Case Study: HRV and Chronic Pain and Anxiety

Early in 2015, our clinical team at Fit To Train treated a female in her mid-30’s who presented with severe lower back pain, and used to be a high-level swimmer just a few years ago. When we saw her, she had already met with many different practitioners in various parts of the world with minimal to no success. She was at a point where there was no comfortable position for her to be in and she had an overwhelming fear that she’d never get better.

Through our assessments, we realized there were many factors that were contributing to her back pain. In particular, there were serious emotional concerns that caused her severe anxiety, which worsened when her back pain became difficult to manage. Due to this, we immediately started her on HRV monitoring in order to track her emotional and physiological parameters, while assuring her that we were giving her the right support and advice to progress.  The concerned patient’s goal was simple: to function normally without pain so she could get back to swimming.  However, we thought it would be best to begin by  setting multiple, smaller goals, such as documenting 5 things she appreciated every day, gradually getting back into the pool, and decreasing her Selective Functional Movement Assessment (SFMA) score.

We immediately started her on HRV monitoring in order to track her emotional and physiological parameters

As we started various methods of treatment and were assured her lifestyle choices were aiding her recovery, we saw no real improvement in her lower than expected HRV scores, which seemed to be quite inconsistent and erratic. When she started to get comfortable with being back in the water to start swimming, we set a goal that within 6 months time – which would be September 1, 2015 – she would do a 1500-meter open-water swim.  At first, the thought of this was overwhelming for her, but we felt that if she were able to achieve a seemingly “impossible” goal, there would be a shift in her pain and overall function. We felt her emotional health was the largest component of her lower HRV score, and to assess if this was true, we set a goal that would lift a large amount of weight off of her shoulders.

Her emotional health was the largest component of her lower HRV score

Once we had this goal, the patient’s rehabilitation had a purpose and progressed so quickly that by early June 2015, just over half of the time we had originally planned for, we felt she was ready for the challenge.  After the swim, we saw a significant jump in her HRV scores, which correlated to her change in mood and improvement in movement capabilities.

With almost every client I have worked with who is monitoring his or her HRV, there is a component of their psychology that needs to be addressed.  This does not mean everyone has mental health issues – it’s just that there is something in their life that is causing them emotional stress, which, in turn, is affecting their health and well-being. Whether it’s issues with work, family, finances or any other emotional stress, it has the potential to be a breakthrough with the client if that emotional barrier is removed. Our stress response is non-specific, so all factors of the patient’s life need to be reviewed when monitoring and looking to improve HRV.

What HRV is to this patient is individual and specific to this patient only.  Someone’s HRV can be affected by family medical history, emotional health, sleep, diet, physical activity, and other lifestyle habits. Therefore, all of these aspects of life must be taken into account before recommendations are given. Someone with a low HRV gives us a warning flag that if this person outwardly seems perfectly healthy, there is likely an underlying factor that hasn’t been addressed and is affecting his or her health.

Someone’s HRV can be affected by family medical history, emotional health, sleep, diet, physical activity, and other lifestyle habits. Therefore, all of these aspects of life must be taken into account before recommendations are given.

Interested in learning more about the science behind HRV and how monitoring it can help improve your health and performance? Get access to the “Foundations of Heart Rate Variability” course in August!