”Learn how to combine ancient wisdom with a scientific, practical, individualized

approach to be healthy and happy – and achieve true wellness.”

Stress Management & Relaxation Training
(SMART) Program
Health Management in CSS Journey
Dr. Shahzad Anwar
MBBS (Pb), Lic. A.C. (China), DOM (China)
Diplomat Pain Medicine Harvard University (USA)
M.Sc. Pain Medicine (UK & RIU)
Fellowship in Interventional Pain Medicine (Hungary)
Fellowship in Interventional Pain Practice-FIPP (WIP-USA)
Diplomat American Board of Regenerative Medicine (USA)

Interventional Pain & Spine Physician

Regenerative Medicine Specialist
CEO
Iffat Medical Complex Lahore, Pakistan
Director
School of Pain & Regenerativ e Medicine The University of Lahore.
www.iffatanw ar.com
 Owner & CEO Iffat Anwar Medical Complex, Lahore.

Director
School of Pain & Regenerative Medicine
The University of Lahore.

Faculty & Examiner World Institute of Pain (WIP)

Faculty Member Pain School International Budapest, Hungary.

Disclosures
Faculty Member International Academy for Endoscopic Spine Surgery
Istanbul, Turkey.

President Society for Interventional Pain Medicine (SIPM) Pakistan.

President Society for Regenerative Medicine (SRM) Pakistan

No financial disclosures
Objectives of the Lecture
• Understanding Stress
• Coping Strategies
• Relaxation Techniques
• Health Preservation
A Challenge

Please write one sentence

Definition of
S T R E S S.
I HATE YOU

WHAT IS STRESS ?

• Stress is anything that causes mental,

physical, emotional, or spiritual tension.

• Stress is the “wear and tear” our minds and

bodies experience as we attempt to cope with
our continually changing environment.
 HELP ME!

WHAT IS STRESS ?

• Simply put, stress is any outside force or event that

has an effect on our body or mind.

Stress is life.

It arises when we worry that we can’t cope.

S=P>R
Stress occurs when the pressure is greater than the resource
TYPES OF STRESS
NOT ALL THE STRESS,
WE EXPERIENCE IS
NEGATIVE
 EUSTRESS

Eustress or positive stress occurs when the

level of stress is high enough to motivate you
to move into action to get things accomplished.
 DISTRESS
Distress or negative stress occurs when the
level of stress is either too high or too low and
your body and/or mind begin to respond
negatively to the stressors.
The Stress Response
 The Stress Response

Dr. Hans Selye Dr. Walter Cannon

1930’s

‘Fight or Flight Response’

 Endocrine System

Stress response is controlled by the Endocrine

System.
➢Sympathetic
➢Parasympathetic
• Increased or excessive demands on the
physical or mental systems of the body
result in increased sympathetic activity and
hormone secretion (Adrenaline,
Testosterone)
 SYMPTOMS OF STRESS

• Physical symptoms
• Mental symptoms
• Behavioural symptoms
• Emotional symptoms
When you are stressed, it may result in any or all
of the following:

• Decrease in communication.

• Decrease in motivation.

• Decrease in performance.

• Learned helplessness.
• According to Wikipedia, “learned
helplessness is a psychological condition in
which a person feels that he/she has no
control over his/her situation and that
whatever he/she does is futile.
• As a result, he/she will stay passive when
the situation is unpleasant or harmful.”
 STRESS RELATED ILLNESSES

Stress is not the same as ill-health, but has

been related to such illnesses as;

• Cardiovascular diseases
• Immune system diseases
• Asthma
• Diabetes
• Cancer
• Modern medical science proves that more
than 95% of diseases result from chronic
stress.
 COSTS OF STRESS

• In the UK, 40 million working days per year

are lost directly from stress - related illness.
Costs in absenteeism to British economy are
estimated at £ 4.5 billion pounds per year.
RECOGNISE THE
PROBLEM

The most important point is to recognise

the source of the negative stress.

This is not an admission of weakness or

inability to cope!

It is a way to identify the problem and

plan measures to overcome it.
RELAXATION
TECHNIQUES
 What is Relaxation?
• Relaxation is the act of relaxing the mind and
body and can also be defined as the state of
being relaxed.
• Exercise
• Sleep
• Leisure
• Deep Breathing
• Meditation
• Qi Gong
• Progressive Muscle Relaxation
• Stretching
• Detoxification
• Fasting
• Spirituality
 EXERCISE
• Exercise daily for 30 – 45 min.
 Benefits of Exercise
• Uses up excess energy released by the
‘Fight or Flight’ reaction.
• Improves blood circulation
• Lowers blood pressure
• Clears the mind of worrying thoughts
• Improves self-image
• Makes you feel better about yourself
• Increases social contact
 Sleep
• Good stress reducer
• Difficult to cope when tired
• Wake refreshed after night’s sleep
• Plenty of daytime energy
 Understanding the Sleep Cycle

