1. MODULE 7 PSYCHOLOGY 310: SPORT & INJURY PSYCHOLOGY UNIVERSITY OF MARY INSTRUCTOR: DR. THERESA MAGELKY SPRING 2016 Relaxation Techniques in Sport Injury Rehabilitation

2. Introduction Athletes are required to cope with many different stressors while participating in sport:  Aspects of competition – e.g., thinking about mistakes  Interpersonal relationships – e.g., expectations from coaches, teammates, or the media  Financial concerns – e.g., sponsorship  Environmental conditions – e.g., weather  Traumatic experiences – e.g., enduring an injury Coping skills, including relaxation techniques, are vital in helping athletes deal with stressors

3. Relaxation Definition of Relaxation – a temporary deliberate withdrawal from everyday activity that aims to moderate the functions of the sympathetic nervous system, which is usually activated under stress (Hill, 2001) When relaxed, individuals exhibit normal blood pressure and decreases in oxygen consumption, respiratory rate, heart rate, and muscle tension Here is a clip on how to calm oneself in sport and manage emotional energy, including using breathing and centering. Please view: https://www.youtube.com/watch?v=9Ij7rSykFoY

4. Purpose of Relaxation Techniques in Rehabilitation The goal of using relaxation techniques is to learn how to voluntarily decrease the amount of tension in muscles, calm the mind, and decrease autonomic responses Various relaxation techniques have been identified as useful for injured athletes (e.g., progressive muscle relaxation, meditation, yoga, breath control techniques, autogenic training) for 2 reasons: 1. To alleviate, control, and assist athletes in coping with pain 2. To reduce symptoms of stress and anxiety

5. Purpose of Relaxation Techniques in Rehabilitation (cont.) Relaxation techniques can also:  Help to focus athlete’s attention  Enhance confidence  Aid in healing  Provide athlete a sense of control over rehabilitation Other psychological techniques useful during rehab (such as imagery, goal-setting, and self-talk) rely on relaxation techniques to enhance effectiveness For example, relaxation training can be used to produce relaxed state that enhances the ability to generate mental images used for healing imagery

6. Useful Relaxation Techniques During Sport Injury Rehabilitation In sport, the term “relaxation” or “relaxation techniques” describes a range of methods through which an athlete can facilitate physical & psychological well-being Methods of relaxation used in sport are typically divided into 2 categories: 1. Physical (somatic) relaxation 2. Mental (cognitive) relaxation

7. Physical (Somatic) Relaxation Techniques Primary goal of physical relaxation techniques is to release physical tension in the body Most commonly used physical relaxation techniques in sport are:  Progressive muscle relaxation (PMR)  Applied relaxation technique  Breath control techniques

8. Progressive Muscle Relaxation (PMR) Progressive Muscle Relaxation (PMR) is the most commonly used and taught relaxation technique in sport Based on work of Jacobson (1938) The goal is to teach what it feels like to relax by contrasting the feeling of tension in specific muscle groups with the feeling of relaxation in those same muscle groups Consists of learning to sequentially tense and then relax groups of muscles, while at same time paying attention to both feelings of tension and relaxation

9. Progressive Muscle Relaxation (PMR) (cont.) Athlete is encouraged to observe early signs of stress and anxiety To scan muscles frequently for any tension in a situation (e.g., in a training or rehab session) (Hill, 2001)  Scanning involves having athlete note signs of muscle tension during the day, at least 2X daily  Implement relaxation response by using deep breathing  When tension is experienced, athlete is instructed to tense these muscles, hold tension for a count of 7, then release the tension, noticing difference in sensation between tension and relaxation In relaxing musculature, a calming effect occurs on the individual via the neuromuscular network

10. Progressive Muscle Relaxation (PMR) (cont.) Please refer to Arvinen-Barrow text for more details on programs of implementing PMR (pages 88-89) Below are sample PMR exercises. You are required to participate in at least 1 for this week’s discussion:  https://www.youtube.com/watch?v=DalxIqYuKYk https://www.youtube.com/watch?v=DalxIqYuKYk  https://www.youtube.com/watch?v=cMbPxvMm6Ug https://www.youtube.com/watch?v=cMbPxvMm6Ug

11. Breath Control Techniques Correct breathing is fundamental to achieving a relaxed state Stimulation of sympathetic nervous system (when anxious) leads to breaths that are short, shallow, and irregular Stimulation of the parasympathetic nervous system (calm and confident) is associated with smooth, deep, and rhythmic breaths Slow breathing has stress-relieving properties and is one of easiest yet most effective ways to control stress, anxiety, and muscle tension

