and Multidisciplinary Intervention in Employees on Sick Leave Due to Low Back Pain. J Occup Rehabil (2022).
11. Kilgour E, Kosny A, McKenzie D, Collie A. Interactions between injured workers and insurers in workers’ compensation systems: a systematic review of qualitative research literature. J Occup Rehabil. 2015 Mar;25(1):160-81. doi: 10.1007/s10926-014-9513-x. PMID: 24832892