Remember back to school, pushing to get through midterms or finals and then crashing immediately after the madness ended? In all of my years in practice, I've seen it from the other side, with students coming home after being off at college or grad school. They come in for a visit after finishing up finals and they're a mess! Their bodies are failing after being overtired, overcaffeinated, overstimulated ... the "let-down effect."
According to Dr. Marc Schoen, who coined the term, the let-down effect "is a condition that leads to illness or symptoms following stressful events, such as conflict, time pressured work projects, or school exams."1 Since our bodies only have one, old-school way of handling stress, this effect can also occur after positive stresses, like weddings, vacations, holidays or transitioning to retirement. We know of these situations as eustress – stress that's considered to be positive.
Whether the stress is positive or negative, our bodies handle it in the same way. The body doesn't recognize the difference, so the process is the same.
The human body only has the capacity to handle so much stress at once. We strive to survive the situation. As soon as we move through it and have a second to catch our breath, all that physiological and psychological aftermath kicks in to affect our overall health. The stress response is designed to be short term, with a regulation back to homeostasis. This is especially difficult under prolonged stress without a clear ending, such as in legal action, illness, grief, or searching for a job.
Post-COVID: Let-Down Running Wild
Since March 2020, our entire society has been in the throes of dealing with the COVID-19 pandemic. As the world begins to now reopen with the vaccine being distributed, we will begin to see the let-down effect in action. This shows up differently for various people, with impact related to their physical and emotional states of health. For some, it will show up as anxiety / depression; for others as arthritic pain, sleep disturbances, binge eating or headaches / migraines.
I've personally seen patients who literally hadn't left their homes in a year. The fear and isolation that has been predominant for so many people will have profound effects that are just starting to be revealed.
Even for people who haven't been as strict about staying home, they still report higher levels of social awkwardness and unwillingness to be in public. Yet life is beginning to get back to business as usual, so even those who aren't fully embracing it will have to push through their comfort zones to some extent.
The chemical effects of chronic stress will begin to present as the stress itself is lessened. What's fascinating is that the same process occurs even if the perceived stress is lowered. The stress hormones, adrenaline and cortisol, which initiate the immune response, have been working so hard to bring each person through their individual situation. They will begin to deplete as the body receives the signal that the stressful stimuli is reduced.
Simultaneously, prostaglandins, chemicals left behind after the stress response, tend to instigate the inflammatory response, which can directly lead to arthritic pain, heavy or painful menstrual cycles and migraines.
A study published in Neurology in 2014 tested the hypothesis for the let-down effect in relation to migraines. It concluded that "reduction in stress from one day to the next is associated with migraine onset the next day. Decline in stress may be a marker for an impending migraine attack and may create opportunities for preemptive pharmacologic or behavioral interventions."2
Anita Wang, MD, says, "The Let-Down Effect is the equivalent of going from 100 mph to a dead stop in a car. It's not good for your car, and it's not good for your body."3
Strategies to Help Affected Patients
Some amount of the let-down effect is inevitable, but how can we smooth out the transition? Reducing the stress gradually is the most profound way to ease the changeover in our bodies. Once the uncontrollable stress is reduced, you can introduce higher levels of mental and physical stress, like running, exercise or crossword puzzles.
Bringing the stress down slowly will allow the body to regulate more efficiently. Coming home after a stressful day and checking out in front of the TV is like bringing your body to that dead stop without any slowing down; whereas going for a walk after work or coloring would guide the body toward a level of homeostasis with a calming effect.
This is known as somatosensory regulation, rhythmic activities to calm the brain. Actions with consistent movement will allow the brain to settle without coming to a complete halt.
Sleep is also an important part of rebuilding the body's strength. After I see a patient who's been involved in a car accident, I teach them that they'll be extremely tired for the next few weeks. This is due to the trauma their body has been through.
Internally, there's an intense amount of repair going on which may not be visible, but will zap their energy. I recommend allowing themselves more time to rest and to lighten up their schedule.
The same process applies for coming down from an emotionally stressful situation. Rest is the way to support the immune system, protecting us from downward spirals into poor health.
Clean eating and minimal alcohol intake also go a long way in supporting the body during the let-down process. Processed carbohydrates and alcohol increase inflammation, which is already high after severe stress; and lead to higher rates of physical pain and migraines.
Another Way to Make a Difference
Collectively, our society will be going through a communal let-down process as the world returns to normal. Knowing that this a time of higher potential for physical and mental conditions is critical, and can keep people from feeling like they're falling apart when they should be better than ever.
As a doctor, I'm aware of this phenomenon and have already seen it repeatedly in my practice. I've found that explaining what the let-down effect is and the timing of it offers comfort to patients dealing with it. Often once the condition is known, it's easier to accept and manage it with the techniques I've outlined.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