The human sleep cycle consists of four stages

- NREM (Non-Rapid Eye Movement) Sleep: Stages 1, 2, and 3
- REM (Rapid Eye Movement) Sleep: The fourth stage

- Each complete cycle lasts about 90 minutes

NREM Sleep: The Foundation of Restoration

- Stage 1: Transition from wakefulness to sleep

- Stage 2: Light sleep, heart rate slows, body
temperature drops
- Stage 3: Deep sleep, crucial for physical
recovery and growth hormone release
 REM Sleep: The Dream Stage
- Occurs approximately 90 minutes after falling asleep
- Characterized by rapid eye movements, increased brain
activity, and vivid dreams
- Essential for memory consolidation, learning, and emotional
processing
- The duration of REM sleep increases with each cycle
throughout the night
 The Benefits of Good Sleep
- Physical Health: Boosts immune function, supports
metabolism, and improves heart health
- Mental Health: Enhances cognition, mood, and
resilience to stress
- Performance: Improves concentration, productivity,
and performance in daily tasks
 The Consequences of Poor Sleep

- Increased risk of chronic diseases like obesity,

diabetes, and hypertension
- Greater susceptibility to mental health issues such as
depression and anxiety

- Impaired cognitive abilities and reaction times

 Promoting Quality Sleep
- Establish a consistent sleep schedule
- Create a restful sleeping environment
- Limit exposure to screens before bedtime
- Engage in regular physical activity, but not too close
to bedtime

- Avoid caffeine and heavy meals in the evening

Deep Breathing
&
Meditation
 Meditation Techniques
• The essence of meditation is to quiet your
thoughts by focusing completely on just one
thing.
• Unlike hypnosis, which is more of a passive
experience, meditation is an active process
which seeks to exclude outside thoughts by
concentrating all mental faculties on the subject
of meditation.
• Keep your body relaxed. It should be in a
position that you can comfortably sustain for a
period of time (20 - 30 minutes is ideal).
 Breathing

• Focus your attention on your breathing.

• Concentrate on breaths in and out. Count your breaths
using the numbers 0 to 9.
• Visualize images of the numbers changing with each
breath.
• Alternatively, visualize health and relaxation flowing
into your body when you inhale, and stress or pain
flowing out when you exhale.
 Qi Gong

• As part of Traditional Chinese Medicine (TCM) being practiced for the last 5000 years for
health preservation.
• Breath out deeply and slowly. First feel your belly
contract in towards your spine, then feel the air
move through the chest, up the neck, and through
your mouth.
• Now breath in slowly.
• Focus on the air moving in your nose, down your
neck into your chest and feel your belly push out.
Hold your breath for a few seconds.
• Hold the breath as long as comfortable.
• Visualize stress leaving your body while breathing
out.
 Progressive Muscle Relaxation

• While sitting or lying down, tense the muscles of

your feet (curling your toes) as hard as you can.
• Then relax them.
• Do this once or twice for each part of the body
• Continue this process for each muscle group all the
way up your body until you reach your head.
• When finished remain relaxed for a few minutes
 Stretching

• Several stretches can be done at your desk

• Tilt head to the left and hold
• Tilt head to right and hold
• Reach arms over the head and interlace fingers
j0140285[1]
ACUPRESSURE
 KI-3
(Kidney 3)

• Location: On the inside of the foot, halfway between

the Achilles-tendon and the side of the ankle-bone.
Use: Press.
Effects: Heals effects on the body of too much fear.
( Also for lower back pain)
 LIV-3
(LIVER 3)
• Location: On the foot, on the line between the big toe and the second toe.
The point is located about 3 finger widths from the edge, in the depression
the size of a finger tip you can feel there.
Use: move your finger in counterclockwise direction over this point.
Warning: Don't use when weak or low on energy (in that case use SP-6
instead).
Effects: Relaxes and unblocks emotions (especially repressed anger).
Depression, Relaxes body muscles.
 SP-6
(Spleen 6)
• Location: On the inside of the lower leg, one hand width (four fingers)
above the tip of the ankle bone, on the back of the shin bone.
Use: Press.
Warning: Don't use this point during pregnancy.
Effects: Calms, relaxes and reduces irritability. Heals effects on the body of
too much fear, worrying and thinking. (Also used for gynaecological
conditions.)
 ST-36
(Stomach 36)
• Location: On the front of the leg, one hand width (four fingers) below the kneecap,
on the outside, in the depression between the shinbone and the leg muscle. It's at the
outside of the bone that's on the front of the lower leg, one finger breadth from the
crest of that bone.
Use: Press. A fingernail or thumbnail is particularly suited for this point, as you will
be able to press more closely to the bone and on a broad range.
Warning: Using this point to go beyond your limits (e.g. overwork) will damage
your health even further.
Effects: Increases stamina and energy. Provides stability and grounding. Heals
effects on the body of too much worrying and thinking.
 LI-4
(Large Intestine 4)
• Location: On the top side of the hand, on the web between thumb and index
finger. To locate, squeeze the thumb against the base of the index finger. The
point is located on the highest point of the bulge of the muscle, level with
the end of the crease.
Use: Press.
Warning: Don't use this point during pregnancy.
Effects: Letting go of grief. Calms. Headaches.
 LI-11
(Large Intestine 11)
• Location: On the side of the elbow, on the outer side of the arm. Bend your forearm
with your hand towards your neck, the point is located at the end of the crease at the
elbow. This is halfway up the side of the arm.
Use: move your finger in counterclockwise direction over this point.
Warning: Use this point only when there is Heat, as when you're red in the face or
your skin feels hot to the touch and you're feeling warm from prolonged anger (not
from exertion). Don't use when weak or low on energy.
• Effects: Heals effects on the body of too much anger.
 PC-7
(Pericardium 7)
• Location: On the middle of the palm-side of the wrist, in the depression
between the two tendons, on or just below the crease of the wrist.
Use: move your finger in counterclockwise direction over this point.
Warning: Don't use when weak or low on energy.
Effects: Heals effects on the body of too much joy or emotion.
Also diminishes nervousness.
 Sj-5
(Sanjoa 5)
• Location: On the lower arm, on the top side, two thumb
widths below the crease of the wrist. In the middle, in the
depression between the bones and tendons.
Use: Press.
Effects: Increases expressiveness and sensitivity to feelings.
 GB 20
(Gall Bladder 20)
• Location: just under the base of the skull in two small muscular grooves at
the back of the neck.
• Use: move your finger in counterclockwise direction over this point.
Warning: Don't use when weak or low on energy.
Effects: Heals effects on the body of too much joy or emotion, headaches,
stress and high blood pressure.
Auricular Massage
 Pre-Breakfast

• 3 – 5 Dates or
• 3 – 5 Figs
(Dipped in water overnight).

• 7 – 9 Almonds.

• 1 - 2 Walnuts.
 Anti aging Nutritional Supplements

• Most of the cultivation done worldwide is inorganic,

size has increased but the natural vitamins and trace
elements have decreased.
• Vitamins are the major source of anti-oxidants.
• Trace elements like Zinc, Selenium, Magnesium &
Calcium.
• Take one tablet of multi vitamins and 2 tablets of
vitamin C.
• Herbs like Ginseng and Ginkobiloba are rich in anti
oxidants.
Detoxification
 Detoxifying Cocktail
• 1 glass of grape fruit juice/ orange juice.
• 2 table spoons full of honey.
• 2 table spoons full of olive oil.
• ¼ cup of lemon juice.
• 2 cloves of garlic (crushed).
• Time: 11:00 pm – 1:00 am (once a month or
every fortnight).
REFLOXOLOGY
 Leisure
• Interest
• Gives you a ‘break’ from stresses
• Provides outlet for relief
• Provides social contact
 Get a Massage from yourself or from
a professional
Self-Massage
• Sit with your shoulders relaxed
• Use your right hand to massage you left
shoulder and neck, working your way up to the
scalp
• Repeat with left hand for right shoulder
 Get Organised

• Poor organisation is one of the most common

causes of stress.
• Structured approaches offer security against ‘out
of the blue’ problems.
• Prioritising objectives, duties and activities makes
them manageable and achievable.
• Don’t overload your mind.
• Organisation will help avoid personal and
professional chaos.
 Time Management

• Managing your time well,

makes you successful.
 Time Management
• Make a list
What MUST be done
What SHOULD be done
What would you LIKE to do
• Cut out time wasting
• Learn to drop unimportant activities
• Say no or delegate
Time Management Quadrant
1 Urgent 2 Not Urgent
Important Important

3 Urgent 4 Not Urgent

Not Important Not Important
 • Plan your day
• Set achievable goals
• Don’t waste time making excuses for not
doing something
 Spirituality
• Stress is one way of nature telling
us to attend our spiritual needs.
 Stress and Spirituality are NOT
polar opposites.

• Stress provides the opportunity for

spiritual growth... when we learn from the
experience!
 PREVENT
P - Prayer/Spiritual Centering
R – Relaxation & Sleep
E – Exercise
V – Viewpoint
E - Eating Healthfully
N - Neighborly Love
T - Time Management
Thank you very much for your
patience.