12. Breath Control Techniques Breath control techniques begin with exploring thoracic & abdominal movements when breathing, leading up to a variety of different methods of breathing Examples of Breath Control Techniques:  Centering  Diaphragmatic breathing  Ratio breathing

13. Breath Control Techniques Centering - deals with focusing one’s attention on the task at hand Most common way to center is to change the focus of attention from the athlete’s head to their center of gravity, thus giving a feeling of stability & balance This feeling of stability, balance, & control is the prompt to relax Over time, centering provides a method of relaxing quickly…  All that is needed is a deep breath for athlete to remove feelings of anxiety. Then, attention can be focused on what needs to be done rather than focusing on the possible negative consequences

14. Breath Control Techniques Diaphragmatic Breathing- emphasizes the downward expansion of the chest cavity that causes the abdomen to swell Aim of diaphragmatic breathing is for the athlete to try to feel their ribs expanding and moving as air is inhaled and then the ribs recoiling as they exhale First step is to guide the athlete to become aware of their regular breathing patterns (this can be achieved by completing the diaphragmatic breathing exercise steps shown on page 91 of the Arvinen-Barrow text) If athlete’s chest rises more than their abdomen, they should be shown how they can breathe differently and should have the benefits of this change explained

15. Diaphragmatic Breathing (cont): Athlete should be aware of how the lungs and diaphragm work  E.g., the diaphragm forms the roof of the abdomen and, at rest, is domed in shape.  When diaphragm is contracted, it flattens, making more room in the chest for air to be inhaled  When diaphragm is relaxed, it returns back to its dome shape, helping to force the air out Breath Control Techniques

16. Diaphragmatic Breathing (cont): Injured athletes might find diaphragmatic breathing helpful just prior to rehab exercises to relax them in preparation for the exercise and to focus attention on the task at hand Also, during rehab activities, diaphragmatic breathing can improve intensity and effort of the work Video example of Diaphragmatic Breathing:  https://www.youtube.com/watch?v=tcm1CFf8Aps https://www.youtube.com/watch?v=tcm1CFf8Aps

17. Breath Control Techniques Ratio Breathing – a deep-breathing technique with a focus on the number of inhalations compared to exhalations  E.g., 4 inhalations to 7 exhalations Individual counts the ratio of breaths. This is particularly useful for distracting from negative automatic thoughts It is also helpful for the athlete to understand how levels of arousal are controlled by the autonomic nervous system, which is not under conscious control When arousal levels are heightened, an individual needs to activate their parasympathetic nervous system, which is associated with a relaxed state  This can be achieved by taking slow, controlled longer “out” breaths

18. Breath Control Techniques Video example of ratio breathing presented by Dr. Andrew Weil (Note: his counting during the breaths is somewhat quick). These breathing techniques really help with stress, relaxation, rehabilitation, and overall health. The exercises are not time consuming (e.g., as little as 2 minutes, 2X daily) and if used regularly, you will notice a significant difference. The 4-7-8 breathing technique can also be very effective for those with sleep difficulties. Give it a try.  https://www.youtube.com/watch?v=YRPh_GaiL8s https://www.youtube.com/watch?v=YRPh_GaiL8s Okay, this next video clip is really cheesey But it does a good job of explaining the process of ratio and diaphragmatic breathing:  https://www.youtube.com/watch?v=Uxbdx-SeOOo https://www.youtube.com/watch?v=Uxbdx-SeOOo

19. Mental Relaxation Techniques Mental relaxation techniques focus specifically on the mind rather than the body  The belief is that a relaxed mind will in turn relax the body Most commonly used mental relaxation techniques in sport are:  Mindfulness  Autogenic training  Transcendental meditation

20. Mindfulness Mindfulness – “a mental state resulting from voluntarily focusing one’s attention on one’s present experience in its sensorial, mental, cognitive, and emotional aspects, in a non-judgmental way” (Cottraux, 2007) Mindfulness has its roots in Eastern meditational practice Mindfulness uses breathing methods, guided imagery, and other practices to relax the body and mind to help reduce stress Encourages individuals to engage in non-judgmental awareness of their internal experience occurring at each moment, such as bodily sensations, cognitions, and emotions, and to environmental stimuli, such as sights and sounds

21. Mindfulness Recent studies in sport psychology have established a relationship between mindfulness and peak performance  Ability to remain focused on the present has been found especially important for performance outcomes In injury rehabilitation, mindfulness can help injured athletes achieve a relaxed state of mind and body and to become more aware of their injury situation Mindful attention may also be useful to draw athlete’s focus to rehab exercises to ensure correct execution of movements and to gain maximum benefits from physical interventions

22. Mindfulness (cont.) As coach of the Chicago Bulls and Los Angeles Lakers, Phil Jackson won a record 10 NBA championships. Mindfulness was an essential components of his coaching. In the following video, Phil Jackson discusses how he taught his teams mindfulness: https://www.youtube.com/watch?v=aqz7R- QalqY

23. Review of Literature on Relaxation Techniques in Sport Injury Rehabilitation Relaxation techniques found to be beneficial during injury rehabilitation can be grouped into 3 main areas: 1. Dealing with pain 2. Alleviating stress and anxiety 3. Increasing injured athlete’s focus, self-confidence, and personal control during rehabilitation

24. Review of Literature on Relaxation Techniques in Sport Injury Rehabilitation Use of Relaxation for Dealing with Pain  Studies have indicated an individual’s overall pain tolerance can be improved, and perceptions of pain can be reduced, by using relaxation training  May reduce the need for pain medication Relaxation is hypothesized to affect pain by: 1. Reducing demand for oxygen in the tissue and lowering levels of chemicals (e.g., lactic acid) that can trigger pain 2. Releasing tension in skeletal muscle that can exacerbate pain 3. Releasing endorphins which interact with opiate receptors in the brain to reduce perceptions of pain

25. Review of Literature on Relaxation Techniques in Sport Injury Rehabilitation Use of Relaxation to Alleviate Stress and Anxiety  An athlete might experience anxiety related to their injury rehabilitation and their return to training and competition  Relaxation training, such as PMR, is useful because it increases athletes’ awareness of their muscle physiology  Relaxation training can help athletes gain greater sensitivity to their body and enable them to be more in control

26. Review of Literature on Relaxation Techniques in Sport Injury Rehabilitation Use of Relaxation to Alleviate Stress and Anxiety (cont):  The use of breathing techniques and PMR are reported to be the most beneficial techniques for coping with stress and anxiety associated with injury  Deep breathing is one of simplest and most effective methods to reduce anxiety during rehab by relaxing muscles and subsequently relieving muscle tension  Relaxation paired with imagery exercises can also be used to enable injured athletes to see themselves performing without anxieties

27. Review of Literature on Relaxation Techniques in Sport Injury Rehabilitation Use of Relaxation to Enhance Healing, Increase Focus, Self-Confidence, and Personal Control  Relaxation techniques can be useful in promoting blood flow to injured limbs, thus promoting healing and reducing likelihood of re-injury  Relaxation techniques have a direct impact on injury recovery in that they enhance the athlete’s ability to focus, their feelings of self-confidence, and their personal control  By controlling pain, discomfort, and anxiety, relaxation techniques provide the athlete with a sense of achievement, which can then enhance confidence  When returning to sport following recovery, the athlete can also use relaxation techniques in training and competition, and prevent future injury or re-injury

28. Practical Advice for Professionals when Implementing Relaxation Techniques Prerequisites necessary to facilitate effective relaxation:  Educating the Athlete –  Purpose, benefits, and reasons for use of relaxation  Providing Suitable Environment for Relaxation –  Ensuring a quiet, comfortable atmosphere conducive to relaxation  Ensuring Appropriate Structure to Relaxation Program  Relaxation is most effective when integrated into the structure of daily sessions  E.g., using ratio breathing during times when pain is high

29. Practical Advice for Professionals when Implementing Relaxation Techniques Prerequisites necessary to facilitate effective relaxation (cont):  Measuring Relaxation Effectiveness  Using physiological (heart rate, respiration rate, blood pressure) and psychological self-rating scales to assess reduction of pain and anxiety when using relaxation techniques  Using Appropriate Relaxation Techniques during Different Phases of Rehabilitation  Ensuring appropriate relaxation techniques are used during specific phases of rehabilitation

30. References Arvinen-Barrow, M., & Walker, N. (2013). The Psychology of Sport Injury and Rehabilitation (1 st ed.). Routledege. Kremer, J., Moran, A., Walker, G., & Craig. C. (2012). Key Concepts in Sport Psychology. Sage Publishing.