1. RELAXATION DR. MOHAMED SEYAM PHD. PT. Assistant professor of physical therapy

2. Outlines ◦ Relaxation, ◦ Muscle fatigue, ◦ Muscle spasm, ◦ General causes, signs, symptoms of tension (mental and physical) ◦ Factors contributing to fatigue. ◦ Types of relaxation (local and general), ◦ Indications for relaxation, ◦ Techniques of relaxation (local and general).

3. Definition Of Relaxation  It is a state in which muscle tension and mental stress are reduced as much as possible through conscious effort, or a process that decreases the wear and tear of life's challenges on your mind and body  It is a conscious effort to relieve tension in muscles.

4. Relaxation can be classified into:  Mental relaxation( reduce mental stress)  Physical relaxation ( reduce physical stress) ◦ Also it can be classified into:  General relaxation  Local relaxation

5. Muscle fatigue ◦ It is the decline in ability of a muscle to generate force. It can be a result of vigorous exercise but abnormal fatigue may be caused by barriers to or interference with the different stages of muscle contraction. ◦ There are two main TYPES of muscle fatigue. 1.The limitations of a nerve’s ability to generate a sustained signal ( neural fatigue ). 2. The reduced ability of the muscle fiber to contract (metabolic fatigue).

6. ◦ repeated activation of muscle cells leads to decreased force production and slower contractions, that is, fatigue develops. Fatigue may set in acutely during high-intensity exercise, and it is then mainly caused by factors related to increased energy metabolism.  Causes of fatigue 1.The depletion of energy stores 2.the accumulation of inhibitory metabolic waste products 3.Dehydration 4.neurological causes

7. Muscle spasm ◦ A spasm is a sudden, involuntary contraction of a muscle or a group of muscles. ◦ It most commonly refers to a muscle cramp which is often accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes.

8. Causes of muscle spasms  Insufficient hydration.  Muscle overload.  Absence of electrolytes.  Spasmodic muscle contraction may be due to a large number of medical conditions, including the dystonias.  Hypertonic muscle spasms is the state of chronic, excessive muscle tone, or tension in a resting muscle – the amount of contraction that remains when a muscle is not actively working.

9. ◦ muscle tone is the continuous and passive partial contraction of the muscles, or the muscle's resistance to passive stretch during resting state. ◦ Physical disorders can result in hypotonia, hypertonia, paratonia, which is associated with dementia. ◦ Hypertonia can present clinically as either spasticity or rigidity. ◦ Spasticity is velocity-dependent resistance to passive stretch. ◦ Rigidity is velocity-independent resistance to passive stretch. ◦ Spasticity can be in the form of the clasp-knife response, in which there is increased resistance only at the beginning or at the end of the movement. ◦ Rigidity can be of the leadpipe type, in which there is resistance throughout to passive movement, or it may be of cogwheel type, in which the resistance to passive movement is in a jerky manner.

10. Excess Muscle Tension Causes ◦ Backache ◦ Headaches ◦ Neck/shoulder pain ◦ TMJ syndrome

11. Factors Affecting Relaxation ◦ 1- Muscle Tone ◦ 2- Postural Tone ◦ 3- Voluntary Movement ◦ 4- Mental Attitude ◦ 5- Pathological Tension in Muscle

12. 1- Muscle Tone ◦ Muscle tone refers to the amount of tension or resistance to movement in a muscle even during rest or relaxation. ◦ Muscle tone is maintained through the activity of the muscle spindles circuit. (Muscle spindles are modified muscle fibers called intrafusal muscle fibers).

13. 2- Postural Tone ◦ It is the muscle contraction against gravity to maintain posture (it is concerned mainly about the anti-gravity muscles). ◦ Postural tone is maintained by a reflex mechanism called myotatic or stretch reflex. ◦ Any stretching of muscles by an external force, such as the force of gravity, stimulates sensory receptors (muscle spindles) situated within the muscles giving rise to a discharge of motor impulses to the same muscles. ◦ These motor impulses will cause stimulation of sufficient numbers of motor units leading to an increase tension of the muscle.

14. ◦ The degree and location of postural tone varies with any alteration in posture. ◦ in upright positions, where the force of gravity tends to stretch muscles more strongly, ◦ in recumbent positions, where the effects of the force of gravity is adequately counterbalanced by full support of the body. ◦ recumbent positions provide full support for all segments of the body general relaxation.

15. Anti gravity muscles 1.Pectoralis major 2.Triceps 3.Biceps 4.Palmaris longus 5.The hand 6.Deltoid 7.Latissimus dorsi 8.Gluteus maximus 9.Gluteus medius 10.Abdominals 11.Quadriceps 12.Sartorius 13.Tibialis anterior 14.Calf muscles

16. Anti Gravity Muscles 1.Pectoralis major 2.Triceps 3.Biceps 4.Palmaris longus 5.The hand 6.Deltoid 7.Latissimus dorsi 8.Erector Spinae 9.Abdominals 1)Gluteus maximus 2)Gluteus medius 3)Hip Flexors 4)Sartorius 5)Quadriceps 6)Hamstrings 7)Gastrocnemius 8)Soleus 9)Tibialis Anterior

17. 3- Voluntary Movement ◦ After any muscle contraction and completion of the movement, the muscles come to rest and relax. ◦ There is a recognized biological principle that activity of living cells tends to be followed by inhibition of that activity (contraction=relaxation). ◦ 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 importance during consideration of methods designed to obtain relaxation of a particular group of muscles ◦ (Reciprocal inhibition).

18. 4- Mental Attitude  Mental attitudes such as fear, anger and exciting give rise of the muscle tension and preparing the muscle for rapid or forceful action.  Normally, this tension is reduced with relaxation and when the need for it no longer exist, but in some cases it may become habitual and lead to change of normal posture.

19. 5- Pathological Tension in Muscle ◦ The tension of higher motor centers (upper motor neuron lesions) leads to increase tension of relaxed muscles which varies from hyper tonicity to spasticity or rigidity. ◦ A temporary reduction in this tension in the affected area can be achieved in some cases by suitable means which promote relaxation, and this allows re-education of any functional activity which remains to take place.

20. Common elements of relaxation training 1)Relaxation involves a reduction in muscle tension in the entire body or the region that is painful or restricted by conscious effort and thought. 2)Comfortable positions and support (Prone lying, Supine lying, Half lying, Side lying) 3)Training occurs in a quiet environment with low lighting and soothing music or an auditory cue on which the patient may focus. 4)The patient perform deep breathing exercises or visualizes a peaceful scene. 5)When giving instructions the therapist uses a soft tone voice.

21. Indication for relaxation ◦ to relieve or reduce pain, ◦ To reduce muscle tension, ◦ To relive anxiety or stress, ◦ and associated physical impairments including 1.tension 2.headaches, 3.high blood pressure 4.respiratory distress.