This document discusses muscle relaxation and tone. It defines relaxation as muscles being free from tension at rest. Tension develops with muscle contraction and is reduced during relaxation. Muscles always maintain some tone or firmness even at rest due to muscle spindles. The document describes anatomy and function of muscle spindles and Golgi tendon organs which help regulate muscle tone and relaxation. It provides techniques to achieve general relaxation through positioning, breathing, and progressive relaxation methods. Localized relaxation techniques are also discussed.

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: