CHAPTER

Relaxation

LEARNING OBJECTIVES
On completion of the chapter, students will be able to:
DEnlist factors affecting relaxation. n Describe the different methods of
achieving general
OOutline the maintenance of postural tone. relaxation.
OState conditions required for general relaxation. O Describe the methods and uses of obtaining local
relaxation.

CHAPTER OUTLINE
O Introduction OPathological Tension in Muscles
O Muscle Tone Technique
O Postural Tone O General Relaxation
O Voluntary Movement 0 Local Relaxation
O Mental Attitudes 3 Conclusion
O Degrees of Relaxation

INTRODUcTION
Muscles which are relatively free from tension and at rest, are said tobe relaxed.) Tension develops in muscies
as they work during contraction and this tension is reduced to avariable degree as the muscles come to rest
during relaxation.

IMUSCLE TONE
Under ordinary circumstances, living muscles are never completely free from tension, as they retain aquliy
of firmness known as muscle tone even when they are as relaxed as possible.
Muscle tone, which represents astate of preparedness in resting muscles, is nowthought tobe maintained
through the activity of the muscle spindle circuit(The etterent fibres of this snall ibre nervous retlex pathwa!
trans1mit impulses which produce a sustained contraction of the snall intrafusal muscle fibres of the muse
spindles, while the large extrafusal fibres concerned in the production of voluntary movement remain relaxe
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POSTURAL TONE
The contraction which persists in the muscles concerned with the maintenance of posture (chiefly the anti
oravity muscles) is called postural tone. Postural tone is maintained and regulated by a reflex mechanism, the
fundamental basis of which is the myotatic or stretch reflex, although the higher centres also exert acontrolling
influence. Any stretching of the muscles by an external force, such as the force of gravity, stimulates sensory
receptors situated within the muscles themselves and so gives rise to a discharge of motor impulses to the
same muscdes. These motor impulses bring about acontraction of asufficient number of the muscles motor
units to increase the tension sufficiently to enable the effects of the force, which produced the stretching to
be counterbalanced.
As tension in these muscles is increased in response to stretching of their constituent fibres by an external
force, and in proportion to the degree of stretching to which they are subjected, it follows that the use of
measures tending to reduce or eliminate the effect of this force assists in promoting their relaxation.
The degree and location of postural tone varies with any alteration in posture. It is greater in the upright
positions, in which the force of gravity tends to stretch the muscles more strongly, than it is in recumbent
positions, in which the effects of the force of gravity upon them is adequately counterbalanced by full support
of the body. Those recumbent positions which provide full support for all segments of the body are therefore,
most suitable for obtaining general relaxation.

IVOLUNTARY MOVEMENT

Specific muscles contract as they work to initiate or control movement, but at the completion of the movement
in question they relax and come to rest.

Must Know
There is a recognised biological principle that activity of living cells tends to be followed by inhibition of that activity.
Contraction in any one group of muscles is accompanied by a reciprocal relaxation of the antagonistic group to allow!
movement to take place smoothly. These facts are of great importance during consideration of methods designed to !
iobtain relaxation of a particular group of muscles.

IMENTAL ATTITUDES
Mental attitudes, such as fear, anger and excitement give rise to a general increase in muscular tension which
Serves a useful purpose by preparing the muscles for rapid or forceful action.
Normally, this tension, developed to serve a useful purpose, is relaxed when the need for it no longer
exists, but in some cases, it persists and becomes habitual which may lead to alterations in normal posture.
Recognition of astate of tension followed by voluntary relaxation of the muscles in which it is present
provide a means of helping the patient to economise in nervous energy, and in cases where the tension has
resulted in the reduction of the normal range of movement inajoint, an increase in mobility can be achieved.
As fear in one form or another is the most usual cause of persistent tension, the physiotherapist must
do her best to reassure the patient and to gain his confidence and co- operation. An atmosphere conducive
to rest, both mental and physical, contributes much to success in helping the patient to acqire the art of
voluntary relaxation.
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| DEGREEsOF RELAXATION
The degree to which muscular tension can be reduced is highly variable and it is better to regard tha.
'relaxation' merely as an indication that some reduction in tension has taken place. It is often
estimate the degree of relaxation achieved by gentle passive movement or by palpating the muscles to possible
instance during massage, and the fact that a patient falls to sleep during treatment is ample proof that
method of obtaining general relaxation has been successful.

IPATHOLOGICALTENSION IN MUSCLES
A
marked, persistent increase in muscular tension or tone is a feature of many pathological conditions wh:a
affect the nervous system. Lesions of the higher motor centres, and those which interfere with the nor
function of the nervous pathways which connect them with the spinal reflex arc, commonly result in
abnormal state of muscular tension which varies from hypertonicity to spasticity or rigidity. A temnor
reduction in this tension in the affected area can be achieved in some cases by suitable means which Drom
relaxation, and this allows re-education of any functional activity which remains to take place.

TECHNIQUE

|GENERAL RELAXATION

Support, comfort and a restful atmosphere are basic conditions for general relaxation and may prove effectie
without additional methods.

Support
Various forms and modifications of the lying position are used, to achieve full support of the body, the relative
suitability of each one varying according to the condition of the patient and to individual preference. The
weight of the body is thus, effectively counterbalanced by the uniform upward pressure of a reciprocal surface.
or by suspension, in a position of semi-flexion which obviates all mechanical tension on muscles or ligaments.
Lying Supine
Afirm surface is essential, and if resilient also, as in the case of a good spring mattress, it is ideal, as it wil
mould itself to the body contours and give even pressure and comfort. At all costs plinths or beds which
sag are to be avoided as they cramp the thorax and so throw additional strain on the inspiratory muscies.
Ahead pillow is required which is sufficientlysoft to prevent the head from rolling to either side, and
be well moulded to support the neck posteriorly.
A smallpillow under the knees relieves tension on
the Hamstrings and the iliofemoral ligament, and
consequently allows the pelvis to roll backwards
so that the lumbar spine is straightened and
supported. The feet are held in the mid-position by
a sandbag or similar device, and each arm, slightly Fig. 7.1: Lying supine for Relaxation
abducted at the shoulder and flexed at the elbow,
rests on apillow (ig. 7.1).
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Sandbag

Footrest

method
Fig. 7.3: Half lying: another
Fig. 7.2: Half lying adapted for relaxation

HalfLying
and abdominal
breathing is easier as there is less weight on the back
This is similar to the previous position but
pressure on the under surface of the Diaphragm is reduced (Fig. 7.2).
or bed, the thighs are fully supported and the feet
An armchair makes quite a good substitute for a plinth
rest on the floor, or a footstool, or a T-shaped footrest (Fig. 7.3).

Prone Lying
pillow, if more comfortable. A firm pillow under the
The head is turned to one side and may rest on a small
lower abdomen prevents hollowing of the back, and for women, it should extend higher to avoid
hips and the free.
elevated so that the knees are slightly bent and the toes
too much pressure on the breasts; the lower leg is
heels to fall apart, still further induces relaxation of the
Adegree of medial rotation at the hips,causing the
sleeping; other dislike it because of the rotated position
legs. Many find this position comfortable and use it for
of the head (Fig. 7.4).

Fig. 7.4: Prone lying as for relaxation

Side Lying
which the shoulder and pelvic girdles
The measure of relaxation obtained is governed by the efficiency with
rested on the supporting surface
are stabilised (Fig. 7.5). The arm and leg which are uppermost may be impedes respiration. The head
instead of on pillows, but some of the weight then falls on the trunk and this
too high. The majority of
pillow supports the neck and head in alignment with the body, and must not be
relaxation plays in
people sleep on the side, but few are conscious of the part that suitable positioning for
promoting it.

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Fig. 7.5: Side lying for relaxation (view from above)

Comfort
In addition to support and individual preference in positioning, for which some suggestions have already
been made, the ingredients of comfort include freedom to breathe deeply, warmth, abdominal quiescence and
a milddegree of physical fatigue. Removal of constrictive clothing, such as corsets and belts, is essential and
any buttons or suspenders liable to cause presure must be removed.
The room should be warm, but should have a free supply of fresh air. In winter, additional warnth
can be supplied by light but warm blankets, acovered hot-water bottle at the feet, an electric blanket or b
non-luminous infrared irradiation, but care being taken to avoid overheating, as this leads to restlessnes.
For home use, a warm bath gives the most even and pleasing type of heat, but its soothing effect must not
be ruined subsequently by vigorous rubbing with a towel. A light well-balanced meal, rhythmical physical
activity of short duration, such as a brisk walk in the open air, and attention to emptying the bladder before
treatment are all conducive to general relaxation.
Restful Atmosphere
As physical and mental relaxation are interdependent, an effort must be made to secure a state of mental
rest. The treatment- room should be as quiet as possible, as many people for whom training in
relaxation is
prescribed are highly susceptible to the disturbing influence of noise. Afew are worried by complete silence,
but in general, it is the high-pitched intermittent sound produced close at hand which is to be avoided; the
continuous low-pitched 'hum' of distant traffic tends to be soothing. Bright lights and strong colours, such
as red and bright yellow, are said to be stimulating, whereas a room with low well-diffused light, for
instance,
with green and peach furnishings gives a soft and warm glow and provides an ideal setting for relaxation. This
is indeeda counsel of perfection, but much can be done with screens and shades used with a
little imagination,
even in a busy department!
The most difficult and important factor in the creation of a restful atmosphere, and one
which determines
the ultimate success or failure of the treatment, is the manner and bearing of the
physiotherapist. She must
inspire confidence, as fear, in one form or another, is at the root of much of the tension which she can help to
relieve. Her appearance must be tidy and her dress suitable; she must be punctual and move calmly without
hurry or hesitation. Her manner must be courteous, pleasant and understanding and her voice low-pitched
and cdear.

Must Know
Asimple explanation of the routine and any instructions
required are given to the patient in language and terms
which he can understand, so that any anxiety or fear of the unknown is
removed. It must be
isituations and routines with which one becomes very familiar often appear strange and terrifying remembered that
when encountered
ifor the first time.
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Chapter 7 RelaXation Nigh Yieldroes
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Conversation, apart from instructions, should direct the patient's thoughts to contemplation of restrul
and pleasant topics.
immediate
Confidence in the physiotherapist and the treatment is gradually built up over a period of time;beyond
psychological factors the
results are not to be expected and are rarely achieved, often because of
place of a habit
control of the physiotherapist or patient. In successful cases,a habit of relaxation is built up in
part of the patient
of tension, but the formation of new habits takes time. Regular and frequent practice on the normal
or relaxing, and the rhythmn of
is essential, until finally, he becomes an expert in the art of letting g¡'
life. in which activity alternates with relaxation, can be re-established.

Additional Methods of Promoting Relaxation

conducive to relaxation, in which case additional
Tension may persist in spite of the provision of conditions
period of time being
methods to help the patient may be employed. Very little should be attempted at first, the
extended as the ability to relax improves.
Consciousness of Breathing
to mundane problems
Under quiet and comfortable conditions the patient's mind may remain active and turn
concentrate on hisown rhythm
and anxieties, with associated physical tension; in this case, it may help him to
of relaxation
ofbreathing, which must be deep with aslight pause at the end of expiration. Expiration is aphase
and should be accompanied by a feeling of letting go' in the whole body.
Progressive Relaxation
A method by which relaxation may be achieved progressively was devised
and practised by Jacobson of
System as the 'Savasana or "Still
Chicago, and something similar appears in modern literature on the Yoga
Pose (Fig. 7.6).

Fig. 7.6: 'Savasana'The still pose'

Contrast Method
patient does not know that if the
Difficulty inappreciating the sensation of relaxation is not uncommon; the the contrast
muscles are tensed, what to do in order to relax them. This can often be taught by demonstrating
being told to contract
between maximal contraction and the degree of relaxation which follows it. The patient
and continue to let go. Success may be
any group or series of muscles as strongly as possible and then to 'let go' untilhe is so
achieved by another method by which the patient is urged to step up this preliminary contraction undesirable
tired that he has to let it go. There is a large element of suggestion about this as it is unlikely and
that astate of fatigue should actually be produced. This method follows the biological principle that activity
of living cells tends to be followed by inhibition of that activity.
' Routine contraction followed by relaxation is carried out in each area ot the body, the attention travelling
in logical sequence from Jimb to limb and to the trunk and head including the neck and face muscles until all
areas can remain relaxed at one and the sane time. Much practice may be necessary before this is accomplished
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and it is not unusual for the muscles of the leg, for instance, to again become tense while attention has he
focused on relaxation of the face muscles. Before the routine has been completed, the patient frequently d
off to slecp and general relaxation is obtained."When possible, he should be allowed to wake -up naturall
Alternativcly, he must be wakened gently in sufficient time for getting up and dressing to be unhurried. I.
the patient learns to relax the muscles at will from the state of tension in which they are normally maintined
and without previous voluntary contraction.
Physiological Relaxation
This method of relieving tensionwas devised by Laura Mitchell, MCSP, Dip. TP, in 1957. It is based on
physiological principle of reciprocal relaxation.
The position of tension of the whole body is defined in detail, viz. raised shoulders, bent-up elbows and
hands, head and trunk flexed, etc. The patient changes the position of every joint in turn, by exact voluntar.
orders which he is taught to give to his own body, e.g.,
'Stretch the fingers out long
'Stop.
'Feel the straightened-out fingers and the fingertips touching the support.
In this way, the patient induces, firstly, reciprocal relaxation in the muscles that had been working t
maintain the tense positions, and then in the opposite group which he used to change that position. He
two senses
registers the new position of the joints and skin pressures associated with them because these
reach the cortex. In this way, he changes the pattern of tension of the whole body to one of ease by means ofa
method which he can use by himself at any time, and so can stop mounting tension.
Afull description of this method and its application to various conditions, e.g., chest, antenatal, etc. is
given in Simple Relaxation by Laura Mitchell, 2nd Revised edition, 1990.
Passive Movement
Rhythmical passive movements of the limbs and head may assist the degree of general relaxation in some
cases. These movements are generally given as a sequel to massage. Group movements of joints, e.g., tlexion
and extension of hip, knee and ankle, are preferable, but a very high standard of performance on the part
of the physiotherapist is required to obtain results. The rhythm of small pendular movements pleases some
patients.
Many patients must eventually learn to relax where and when the opportunity presents itself, e.g, in
can sometimes becarried out
the train or on a mountain top after a strenuous climb. General relaxation
some asthmatic and
effectively in groups, as in the case of pregnant women, who tend to relax easily, and with
bronchiticsufferers who have had previous individual instruction.