1. 22/10/1436 1 RHS 322

2. 22/10/1436 2 After studying this lecture, the student will be able to;  Define the Relaxation  Classify relaxation  Enumerate the factors affecting relaxation  Understand the benefit of relaxation  Understand Common elements of relaxation training  Apply the different techniques of relaxation (relaxation training) 22/10/1436 RHS 322

3. 22/10/1436 3  Definition of Relaxation  Classification of relaxation  Test of relaxation  Factors affecting relaxation  Relaxation training  How to gain relaxation  How to test relaxation  Indicators of relaxation 22/10/1436 RHS 322

4. 22/10/1436 4  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. Interventions that promote general or local relaxation can complement starching program 22/10/1436 RHS 322

5. 22/10/1436 5 1. Mental relaxation( reduce mental stress) 2. Physical relaxation ( reduce physical stress) Also it can be classified into: 1. General relaxation 2. Local relaxation 22/10/1436 RHS 322

6. 22/10/1436 6 RHS 322

7. 22/10/1436 7  Muscle tone refers to the amount of tension or resistance to movement in a muscle even during rest or relaxation. 22/10/1436 RHS 322

8. 22/10/1436 8  Muscle tone is maintained through the activity of the muscle spindles circuit. (Muscle spindles are modified muscle fibers called intrafusal muscle fibers). 22/10/1436 RHS 322

9. 22/10/1436 9  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. 22/10/1436 RHS 322

10. 22/10/1436 10  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. 22/10/1436 RHS 322

11. 22/10/1436 11  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. 22/10/1436 RHS 322

12. 22/10/1436 12  recumbent positions provide full support for all segments of the body general relaxation. 22/10/1436 RHS 322

13. 22/10/1436 13  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). 22/10/1436 RHS 322

14. 22/10/1436 14  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). 22/10/1436 RHS 322

15. 22/10/1436 15  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. 22/10/1436 RHS 322

16. 22/10/1436 16 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. 22/10/1436 RHS 322

17. 22/10/1436 17 Relaxation training 22/10/1436 RHS 322

18. 22/10/1436 18 Relaxation training, using methods of general relaxation (total body relaxation), has been used by a variety of practitioners to help patient to  Relieve pain  Relieve muscle tension, anxiety or stress  Relieve associated physical and mental dysfunctions, including tension headaches, high blood pressure, and respiratory distress 22/10/1436 RHS 322

19. 22/10/1436 19 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) 22/10/1436 RHS 322

20. 22/10/1436 20 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. 22/10/1436 21 22/10/1436 RHS 322

22. 22/10/1436 22  This is similar to the previous position but breathing is easier as there is less weight on the back and abdominal pressure on the under surface of the diaphragm is reduced.  An armchair makes quite a good substitute for a plinth or bed, the things are fully supported and the feet rest on the floor, or a footstool, or a T- shaped footrest. 22/10/1436 RHS 322

23. 22/10/1436 23 22/10/1436 RHS 322

24. 22/10/1436 24 22/10/1436 RHS 322

25. 22/10/1436 25 Examples of approaches to relaxation training 22/10/1436 RHS 322

26. 22/10/1436 26 1. Autogenic training. It involves conscious relaxation through autosuggestion and a progression of exercises 2. Progressive relaxation. It uses systemic, distal to proximal progression of voluntary contraction and relaxation of muscles. 3. Awareness through the movement. It combines sensory awareness, movements of the limbs and trunk, deep breathing, conscious relaxation procedures, and self- massage to alter muscle imbalances and abnormal postural alignment to remediate muscle tension and pain. 22/10/1436 RHS 322

27. 22/10/1436 27 1.Place the patient in quiet area and in a comfortable position, and be sure that restrictive clothing is loosened. 2.Have the patient breath in a deep, relaxed manner. 3.Ask the patient to contract the distal musculature in the hands or feet voluntarily for several (5 to 7) seconds and then consciously relax those muscles for 20 to 30 seconds. 22/10/1436 RHS 322

28. 22/10/1436 28 4.Suggest that the patient try to feel a sense of heaviness in the hands or feet and a sense of warmth in the muscle just relaxed. 5.Progress to a more proximal area of the body and have the patient actively contract and actively relax the proximal musculature. 6.Suggest to the patient that he or she should feel a sense of relaxation and warmth throughout the entire limb and eventually throughout the whole body. 22/10/1436 RHS 322

29. 22/10/1436 29 1. Preparatory to massage and passive movement. It can complement starching program 2. For relief of spasm. 3. To prevent adaptive shortening. 22/10/1436 RHS 322

30. 22/10/1436 30 1. Heat: superficial or deep heat is applied to increase circulation to the soft tissue. (increase soft tissue extensibility prior stretching exercises) 2. Massage: superficial and deep massage can be used to increase local circulation and decrease muscle spasm. 3. Biofeedback: it reduce the amount of tension in a muscle (visual and /or auditory biofeedback). 22/10/1436 RHS 322

31. 22/10/1436 31 4. Joint traction or oscillation: slight manual distraction of joint surface can be used to decrease muscle spasm around the joint. 5.Contrast method 6.Reciprocal method 7.Suggestion method 22/10/1436 RHS 322

32. 22/10/1436 32  Physiology Strong contraction of the muscle is followed by an equal relaxation of the same muscle or Excitation= inhibition 22/10/1436 RHS 322

33. 22/10/1436 33 technique The technique consists of  sequence of contractions of the muscles performed, usually, in a distal to proximal sequence in each limb or pair of limbs in turn followed by letting go or relaxation for an equal or longer period of time  Then the contractions for each limb part are usually added to one another so that tension in the limb is total and relaxation should be controlled in reverse sequence 22/10/1436 RHS 322

34. 22/10/1436 34 Value It can be used for a limited part of the body, for example, for relaxation of the hand or of the shoulder girdle or of the hip adductors and lateral rotators. 22/10/1436 RHS 322

35. 22/10/1436 35  physiology The antagonistic groups of the muscles always relax reciprocally and to equally to the contraction of the agonist group of muscles. Tension will be relieved by contraction of the antagonistic muscles. 22/10/1436 RHS 322

36. 22/10/1436 36 technique 1. The sequence used is more usually proximal to distal 22/10/1436 RHS 322

37. 22/10/1436 37 technique 1. In this technique the therapist provides comfortable relaxing conditions for patient: 2. A warm well-ventilated room 3. A comfortable support 4. Light covering 22/10/1436 RHS 322

38. 22/10/1436 38 5. Then by using quiet hypotonic mellow tones 6. The patient is told to think about each part of the body in turn. To think that it is very heavy and this suggestion is repeated several times until the limb gives the appearance of relaxation, e.g. until the lower limb is rolled out 22/10/1436 RHS 322

39. 22/10/1436 39 The technique This is used for relaxation of the limbs. The arm/s or leg/s may be swung back and forward until they feel numb.. The sensory receptors have accommodated to the constant movement. This type of swinging may be aided by adding from a 1/2 to 1 kg weight to the limb 22/10/1436 RHS 322

40. 22/10/1436 40 Value This type of swinging is of particular value to reduce the rigidity of Parkinsonism, but is also used for shorter periods of time to mobilize joints by patient activity. It is the most suitable for the shoulder, hips, knee and lumbar spine 22/10/1436 RHS 322

41. 22/10/1436 41 9. Active inhibition techniques : are reflex relaxation procedures that therapist use to inhibit muscle prior to stretching or lengthening. Active inhibition techniques include: 1.Contract- relax 2.Contract - relax –contract 3.Agonist contraction 22/10/1436 RHS 322

42. 22/10/1436 42  Start with the tight muscle in comfortably lengthened position  Ask the patient to isometrically contract the tight muscle against resistance for 5 to10 seconds, then relax.  Repeat the procedure several times. 22/10/1436 RHS 322

43. 22/10/1436 43  Follow the same procedure as done for contract- relax, then ask the patient to perform concentric contraction of the muscle opposite to the tight muscle. 22/10/1436 RHS 322

44. 22/10/1436 44  Passively lengthen the tight muscle to a comfortable position.  The patient perform a dynamic contraction of the muscle opposite the tight muscle.  Apply mild resistance to the contracting muscle, but allow joint movement to occur.  The tight muscle will relax as a result of reciprocal inhibition. 22/10/1436 RHS 322

45. 22/10/1436 45  By sight  By palpation  By passive movement  By shacking the limb  By raising the limb and sudden fall down  By EMG 22/10/1436 RHS 322

46. 22/10/1436 46 1.Decrease in muscle tension 2.Lowered heart and respiratory rates and blood pressure 3.Increase skin temperature in the extremities associated with vasodilatation 4.Constricted pupils 5.Eyes closed and flat facial expression 6.Jaw and hands relaxed with palms open 7.Decreased distractibility. 22/10/1436 RHS 322