kinesiology DPT

1. RELAXATION
Dr. Farwa Asad
(DPT, MS-OMPT)

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

3. MUSCLE TONE:
Muscles are never completely free
from tension
Quality of firmness in resting muscle
 A state of preparedness in resting
muscle maintain through out the
activity of muscle spindle
 Extrafusal fibers remain relaxed
 Intrafusal fibers maintain muscle tone.

4. ANATOMY OF MUSCLE SPINDLE

5. MUSCLE SPINDLE CIRCUIT:
 Efferent fibres of reflex
pathway transmit impulses
produce sustained contraction
of small Intrafusal muscle fibres
 Large Extrafusal fibres
concerned in the production of
voluntary movement remain
relaxed.

6. MUSCLE SPINDLE:
 Muscle spindles are small sensory organs with an
elongated shape, involved in proprioception.
 Proprioception is the sense that perceive the location
movement and action of parts of body.
 Stretch receptor with its own motor supply consisting
of several Intrafusal muscle fibres.
 Intrafusal: modified muscle fibers enclosed in a
sheath of connective tissue
 parallel to the regular, power-producing Extrafusal
fibres.
 Intrafusal muscle fibers are up to 8-mm long.
 Each muscle spindle contains on average 8–20
Intrafusal fibers.

8. POSTURAL TONE:
 Contraction which persists in muscles maintaining
posture is postural tone
 Maintained by Myotatic Stretch Reflex
 Degree and location of postural tone varies with
change in posture
 Greatest in upright position

9. POSTURAL TONE:
 Postural tone is maintained and regulated by reflex
mechanism called Myotatic or stretch reflex.
 Stretching of muscle by a external force such as gravity
stimulate sensory receptors situated with in muscle
Discharge of motor impulses to same muscle.
 Motor impulses to result in contraction of sufficient
number of muscle motor units.
 Increase tension sufficiently to counterbalance the effect
of stretching force.
 After contraction, relaxation is promote.

11.  The motor unit consists of a
single motor neuron and all the
muscle fibers it innervates.

12. POSTURAL TONE:
 Degree and location of postural tone varies with
change in posture
 Greatest in upright position:
 Force of gravity tends to stretch the muscles more
strongly.
 In recumbent position effect of force of gravity is
counterbalanced by full support of body.
 Those recumbent positions which provide full
support for all segments.
 Most suitable for obtaining relaxation.

13. VOLUNTARY MOVEMENT:
 Specific muscle contract as they work to initiate or
control movement.
 At completion of movement they relax and come to
rest through autogenic inhibition by Golgi tendon
organ.
 Example: post isometric relaxation (Muscle energy
technique)
 Contraction in one group of muscle is accompanied
by reciprocal relaxation of antagonist to allow
smooth movement of agonist.

15. GOLGI TENDON ORGAN
 GTOs are proprioceptors that are located in
the tendon adjacent to the myotendinous junction.
 Muscle tension receptor
 10 to 20 muscle fibres are connected to one tendon
organ.

16. GOLGI TENDON:
 GTOs lie in series with the extrafusal fibers and
receive no motor innervation.
 If that muscle's force level exceeds this set point,
the GTO inputs inhibit the alpha motor neurons
innervating that muscle, which lowers the force
produced.

20. MENTAL ATTITUDES:
 Increase Muscle Tension to prepare for action (fear,
anxiety and excitement)
 Incase this tension persist and become habitual result
in alteration in normal posture.
 Fear is one of the usual cause of persistent tension.
 Physiotherapist should reassure the patient to gain
confidence.
 Environmental settings
 Atmosphere conductive to rest both mental and
physical promote voluntary relaxation.

21. DEGREE OF RELAXATION:
 Degree to which muscular tension reduced.
 Very Variable
 Some reduction in tension
 Estimated by:
 Gentle Passive Movement
 Palpating the muscle

22. PATHOLOGICAL TENSION IN MUSCLES:
 Marked and persistent Increase in tone as a result of
pathological Condition.
 Lesions of higher motor centers which interfere with
normal function of nervous pathway which connect with
spinal reflex arc.
 Example: UMNL (upper motor neuron lesion)
 Abnormal state of muscular tension
 Varies from hypertonicity to spasticity or rigidity.
 Temporary reduction in tension in affected areas can be
achieved by different techniques which promote
relaxation.
 Allow re-education of functional activity.
 Example: PNF techniques; Contract relax
(Proprioception Neuromuscular Facilitation )

23. UMN AND LMN:
 Upper motor
neurons originate in
the cerebral cortex and
travel down to the
brain stem or spinal
cord,
 Lower motor
neurons begin in the
spinal cord and go on
to innervate muscles
and glands throughout
the body.

24. HYPERTONICITY, SPASTICITY AND RIGIDITY:
 Hypertonia is resistance to passive movement, it is
not dependent on velocity, can be with or without
spasticity.
 Spasticity is an increase in resistance to sudden
passive movement and is velocity dependent.
 The faster the passive movement the stronger the
resistance.

28. TYPES OF RIGIDITY
 Lead pipe rigidity is
defined as a constant
resistance to motion
throughout the entire
range of movement.
 Cogwheel rigidity refers
to resistance that stops
and starts as the limb
is moved through its
range of motion.
Lead pipe Cogwheel

30. TECHNIQUES
General Relaxation:
 Support
 Comfort
 Restful Atmosphere
 Additional Method
 Consciousness of breathing
 Progressive Relaxation
 Contrast Method
 Physiological Relaxation
 Local Relaxation

31. SUPPORT
 Various forms of lying position are used
 body weight is counterbalanced by uniform upward
pressure of the reciprocal surface
 By suspension in semi flexed position which
obviates all mechanical tension on muscle

32. LYING POSITION:
 A firm surface is essential.
 Resilient in case of good spring mattress
 Mold itself with contours of body
 Even pressure and comforts.
 Plinths or bed which sag are to be avoided as:
 Cramp the thorax
 Additional strain on inspiratory muscles.
 Head pillow is required sufficiently soft and prevent
head rolling to either side.
 Well molded to support neck posteriorly.

33. LYING POSITION:
 A small pillow under knees to relieves tension in
hamstring and ilio-femoral ligament.
 Allow pelvis to roll backward
 Lumbar spine straightened and supported.
 Feet in mid position
 Arm slightly abducted at shoulder
 Flexed at elbow and rest on pillow.

35. HALF LYING:
 Breathing is easier
 Less weight on back
 Abdominal pressure on under surface of diaphragm
is reduced.
 Arm chair makes a good substitute for plinth.
 Thighs are fully supported
 Feet are rest on floor or footstool or T shaped foot
rest.

36. HALF LYING

37. PRONE LYING

38. PRONE LYING:
 Head is turned to one side, rest on small pillow.
 Firm pillow under hips and lower abdomen to
prevent hollowing of back.
 Lower leg is elevated, knees are slightly bent and
toes are free.
 A degree of medial rotation at hips causing heels
apart which further induces relaxation of legs.

39. SIDE LYING

40. SIDE LYING:
 Measure of relaxation depend on shoulder and
pelvic girdle stabilization.
 Uppermost arm and leg supported on pillows.
 Some of the weight then falls on trunk which
impedes respiration.
 Head pillow supports the neck and head in
alignment.

41. COMFORT
 freedom to breathe deeply
 warmth
 abdominal quiescence
 mild degree of physical
fatigue
 remove constrictive clothing

42. COMFORT:
 Room should be warm but have free supply
of oxygen.
 In winter additional warmth can be supplied:
 Light
 Warm blankets
 Covered hot water bottle at feet
 Electric blanket
 Non luminous infra red radiation.
 Care should be taken to prevent over
heating as it can cause restlessness and
burn.

43. RESTFUL ATMOSPHERE
 Quiet Room
 Soft warm well diffused lights
 manner and bearing of physiotherapist
 Appearance of Physiotherapist
 Confidence in Physiotherapist
 Immediate results are not be expected.
 Psychological factors beyond control
 Regular and frequent practice
 Re establish activity alternates with
relaxation.

44. ADDITIONAL METHOD OF RELAXATION:
Breathing Relaxation
 Progressive Relaxation (The Still
Pose)
 Contrast Method
 Physiological Relaxation
 Passive Movement

45. CONSCIOUSNESS OF BREATHING:
 To overcome the problems and anxieties
associated with physical tension.
 Patient concentrate on his own rhythm of
breathing.
 Deep breathing exercises
 Slight pause at end of expiration.
 Expiration is a phase of relaxation
 Accompanied by feeling of letting go in the
whole body.

47. PROGRESSIVE RELAXATION:
 A method by relaxation may achieved
progressively.
 This method was devised and practiced by
Jacobson.
 Similar to Savasana or Still Pose of yoga.

50. CONTRAST METHOD:
 Contrast between maximal contraction and degree
of relaxation.
 Patient told to contract any group or series of
muscles as strongly as possible .
 Then relax them gradually and let go and continue
to let go.
 Routine contraction followed by relaxation carried
out in each area of body.
 Logical sequence from limb to limb and to trunk and
head including neck and face muscles.

51. CONTRAST METHOD:
 Until all areas can remain relaxed at one and same
time.
 Its not unusual that leg muscles again become
tense while attention has been focused on
relaxation of face muscle.
 Patient frequently drops off to sleep and general
relaxation is obtained.
 Patient learns to relax muscles at will from state of
tension.

52. PHYSIOLOGICAL RELAXATION:
 This method of relieving tension was devised by
Laura Mitchell in 1957.
 Based on physiological principle of reciprocal
relaxation.
 Position of tension of whole body defined as:
 Raised shoulders
 Bent elbows
 Hands, head and neck flexed
 Then patient changes the position of every joint in
turn.

53. PHYSIOLOGICAL RELAXATION:
 Stretch the fingers out long, stop and feel the
straightened out fingers and fingertips touching the
support.
 Patient induced reciprocal relaxation in the muscles
that had been working to maintain tensed position.
Indications:
 Respiratory problems : respiratory rate decrease
 Orthopedic conditions; muscle tension decrease
 Antenatal and postnatal: conserve energy for labor
 Psychiatric condition: stress reduced

58. PASSIVE MOVEMENTS:
 Rhythmical passive movement of limb and head
induce some degree of relaxation.
 Group movement of joint e.g:
 Flexion and extension
 Rhythmical small pendular movements

59. LOCAL RELAXATION:
 General relaxation takes time, not always essential
or desirable.
 Methods for local relaxation depends to some
extent on:
 Cause
 Distribution of tension.
Indications:
 Preparatory to Massage and Passive movement.
 Relief of Muscle spasm
 Prevent and combating adaptive shortening of
Muscle.

60. PREPARATORY TO MASSAGE AND PASSIVE
MOVEMENT:
 Relaxation of area under treatment
 Relaxation of specific area can be obtained by the
application of principles of general relaxation.
 Rest will assist relaxation
 Abducted or flexed arm supported by table or sling
more inclined to relax when patient lies or reclines
in chair

61. RELIEF OF MUSCLE SPASM
 Muscle spasm or muscle guarding is protective
mechanism after injury.
 Effectively reduced by relief of pain.
 If it persist because of fear of pain
Techniques for mobility with in pain free range.
 Hold- relax or pendular movements can be
applicable
 Start in pain free range and gradually increase in
amplitude.
 Restore patient’s confidence and achieve
relaxation.

63. PATHOLOGICAL SPASM IN CNS LESIONS:
 Relief of pathological spasm after lesion in CNS is
only temporary.
 Voluntary control should remain intact and can be
re-established.
 Temporary relief useful to permit the re-
development of voluntary control.
 Maintain the joint range and circulation in affected
area.

64. INITIATION OF REFLEX MOVEMENT:
 Use of stretch reflex at same time as command for
patient voluntary effort of contraction
 Care must be taken to ensure that spasm which is
useful to maintain postural tone should not be
reduced by hyperactivity of antagonistic reflex.
 Unless sufficient voluntary power is present.
Example:
 Extensor spasm of leg makes it possible for patient
to stand.

65. ADAPTIVE SHORTENING:
 Persistent tension or hypertonicity of muscle upon
one aspects of joint:
 State of muscular imbalance leads to adaptive
shortening of tense muscles
 Progressive lengthening and weakening of
antagonists on opposing aspect of joint
Example:
 Upper cross syndrome
 Lower cross syndrome

67. TREATMENT FOR MUSCULAR IMBALANCE:
Relaxation techniques for shortened
muscles
Strengthening techniques for
antagonist
To establish increase in range of
movement.

68. OLD CONCEPT FOR SOFT TISSUE INJURY: