Progressive muscle relaxation

Progressive muscle relaxation (PMR) is a non-pharmacological method of deep muscle relaxation, based on the premise that muscle tension is the body's psychological response to anxiety-provoking thoughts and that muscle relaxation blocks anxiety.[1] The technique involves learning to monitor the tension in specific muscle groups by first tensing each muscle group. This tension is then released, as attention is directed towards the differences felt during tension and relaxation.[2]

History

Initial development of PMR by American physician Edmund Jacobson and presented first in 1908 at Harvard University.[3] In 1929, Jacobson published the book Progressive Relaxation, which included a detailed procedure for removing muscular tension. His work led to the use of the word "relax", in the sense of "to become less tense, anxious or stressed, to calm down".[4] He continued to work on this topic throughout his life and wrote several books about it.

Training

These learning sessions are not exercises or self-hypnosis. Training sessions are conducted in a darkened room with the learner in a reclined position and eyes closed. The instructions begin by telling the person to relax and just let go, detaching from thoughts or physical distractions or trying to solve problems. In each session the teacher reviews tensing one particular muscle group. A modification of the technique is "biofeedback" in which one uses external measuring devices to indicate how successful one is in relaxing and then to use those techniques to relax without the help of external measuring devices. Progressive muscle relaxation is suggested to be applied daily. The technique has its own top-down sequence, beginning with the upper body and proceeding to the lower parts. Typically, the duration of a course is eight weeks, with each weekly session each lasting an hour or so. Progressive muscle relaxation technique requires a high degree of personal motivation, as the effects are often seen only after prolonged sessions. Before starting a course it might be recommended to consult with a doctor in order to ensure special care and attention is paid to selected muscle groups, as well as to obtain a recommendation on the ideal course. Jacobson's progressive relaxation has remained popular with modern physical therapists.[5] Although many institutions and individuals offer progressive muscle relaxation training, what they teach is not standardized, and no credentialing process is available for progressive muscle relaxation technique instructors.

Applications

There are two general purposes of tension control: prophylactic and therapeutic.

Insomnia

Nowadays, non-pharmacological treatment of insomnia has become an alternative replacement or complement to routine medical care. Progressive muscle relaxation is used as a treatment for some causes of insomnia. They are meant to reduce physical tension and interrupt the racing thoughts processes that affect sleep.[6] A common psychological problem of cancer patients and particularly for those in pain is insomnia. Some studies reported benefits of the Progressive muscle relaxation technique used by cancer patients. One of them postulated: "the significant effect for the muscle relaxation group on the sleep onset latency indicates that the subjects' self-reported insomnia was significantly improved. Total sleep time was increased as well".[7]

Pain relief

Pain is one of the most frequent symptoms in patients undergoing surgery or cancer chemotherapy and various treatments are proposed for its relief, including relaxation techniques. Progressive muscle relaxation technique is suggested to lead to an increase in blood flow which supplies more oxygen, thus enhancing local metabolism, resulting in reduced pain and muscle spasms.[8] Additionally, progressive muscle relaxation might reduce the perception of pain as well as providing pain relief by the patients after undergoing surgery. One of the recent study indicated "a significant tension decrease in all the types of muscles between pre- and post-relaxation situations for patients after surgery a result of Progressive Muscle Relaxation".[9] Also, the progressive muscle relaxation technique has been indicated to show some positive achievements in the treatment of chronic pelvic pain in women. In case of chronic pain it seems to be not possible to avoid the pain but possible to avoid the perceived threat (pain). Chronic pelvic pain often associated as results from abdominal functioning of the nervous system (often called "neuropathic pain"). If medications prescribed fail to be successful, women may be referred to a practice specializing in a pain management, such as progressive muscle relaxation technique. Here, the treatment aims to release tightness of the muscles in the abdomen and lower back, as well as musculoskeletal tension.[10]

Sport

Several studies tried to demonstrate whether there are some advantages to apply the progressive muscle relaxation technique into the sports field. Professional sports require constant tension from athletes both physically and mentally, therefore the progressive muscle relaxation technique may help athletes achieve optimal performance and optimize functioning in daily life. H.A. Hashim and H. Hanafi conducted an experiment with adolescent soccer players to understand the effects of progressive muscle relaxation on athletes. Results obtained in this experiment suggested reductions in the confusion, depression, fatigue, and tension subscale scores following progressive muscle relaxation.

Schizophrenia

Progressive muscle relaxation technique has been used in psychiatric settings as an alternative means of coping with subjective stress and state anxiety. A few modern studies are reported a therapeutic effectiveness on psychological distress and anxiety symptoms as well as on response/remission for people with schizophrenia. There is evidence revealing a decrease in stress level after regular training, after which patients tend to feel a greater sense of wellness and well-being. Moreover, they aim to learn how to manage stressful situations, especially those related to "self-control", "assuming responsibility" and "positive re-evaluation". However, the application of progressive muscle relaxation technique to the patients with schizophrenia is not widely used and requires additional research.[11][12]

Other

Progressive relaxation has formed the basis for natural-childbirth methods.

Long term effects

According to Encyclopedia of medicine by Miller-Keane, long term effects of practicing progressive muscle relaxation include:

• A decrease in generalized level of anxiety
• A decrease in anticipatory anxiety related to phobias
• Reduction in the frequency and duration of panic attacks
• Improved ability to face phobic situations through graded exposure
• Improved concentration
• An increased sense of control over moods
• Increased self-esteem
• Increased spontaneity and creativity[13]

See also

• Autogenic training
• Autosuggestion
• Biofeedback

References

1. "progressive muscle relaxation". TheFreeDictionary.com. Archived from the original on 2018-07-13. Retrieved 2017-07-20.
2. Jacobson, E. (1938). Progressive relaxation. Chicago: University of Chicago Press
3. Jacobson, E. (1929). Progressive relaxation. Chicago: University of Chicago Press
4. Bernstein, Douglas (2000). New directions in progressive relaxation training : a guidebook for helping professionals. Westport, Conn. : Praeger. pp. 2–5. ISBN 0275968375.
5. Craske & Barlow (2006), Worry, Oxford University Press, p. 53, ISBN 978-0-19-530001-7
6. Blanaru, Monica; Bloch, Boaz; Vadas, Limor; Arnon, Zahi; Ziv, Naomi; Kremer, Ilana; Haimov, Iris (7 August 2012). "The effects of music relaxation and muscle relaxation techniques on sleep quality and emotional measures among individuals with posttraumatic stress disorder". Mental Illness. 4 (2): 13. doi:10.4081/mi.2012.e13. PMC 4253375. PMID 25478114.
7. Wang, Fang; Eun-Kyoung, Othelia; Feng, Fan; Vitiello, Michael V.; Wang, Weidong; Benson, Herbert; Fricchione, Gregory L.; Denninger, John W. (1 December 2016). "The effect of meditative movement on sleep quality: A systematic review". Sleep Medicine Reviews. 30: 43–52. doi:10.1016/j.smrv.2015.12.001. ISSN 1087-0792. PMID 26802824.
8. "Effect of Progressive Muscular Relaxation on Stress and Disability in Subjects with Chronic Low Back Pain (PDF Download Available)". ResearchGate.
9. Paula, Adriana Aparecida Delloiagono de; Carvalho, Emilia Campos de; Santos, Claudia Benedita dos (2002). "The use of the "Progressive Muscle Relaxation" technique for pain relief in gynecology and obstetrics". Revista Latino-Americana de Enfermagem. 10 (5): 654–659. doi:10.1590/S0104-11692002000500005. ISSN 0104-1169. PMID 12641051.
10. McLennan, Mary T. (2014-07-31). Pelvic Pain in Women, an Issue of Obstetrics and Gynecology Clinics, E-Book. ISBN 978-0-323-32336-9.
11. Melo-Dias, Carlos; Alves Apóstolo, João Luís; Batista Cardoso, Daniela Filipa (October 2014). "Effectiveness of progressive muscle relaxation training for adults diagnosed with schizophrenia: a systematic review protocol". JBI Database of Systematic Reviews and Implementation Reports. 12 (10): 85–97. doi:10.11124/jbisrir-2014-1639.
12. Vancampfort, Davy; Correll, Christoph U; Scheewe, Thomas W; Probst, Michel; De Herdt, Amber; Knapen, Jan; De Hert, Marc (27 July 2012). "Progressive muscle relaxation in persons with schizophrenia: a systematic review of randomized controlled trials". Clinical Rehabilitation. 27 (4): 291–298. doi:10.1177/0269215512455531. PMID 22843353.
13. O'Toole, Marie T., ed. (2005). Encyclopedia & dictionary of medicine, nursing, & allied health (7th ed., revised reprint. ed.). Philadelphia: Saunders. ISBN 9781416026044.