RELAXATION

 

INTRODUCTION

Muscles which are relatively free from tension and at rest are said to be relaxed. Tension develops in muscles as they work during contraction and the distance is reduced to a variable degree as the muscles come to rest during relaxation.

 

Muscle tone

Under ordinary circumstances living muscles are never completely free from tension is there any time equality of firmness known as “Muscle Tone” even when they are as relaxed as possible.

Muscle tone which represents a state of preparedness in resting muscles is now thought to be maintained through the activity of the muscle spindle circuits.  Efferent fibers of this small fiber nervous reflex pathway transmits impulses which produce sustain contraction of the small intrafusal muscle fibers of the muscle spindle while the large extrafusal muscle fibers concerned in the production of voluntary movements remain relaxed.

 

Postural tone

The contraction which persist in the muscles concerned with the maintenance of posture called postural tone.

 Postural tone is maintained and regulated by a reflex mechanism the fundamental basis which is the myotatic for stretch reflex although the higher centers also exerts a controlling influence.  Any stretching after muscles buy an external force searches force of gravity stimulates sensory receptors situated within the muscles themselves and so gives rise to a discharge of motor impulses to the same muscles. 

The degree and location of postural tone varies with  any alteration in posture. It is Greater in the upright positions in which the forces of gravity tense to stretch the muscles more strongly, then it is in the recumbent position in which the effects of the force of gravity upon them is adequately counterbalanced by Full support of the body.

 

Voluntary movement

Specific muscles contract as they work to initiate or control movents, but at completion after movement in question relax and comes to rest. Contraction in  any one of the group of muscles is accompanied by reciprocal relaxation of the antagonistic group to allow movement to take place smooth .

 

Mental attitudes

Mental attitudes searches fear, anger and excitement gives rise to a gentle increase in muscular tension which serve a useful purpose by preparing the muscles for rapid fire force full action.

Normally this tension developed to serve a useful for as is relaxed when the need for it no longer but in some cases it persist and becomes habitual which may lead to alterations in normal process.

Recognition a state of tension followed by voluntary relaxation of the muscles in which it is present provide means of helping the patients to economise in nervous energy. 

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 cooperation. An atmosphere conducive to rest both mental and physical contributes much to success in helping the patient to acquire the art of voluntary relaxation. 

 

Degrees of relaxation 

The degree to which muscular tension can be reduced is variable and it is better to regard that some relaxation merely as an indication that some reduction in tension has taken place. It is often possible to estimate the degree of relaxation achieved by gentle passive movements or palpating the muscles as for instance during massage and the facts that a patient falls to sleep during treatments is ample proof that the method of obtaining general relaxation has been successful.

 

Pathological tension in muscles

Marked persistent increase in muscular tension or tone is feature to many pathological conditions which effects the nervous system. Lesions of the higher motor centers and those which interfere with the normal function of the novels Pathways which connects them with spinal reflex arc commonly results in an abnormal state of muscle tension which variable from hypertonicity to spasticity or rigidity. Temporary reduction in this tension in the affected area can be achieved in some cases suitable means which promotes relaxation and base allows Re-education of early functional activity which reminds to take place.

 

METHODS OF RELAXATION

General relaxation   Support,  comfort and restful atmosphere are basic conditions for general relaxation and many to effective without additional methods.   Support  Various forms and modifications of the lying position are used to achieve full support of the body the relatively suitability of each varying according to the condition of the patient and to individual difference. The weight of the body is does effectively counterbalanced by uniform upward pressure of reciprocal surface or by suspension in a position of semi flexion which obviates all mechanical tension on muscles or ligaments.  (The types of the following techniques support in lying supine half lying adopted for legislation half lying, prone lying, side lying.)   Comfort In addition to support and individual differences in Positioning for which some suggestions have already been made the ingredients of Comforts include freedom to breathe deeply, warmth, abdominal quiescence and mild degree of physical fatigue. Removal of constrictive clothing such as corsets and belts is essential and any garters buttons or suspenders liable to cause must be removed.  The room should be warm can be supplied by flights but warm blankets covered hot water bottle at the speech and electric blanket or by non-luminous infrared radiations but can be taken to avoid overheating as this leads to restlessness, to stop for home use warm bath gives the most even and pleasing type of heating, but it is shooting must not be ruined subsequently by vigorous rubbing with towel. Light well balanced meal rhythmical physical activity of short duration success brisk walk in the open air and attention to empty the bladder before treatments are all conducive to general relaxation.    Restful atmosphere As physical and mental relaxation are interdependence and effort must be 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. If you are worried by complete silence, but in general it is high pitched intermittent sound produce close at hand which is to be avoided a company has low pitched ‘Hum’ of the distance traffic tends to be soothing.  Bright lights and strong colours searches red and bright yellow are said to be stimulating where as a room with low well diffused lights with for instance green and peach furnishings gives a soft and warm glow and provides an ideal setting for relaxation. This is indeed councel of perfection but how much can be done with screams and sells used with little imagination even in a busy departments. The most difficult and important factor in the creation of the atmosphere and one which determines the ultimate success or failures of treatments is the manner and bearing of physiotherapist. She Must inspire conference as fear in one form or another is at the roots of much of the tension which she can help to relieve. Her appearance must be tidy and a 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 pitch and clear. A simple explanation after routing and any instruction required are given to the patient in language and terms which he can understand, show that any anxiety or fear the unknown is removed. It must be remember that's situations and proteins which speech can becomes very familiar often appear strange and terrifying when encounter for the first time. Conversations apart from this inspection should direct the patience thoughts to contemplation of restful and pleasant topics. Confidence in the physiotherapist and treatment is gradually built up over a period of time; immediate results are not to be expected and are rarely achieved often because of psychological back factors beyond the control of the physiotherapist or patients. In successful cases a habit of relaxation is buildup in place of a habit of tension but the  formation of new habits takes time. Regular and frequent practice on the part of patient is essential until finally he becomes and experts in the art of letting go or relaxing and the normal rhythm of life in which activity alternates with relaxation can be Re-established.   Additional methods of promoting relaxation Tension may persist in spite of the provisions of conditions conducive to relaxation in which case additional methods to help the patient may be employed. Very little should be attempted at first the period of time be extended as the ability to relax improves. Tension may persist in spite of the provision of conditions conducive to relaxation in which case additional methods to help the patient may be employed. Very little should be attempted at first the period of time being extended as the ability to you relax improves.   Consciousness of breathing Under conditions of quotes and comfortable the patient's mind may remain active and turn  to mundane problems and cities with associated physical tension; in this case It may help him to concentrate on his own rhythm of breathing which must be deep with slight pause at the end of expiration.   Progressive relaxation A method by which relaxation maybe e achieved progressively was devised and practiced by Jacobson, and something similar appears in modern literature on the system as the “savasana” or still pose.   Contrast method Difficulty in appreciating the sensation of relaxation is not uncommon; the patient does not know about the muscles are tense or what to do in order to relax them. This can often be taught  by  demonstrating the contrast between maximal contraction and the degree of relaxation which follows its the patients being told to contracts any group or series of muscles as strongly as possible and then to ‘let go’ and ‘continue to let go’. Routine contraction followed by relaxation is carried out in each area of the body the attention travelling in logical sequence from Limb to limb and to the trunk and the head including the neck and face muscles until all areas can remind relaxed at one and the same time.   Physiological relaxation This method of tension relieving was devised by Laura Mitchell in 1957. It is based on the 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 exacts voluntary orders which is taught give to his own body. E.g. stretch the fingers out long stop feel the straightened outs fingers and the finger tips touching the supports. In this way the patient induces firstly  reciprocal relaxation in the muscles that had been working to maintain the tense positions and then in the opposite group which key used to change that position. He is registers the new position of the joint and the skin processes associated with them because this two sense reach the cortex. In this way key changes the pattern of tension of the whole body to one of ease by means of method which he can use by himself at any time and so can stop mounting tension.   A full description of this method and its application to various conditions e.g chest, antenatal is given in “simple relaxation” by Laura Mitchell Second Edition 1980.     Passive movements Rhythmical passive movements after Limbs and head may assist the degree of general relaxation in some cases. In this moment are generally given as a sequel to massage. Group movements of the joints e.g flexion and extension of the hip and ankle are preferable, but a very high standard of performance on the parts of the physiotherapist is required to obtain results. The rhythm of small pendulum movements pleases some patience.   General relaxation can sometimes be carried out effectively in groups as in the case of pregnant womens who tend to relax easily and with some Asthmatic and Bronchitic sufferers who have had previous individual instruction.   LOCAL RELAXATION    General relaxation takes time and is not always essential or desirable.  Methods of obtaining local relaxation depends to some extent on the cause and distribution of the tension.   Preparatory to  massage and passive movements Massage and passive movement both purpose relaxation of the area under treatments. Relaxation is obtained of specific area by the application to that area of general principles already described for the whole body. General attitude of rest however will assist the process example the updated and flexed arm supported by a table or slings is more incline to relax when patients lies or reclining in the chair than when he sits bolts uprights.   For the relief of spasm Spasm due to pain is protective and is most effectively reduced by the relief of the pain which caused it. However if it is persist because of fear of pain techniques which ensure pain free movement are often successful. Hold relax is applicable in this circumstances are pendulum movements start in the free range and gradually increase in amplitude restore confidence and achieve relaxation. The relief of pathological spasm resulting from lesions affecting the central nervous system is only temporary unless some voluntary control remains and can be Re-established. Temporary relief is useful to permits the redevelopment of voluntary control which is masked by the spasm and to maintain joint range and circulation in the affected area. The initiation of relax movements by the use of the stretch reflex applied at the same time as a command for the patient's voluntary effort of contraction can be  used for this purpose but care must be taken to ensure the spasm which is useful is not reduced by hyperactivity of the antagonistic reflex unless sufficient voluntary power is present example extensor spasm of leg which makes it possible for the patient to stand.   In incrementing and combating adaptive shortening persistent tension or hypotonicity e of the muscles acting upon one aspect of the joint produces a States of muscular imbalance which leads to two adaptive shortening of the tense muscles and progressive lengthening and weakening of the antagonist on the opposing aspects of the joint. Both agonistic and antagonistic muscles are inefficient when this situation develops. Relaxation techniques for the short and muscles and strengthening techniques for their antagonistic are followed by integration half their reciprocal action to establish the increase in the range of movements. THOSE ABOVE ARE COLLECTED FROM SOME BOOK.. (The Principles of Exercise therapy - M. Dena Gardiner) THANK YOU, SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER