20 CHAPTER Relaxation Cater cee 4 Elements of Relaxation Training © What is Stress? 4 Physiological Changes during Stress/Stress @ Relaxation Techniques Reaction BEWHAT IS STRESS? Stress is how our body responses to anything that requires action or attention. Stress can be physical, psychological, and emotional. Stressful situation triggers release of hormones that alters the normal physiological function of our body. These physiological reactions are known as acute stress response or fight or flight response. ‘The sympathetic division of the autonomic nervous system (ANS) is associated with this fight or flight response, it mobilizes the body in emergency and stressful situation, When stress persists fora prolonged period of time these changes become habitual and it requires medical attention. Relaxation techniques are most ind are effective to treat such condition, commonly used au of increased calmness, reduced level @ Relaxation techniques help a person to attain a state ofanxiety, stress, anges, and even pain. 5 the direct negative of nervous excitement. Its the absence of nerve-muscle @ Relaxation i: impulse—Jacobson. In simpler terms, itis relatively tensionless state of body and mind IN PHYSIOLOGICAL CHANGES DURING STRESS/STRESS REACTION (FIG. 25.1) Stress effects the body in multiple ways. It has profound effect on almost all the systems of our body. The changes that takes place when the body is uncler stress are as follows Increased heart rate @ Increased respiratory rate Increased blood pressure Increased muscle tone both local and postural muscles Extreme fatigue and chronic pain Lack of concentration| + Depression + Centra fatique Heart +t Heart rate +1 BP +1 Cholesterol +t Risk of heat attack Digestive system + Stomach carmps Acidity Nausea table bowel + Diarthea Muscles 7 Bone + Fatique and + Frequent joint pain Fig. 25.1: Effects of stress on body. (BELEMENTS OF RELAXATION TRAINING 4 Quiet and peaceful environment: Its a requirement for all the relaxation techniques. This, helps the patient to concentrate on the commands of he therapist and follow t. There should beno distraction of any type that will divert the attention of the patient. 4 Passive attitude: Passive attitude of the patient is very much essential as it is mandatory that he ollows all the instructions passively. This helps the patient to refrain from stray thoughts and do as instructed by the therapist. + Support and comfort of the patient: The patient should be in a most comfortable position with all the body parts supported and the muscles should be in a relaxed position, so that the muscle activity is reduced to minimum. Commonly used positions for relaxation are as follows. Supine Patient is positioned in supine on a firm mattress which accommodates to the contours of the body, Head and neck supported on a pillow without rolling to either side. A small pillow Placed under the knee to relax the hamstring muscles and structures anterior to hip joint ‘nd the lumbar spine. Arms supported by pillows in slight abduction at shoulder and elbow flexed wrist and hands held loose and rests on the pillow. Feet supported in mid-position by Pillow (Fig, 25,2),ETSI Chapter 25 | Relaxation . eae? Fig. 25.2: Relaxation in supine position, Prone Head tumed to one side. A small pillow is placed under the hip and abdomen to preven hollowing ofthe back. For women, a small pillow is placed under the chest to prevent presse on the breasts. A pillow is placed under the distal legs which help to relax the knees as yelan supports the ankle (Fig. 25.3). Side Lying In side lying, a pillow under the head supports the head and keeps it aligned withthe ba The uppermost arm and leg are supported on pillows placed anterior tothe body (Fig, 25.4) Fig. 25.3: Relaxation in prone position. Fig. 25.4: Relaxation in side lying position. ar wy coe a g or Reclined Position such as respiratory problem, the patient finds it difficult to assume any ofthe above a4 position. In such cases, half-lying position or reclined sitting is ideal for relaxation, rmenioned cchait may be used or pillows can be used to support the body in reclined position, ee aon vechniques can be broadly classified in L ‘Local relaxation 2, General relaxation Local Relaxation ‘jal relaxation technique is required when only a part of the body ora particular muscle js under excessive tension, which occurs due to excessive work of a particular group of _fnseleas occursin occupational stress. In such instances techniques are used torelaxonly the paral group of muscle. Various techniques used for local relaxation areas follows: + Contrast method: Sometimes, the tensed state of the muscle lasts for so long that the patient doesnot appreciate the relaxed state. In such situation, the muscle is made to contract with ‘a maximum force either isometrically or concentrically for a brief period of time. In other words, the muscle is made to fatigue and then itis released or let go. The muscle is allowed {orelax and feel the state of relaxation, By repeating it for a number of times, the muscle is helped to relax. 4 Hold-relax: This technique is one of the special techniques used in proprioceptive neuromuscular facilitation (PNF). In this technique, the tense muscle sidentified. Then the muscleis contracted isometrically against resistance given by the therapist. The contraction {sheld till the muscle begins to fatigue. Then the contraction is released and the muscle is. allowed to relax. Contract-relax: Like hold-relax, this technique is also a special technique of PNE. Here, the tensed muscle is identified and it is contracted concentrically against a strong resistance in ‘small range. After this, the resistance is released and the muscle is allowed to relax, Passive movement or pendular movement: Both types of movement when done thythmically can be used for relaxation of a particular group of muscle. It is explained in detail in separate chapter. Massage: Massage is used since long to induce both local and general relaxation. It is explained in detail in a separate chapter. General Relaxation ae of relaxation is used when itis required to relax the whole body as well as the 4 The following techniques are used for general relaxation: ; ee 's progressive muscle relaxation (JPMR) 4} Llit® Mitchell's method of physiological relaxation “ aang cognitive imagery/guided imagery technique * Meditation * Deep breathingpo Jacobson Progressive Muscle Relaxation scan physician Edmund Jacobson in 1920s. Wisbased on th thy eican promote mentalrelaxation. He found thata muscle asa tenga h group of muscle i tensed and then itis af relay before moving on to next group of muscle. ntis positioned in a comfortable position. The Surrounding are hey nut any distraction, is given the following instructions. ‘group of muscle Inthe fst phase, tense the muse The count should be rhythmic, Inthe second phase, rely ation for a count of 10. o toe, observe and fel the sensation oflightness an telaxatign > Asyouexercise from head t each part of the body. f other parts of the body sts separately, feel the tension in both the fist and forearm, e it and feel the relaxation in your hand and forearm, Do each arm separately, bend the elbows and tense the muscles ofthe arm with the ads relaxed. Feel the tension (count of). Release the tension, relax the arms and fel the relaxation (count of 10). Scaighten both the arms separately tense the muscles ofthe back ofyour arm, and fee the tensioniin the back ofyour arm (count of5). Release it and feel the relaxation (count of 10) For facial muscle: > Raise your eyebrows toward your hair line, wrinkle the forehead, and feel the tension in the forehead muscles (count of). Release it and feel the relaxation in the forehead. > Close your eyes screw the muscles around your eyes, Feel the tension in the muscles (count of 5). Release it and relax, fee! the relaxation in your muscles. » Tense your jaws by grinding the upper and lower teeth together, feel the tension in the muscle of the jaw (count of 5). Release it and relax, and feel the relaxation, > Press the tongue hard against the roof of your mouth with lips closed, feel the tension in the throat (count of). Release it and relax, and feel the relaxation. Forneck and shoulder: ~ Push the head back against the plinth, and feel the tension for a count of 5. Release the pressure and relax the muscle. Feel the relaxation. ” Press the chin on the chest and hold it (count of 5), then release it. Feel the relaxation. ~ Shrug your shoulder toward your ears and tighten the shoulder muscle. Feel the tension in the shoulder muscles (count of 5). Release the tension. Let the muscle relax and feel the relaxation. ¢ For chest: Take a deep breath till you completely feel the lungs holding the breath for a few seconds, and then exhale passively. Relax and feel the relaxation.Chapt 28 | totnaion abdomen he muscles of your anterior abdominal eomach as if squee7ing t Jor abdominal wall. Hold it Fojuain the stetmion in the abdominal muscle (5 sec onds) Pea ivel De the tension Geoant of 10)- ‘and relax the muscle feel the relaxation in the front of your abdomen, , pack upward as iflifting it up from the plinth. Tense the muscles and feel the hem and hold it (count of 5). in sles and relax and feel the relaxation in your back 7 Sogn and buttock: + For a ene thighs and buttocks by squeezing the muscles ofthe thigh and buttock, “cand feel the tension (count of 5) rae he muscles lose and fee the relaxation yout wl . For eet ene oes toward Your head, producing tension in the calf muscle. Hold it (count of » PeRelax and feel the Felaxation in the back ofthe leg > mantyour toes away from the head. Feel the tension inthe front of your leg (5 seconds). Posgt and feel the relaxation in the front of your leg (10 seconds) | rortoe: Point your fet downward and curl your toes. Tense the toe muscle feel the tension Forteount of5, Release it and feel the relaxation in the toes for a count of 10 _, Mhasexercise: Relax the body completely, keep your eyes closed. Let yourself remain in Apet sition (2 munutes). Open your eves and enjoy the renewed energy. Feel relaxed, sit tp scetch the body, and stand slowly. Laura Mitchell's Method of Physiological Relaxation 's This technique was devised by Laura Mitchell in 1957. It is based on the physiological of reciprocal inhibition, that is, when a particular muscle group is tightened to produce a movement the opposite group of muscle tends to relax to allow the movement totake place. 4 Once leaned and practiced, it can be used easily anywhere to relax and reduce muscle tension produced by stress. ¢ Movementis controlled by nervous system, when one group of muscle is instructed to tighten and the opposite group of muscle receives an instruction to relax. So in this technique, the tensed muscle or muscle group is identified. Instructing the opposite group of muscle to tighten will automatically result in relaxation of the tensed muscle group. Procedure Kinvolves three basic steps: 1 Identify the position of stress 2. Move away from the position of stress 3. Stop, be aware of, and feel the new position Orders to the arm + Shoulder: > * Pull your shoulders toward your feet, away from the ears, making the neck longer. * Feel that the should i fers are lower down and there is a new wider space between your ears and shoulders nyyo a. | EE crore 25 | Relaxation * Elbows: » Keep your elbows your elbow joints. > Stop > Feel the position of your atm and elbows and pressure of your arm on they my through the sensation of your skin, Port * Hand: » Fingers and thumb long and supported. Open out your fingers and thumb With wig resting on their support " Stop Feel your fingers and thumb fall back on their support feel the hands at sill ang ad of the finger touching their support. ” Concentrate on the pleasure of feeling your resting hands. Order for legs * Hip: > Tum your hips outward. > Stop » Feel that your legs have rolled outward. @ Knees: > Press your knees gently until uncomfortable. > Stop ‘el comfort in your knees. nd open, Keep your aris supported then push them doy one q iy = v * Feet: > Push your feet away from your face. Bend the ankle downward gently pointing your toes > Stop > Feel that your feet are loose at the ankle and all the leg muscles are now relaxed Orders to the body Press your body into the support of bed or floor, % Stop % Feel the pressure of your body on the support. Orders to the head % Press your head on to the pillow chair, Feel the movement of the neck as you do this, % Stop Feel the weight of your head on the pillow as your brain registers. This relaxes the neck muscle. Breathing orders * Take a deep breath, feel your tummy swell out then breathe out easily, repeat it twice. Feel the ribs moving in and out Order for face * Jaw: * Drag your jaw down. Do not open your mouth, just unclench your teeth inside the mouth. > Stop 7 Feel the space between upper and lower teeth with your lips, gently touching each other. © Tongue: > Bring your tongue down and let it li in the middle of mouthme » S10 7 ae tip of your tongue touching your lower teeth > yes: 4 Evtjose your eyes lightly do not screw them shut 5 eam of the darkness with your eyes at rest yead: > Smooth the skin of yout forehead from the eyebrows o your hair continuing the movement verthe top ofthe head and down to the neck, widening the eyebrows, and making them wrinkle free. » Stop > Feel the smooth skin of your forehead, skull, and back of the neck and relax them. You have completed the whole sequence. Itcan be practiced in the same manne: again Itcan be started with one body part ata time, till you feel the tens ‘Once you master this, it can be performed after any stressful condition. To return to full activity after doing the Mitchell's methed of relaxation, stretch your limbs inany direction. Try not to hurry, sit up or stand up slowly. Practice total relaxation daily, until you have mastered the changes. Once you feel confident, you can find positions and timings thatwork for you, and help you to find relaxation when you need it. Biofeedback This technique involves giving feedback to the patient about various body functions which are supposed to be altered in anxiety (absence of relaxation). Electrical sensors are connected to various body parts which are connected to a biofeedback device. These feedbacks help the patient to perceive the phase of tension and then make subtle changes to relax them, e.g, if the sensors are connected to show rate of breathing, the patient ismade aware of this increased rate of breathing. He is then encouraged to normalize it. In the same manner, increased muscle tension can be perceived by the sensors attached to a tensed ‘muscle and the patient tries to normalize it. By this way, the patient learns the ability to practice new way to control body which ultimately helps to p health ofthe patient. Types of feedback 1. Brain waves: Sensors are placed on the scalp to monitor the activity of brain by using an electroencephalogram (EEG), 2. Rate of breathing: Bands are placed around chest and abdomen to monitor breathing pattern and respiratory rate by using a respiratory biofeedback. 4. Heart rate: Sensors are placed on chest, trunk, and wrist by using an electrocardiogram (ECG) to measure heart rate and see how it varies, ‘contraction: Sensors are placed on skeletal muscles to monitor the electrical activity dfamscle by using an electromyogram (EMG). Helps to perceive the abnormality and helps Normalize it 5 Sweat land activity: An electrodermatograph (EDG) is used to measure the activity of sweat ‘land by placing sensors on fingers, palm, or wrist. Increased perspiration alerts a state of in and 8 al ease. ote relaxation and in turn improves om. ‘Temperature: Sensors are attached to palm fingers or feet. Temperature often drops under and feeling of cold hands and feet is perceived by the patient. Lower reading of ‘ture prompts the patient to begin relaxation technique. a XNDET cane 25 | Relaxation Mental Imagery/Cognitive imagery/Guided Imagery Technique | pmote relaxation, st as magination of sess ing and soothing events ean induce at This technique uses imagination to produces anxiety, the imagination of 16 involves concentrating om a specific objec, sound, oF experience to cal theming si Nidan Maton, 4 Procedure + Patient assumes a comfortable relaxing position Relax and concentrate on his own breathing pattern Imagine a peaceful scene, such as forest mountala range or a quiet beach Think of the details in the scene, such as the sound of the water or the breeze Imagine a path in the scene and walk along the path + Relax in your scene for several minutes # After 15 minutes, count to 3 and open your eyes This technique can also be performed easily with an audio recording Effect According to research, this technique helps to reduce stess and anx and eases various symptoms related to stress. el, PHOMOWES relaxation Meditation Meditation is method used since ancient times to improve concentration, stress reduction, and relaxation. During meditation, we focus ou attention and eliminate the jumbled thoughg that lead to stess, There are many types of meditation used for reducing ansiety and induce relaxation, Meditation affects the boul in exactly the opposite way that stress does. riggers the boy relaxation response and restores the body toa calm state, helping it to repair itsel. calms the body and mind, and quite the stress induced thoughts that keep the stress response triggered There are many forms and types of meditation that are used successfully to help in relaxation Deep Breathing Deep breathing techniqu ina separate chapter. al relaxation. tis explained in deta we used as a techn ue of gene Effects of relaxation training © Reduces anxiety and tension Improves sleep Relieves pain, such as back pain and neck pain Improves both systolic and diastolic blood pressure Decreases heart rate Decreases rate of breathing Increase in blood flow to primary muscle Increases self-confidence and manage problems Suppress tension and anger Lower blood pressure Increases concentration and memory Increase in energy level Reduces sleep deprivation Decreases metabolic rate Poorer erecees