The Stress Bucket
If you’ve ever worked with me at Precision, I’ve probably talked to you about “stress is stress” and the imaginary “stress bucket” which holds all of our stress. This concept and how both biomechanical load and social and emotional load affect our body and injuries has come up a lot in the clinic recently, so I figured it was time to bring it to the blog.
The stress bucket is not an idea that I came up with, and I want to give credit to the PTs whose ideas I have expanded on when describing how the whole person and their environment affect injury and pain perception. Physical Therapist Greg Lehman is credited with using the idea of the overflowing cup to visualize how load or stress from different inputs and Dr. Kate, Precision PT founder and my mentor, has explained the same in the form of a stress bucket, which carries all stress, good and bad, and when the bucket overflows, we see injury. All of these are visualizations of the biopsychosocial model, which explains that illness, health, and injury, are resultant of the interplay of biological, psychological, and social factors. This was first described in 1977 by Dr. George Engel.
Here is how I describe this phenomenon to my patients: Imagine a bucket. The bucket holds all stress or load on the body. The bucket already has some water in it from your everyday activities like working or studying, the energy it takes to commute, feed yourself, etc. Running and training are usually good things, but they take up space in the bucket. If you are training for a race, your training is going to fill the bucket more than usual. Now imagine there is something else going on in your life – a few examples that my clients have experienced include having a new baby; changing jobs; taking care of a sick family member; a car accident. None of these necessarily directly change your running load, but they also fill the bucket with a new type of stress or load. This may bring the volume of the bucket precariously close to the edge. At this point, sometimes it only takes a small stressor to overflow the bucket. This may look like getting a cold; travel that leaves you sleep deprived for a few nights; an increase in outdoor temps that increase the intensity of your running despite no change in total volume. In isolation, these seem like small happenings that shouldn’t lead to an injury. But in the greater picture of overall load and stress on the body, they could be the little extra volume in the bucket that causes it to overflow, resulting in injury.
Why does this happen?
Just like a car doesn’t have endless miles on one tank of gas, our bodies have limits in how much they can do or handle. Our ability to handle load isn’t solely dependent on training volume, because the energy required to run, lift weights, and recover, comes from the same (finite) energy supply that also fuels our brain at work, our bodies as they chase toddlers around the house, our bodies as they sweat extra and temperature regulate in the heat and humidity, the middle of the night taking care of a pet or child, and more. If we are constantly running on low, our engine (body) is under extra strain. Maybe our engine can bounce back from a day or two like this, but if we don’t properly refill our tank and give the engine time to recover, that engine may sustain damage. (Do you like all of these analogies?)
What can we do?
Many of us carry a lot in our imaginary buckets – we are athletes, professionals with jobs, parents, friends, children who have many responsibilities. And unfortunately, life and these responsibilities don’t just stop because you started training for a race. Sometimes, taking care of ourselves can fall to the bottom of the list, which is often when our bucket overflows. There are several ways in which you can reduce the risk of overflow (this means that we are finding ways to increase our body’s resiliency to load!). First, we try to remove extra things in the bucket. Is there one plan that you can say no to this week to decrease volume in the bucket? Maybe it means taking an extra rest day or swapping a workout for an easy run. What about ditching 30 minutes spent scrolling before bed that is negatively affecting your sleep? Improving sleep and other restorative practices like meditation and therapy help your body handle other loads better. You can visualize this as poking a hole in the side of the bucket to let some water out. We can also think about helping our bucket to grow. Consistent use of mental strategies like those listed can help your bucket grow larger over time. You can also increase the size of your bucket by improve physical resiliency to load through strength training. This is best accomplished in an off season where other training volume is low.
So, this is why when we are trying to figure out why an injury may have occurred, it’s rarely as simple as just one stimulus change, one run, one shoe change. We need to look at the bigger picture, what’s going on in your personal life, work life, training, nutrition, sleep and more to have an idea of all of the loads and stressors that are affecting an athlete. If you are going through a particularly stressful time where you have a lot on your plate, it’s important to consider how you are emptying your bucket or helping it to grow. There are times when we may need an extra rest day, a nap, or an extra snack or gel during a run to provide more support when the bucket is close to overflowing. Being aware of all of the things filling your bucket can help you to be more patient with yourself, and may help you keep an injury at bay.
I hope you enjoyed reading! I challenge you to assess what is in your stress bucket right now, and how you could support your body in skimming off some of that volume
Happy Running,
Dr. Elizabeth Karr PT, DPT, OCS
Precision Performance and Physical Therapy Atlanta, Georgia
404.343.3314
