Page Fourteen P H Y S I O T H E R A P Y September, 1957 RELAXATION - CONSCIOUS INHIBITION By MARY PHILLIPS, M.C.S.P. D e p t, o f P h y s ic a l M e d ic in e , S t. T h o m a s ’ H o s p ita l, L o n d o n . TH E term “ Conscious Inhibition” may at first appear to bear no relationship to relaxation; even the meaning by itself requires m ental exercise before it is clearly under­ stood in this context. To many, relaxation is a simple m atter in the absence o f disturbance, and when th e surroundings are such th at the quietness, the absence o f bright lighting and a com fortable tem perature, produce a feeling of ease and com fort. There is then nothing to stim ulate m ental or physical effort. A dd to this a norm al degree o f fatigue after a day’s work, together w ith a feeling o f satisfaction for its achievements and a plan o f action fo r the morrow. The result is a mind a n d body tuned fo r complete and refreshing relaxation. Types o f P atient. T he physiotherapist is frequently called upon to give relaxation exercises to patients who have developed an habitual state o f tension, and who are unable to bring ab o u t a reversal which would enable them to recuperate from the effects o f constant m ental and physical activity. They sleep badly. They suffer from physical aches and pains and they are im patient an d irritable. Also included in this group are the sufferers o f chronic illnesses, as, for example, asthm atics and chronic bronchitics and patients who are the victims o f chronic arthritis ,and there are many others. Expectant m others form a group o f their own. F o r them, relaxation exercises are a preparation for active participa­ tion and m aintaining self-control under conditions of considerable stress at the time o f their confinement. Training in Relaxation. A t the outset it is im portant for the physiotherapist to face the fact th at training in relaxation may take a long time. Patients who need this treatm ent possess a continual and abnorm al am ount of activity o f their muscles. There is no pathological lesion of the anatom ical systems invloved. They have simply to learn to rest their muscles, to reduce activity o f them to a low er level. This is the argum ent against the contrast method of teaching relaxation, which emphasises tightening and letting go, but fails to impress upon the patient his need to relax from his h abitual hyper­ tonic resting position. Muscle Relaxation. A planned course o f relaxation therapy should begin with a clear and simple explanation to the patient of the meaning o f muscle relaxation. T he first essential that he must grasp is th at it involves m ore than ju st assuming a fully supported position under ideal conditions. A dog lying in its basket, but evidently on the alert having been disturbed by the noise of footsteps outside o r a distant bark o f another dog, may be lying completely supported, but its muscles are in a state of readiness, o f having “ taken up the slack.” T he eyes are wide open and the head alm ost raised, while the respiratory movem ents are increased in rate. A com ­ pletely different picture is th at o f a cat lying on the hearth, n o t necessarily asleep, but w ith limbs outstretched and head supported, the limbs being limp because the muscles are soft and the joints loose. The movements o f its chest are characteristic o f relaxed breathing, being quite slow and m oderately shallow w ith a pause at the end o f every expiratory phase. This is a picture o f subconscious relaxa­ tion. T he patient who is habitually tense has to practice relaxation consciously before it becomes a habit—a p art o f himself. Initially he needs help directed tow ard developing muscle awareness, so th at he can appreciate muscle activity in its m inor degrees, and then be able to relax it completely. Thus he can be certain fo r himself if-h e has o r has not relaxed his muscles when he is supported in the correct position. , Muscle Activity. U nderstanding and appreciation o f muscle activity go han d in hand. Muscles w ork to m aintain a position, that is to prevent movement. T he most obvious illustration o f this is the ordinary standing position, the smallest possible area o f the body w ould cause it to collapse in a heap on the floor if it were not fo r the muscles supporting the ankles, knees, hips and spinal joints which hold th e body upright. The effort is minimal and subconscious o r reflex. T his can only be appreciated if it is understood. Again any m ovem ent^ however large d r sm all, is th e result o f muscle activity, ancF this too, more often than not, is subconscious. Gesticulating, changes in facial expression, drum m ing with a little finger— all are examples o f outw ard and physical expressions of inner m ental activity to the level o f awareness, by drawing attention to it, by doing and feeling it, and then allowing it all to cease. I t involves simple active movements through which th e patient understands when a muscle is shortening, o r lengthening, o r holding a position. D uring th e movement the patient is told when the working muscles are fixing the p a rt o r moving it o r controlling the movement brought about by the weight o f the part. W hen the distance to fall is harmless, the patient can learn to completely, release the muscle effort and allow the full weight of the p a rt to bring it to rest. These exercises are simplicity itself, but success fo r the patient may mean constant and lengthy repetition. However, once it is mastered, it will be as autom atic as riding a bicycle eventually becomes. So long as the fundam ental principles are applied, the patient will now find it easy to relax in any position in which the whole body weight is supported. Advanced Training. T he more advanced relaxation exercises are h arder to accomplish, for the patient is called upon to m aintain his muscles in a relaxed state when disturbances are introduced. D isturbances, which, if allowed to produce a response*-- would result in reflex muscle tension. (D This is true conscious inhibition. The com fort o f so fr- pillows is taken away, dim lighting is changed to normal day lighting, silent surroundings are altered to a certain am ount o f noise and movem ent in the room . The p atient learns to m ake no response when touched o r moved. He allows full range passive movem ents o f his neck, arm s and legs. H e is asked to throw all the muscles o f one limb into extreme tension and still m aintain com plete relaxation elsewhere, which can be demonstrated by passive move­ ments. L ater he learns to swing the emphasis in the opposite direction, so th a t all but one limb are tensed. I t is indeed advanced relaxation to be able to inhibit localised muscle activity which so many o ther muscles are striving to reinforce through their own activity. The practice o f conscious inhibition is a state o f self­ detachment fr o m external and internal influences o f which the individual is fu lly aware. Scheme o f Relaxation Training. The im portance o f a systematic scheme o f relaxation training cannot be overstressed. T he p atient should be encouraged to practice fo r him self and be provided with som ething definite to do fo r hom e practice. W hether {Continued on page 16.) R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Page Sixteen P H Y S I O T H E R A P Y September, 1957 Relaxation— Conscious Inhibition (Continued fro m page 14). it be to concentrate on the muscles which influence one particular jo in t and which he finds difficult to relax, or perhaps, simply to repeat the relaxation achieved at the previous treatm ent. T he patient’s aim should be to m aintain the relaxation for a definite ten minutes adding a few minutes each day and working up to half an hour. This is the hardest exercise o f all to many people, but it is of param ount im portance and the most effective way o f making muscle relaxation a habit to replace habitual muscle tension. G radually the new habit is transferred to and put to every day use, less unnecessary muscular energy is expended whilst sitting at a desk a t work, or standing or walking. Any opportunity should be taken if it offers a chance for some degree o f relaxation. T he busy housewife finding herself seated at som e piece o f w ork makes the most of the m ore restful position. Breathing Exercises. DeeD breathing exercises are given by many physio­ therapists to helD patients to relax. They certainly have their place, but in the m ethod described in this paper, no reference is m ade to respiration, except to point out th at it is a continuous activity and th a t in the relaxed state it is quite characteristic and entirely autom atic. D uring relaxa­ tion it becomes m ore evident to the patient because it is the only movement. Muscle activity disturbs the depth and rate o f breathing in direct proportion. W hen th e skeletal muscles are a t rest the respiratory muscles respond to the controlling influence o f the respiratory centre of the brain which functions in the resting state to ensure an adequate ventilation o f the lungs. Conclusion. There is truth in the statem ent th at a tense mind cannot exist in a relaxed body. T he state o f the mind influences the muscles too, but the practice of physical relaxation will' help to relieve m ental tension. In this way the physiothera­ pist is able to relieve patients who suffer from muscle tension caused by a physical disability, and patients who suffer from m ental tension causing sym ptom s o f physical tension. Everyone will find th at half an hou r’s complete relaxation before participating in strenuous mental and physical activities has a beneficial effect in com bating anxiety and fatigue. It is, in fact, a practice com m on amongst famous men and women in the worlds o f politics, dram a and sport. E TH IC A L RULES FO R M E M B E RS O F T H E S.A. SO C IE T Y O F PH Y SIO T H E R A PY . 1. N o t to undertake the treatm ent o f any patient, except when referred by a registered medical practitioner. 2. N o t to sell goods to a patient in a professional capacity, no r to accept comm ission on the sale o f goods. 3. N o t to pay a comm ission o r give any valuable con­ sideration for the introduction o f patients. 4. N o t to advertise, except in recognised medical publi­ cations. 5. N o t to influence a patient for the purpose o f effecting - a change o f medical adviser. 6. N o t to conduct oneself in such a way as to bring dis­ credit on the profession. 7. At all times to conduct oneself so as to ensure a proper respect for the interests o f the patient, proper discharge o f duty to the public, and to preserve m utual confidence and dignity within the profession. SOUTH AFRICAN SOCIETY OF PHYSIOTHERAPY GROUP ENDOWMENT FUND We have pleasure in announcing th at a G roup Endowm ent F u n d has been inaugurated for members o f th e South African Society of Physiotherapy and will be underw ritten by The Colonial M utual Life Assurance Society Limited (hereinafter referred to as the Underwriters). T h e F und will enable m em bers of th e S ociety to o b ta in assu ran ce a t a low er co st th a n is possible w ith individual c o n tra c ts an d will enable them h o t only to insure th e ir lives fo r th e benefit of th e ir dependents b ut to save for th e ir retirem e n t by deduction of reg u lar m onthly co n tributions from s a la ry . M em b e rs o f th e S ociety who wish to insure un d er th is schem e m ust com plete a s h o rt P ro p o sa l F o rm to g e th e r w ith a S to p O rd e r for th e deduction o f contributions m onthly from s a la ry . T he Trustees of th e F u n d will hold at th e Society’s headquarters a m aster policy on the schedules of which will be entered full particulars of each mem ber’s assurance. T he benefits consist o f guaranteed am ounts pay­ able a t the age selected by the member, o r on prior death, and are subject to increase by annual bonus additions. A dditional benefits in the form o f Cash Paym ents subject to increase by bonus additions as declared in the U nderw riter’s Accident D epartm ent and waiver o f future contributions are payable upon disablement due to certain contingencies prior to the selected age as set ou t on the m aster policy. B EN EFITS W IL L D EPE N D U P O N : (1) The member’s age on entry into the scheme; (2) The monthly contribution to be paid; (3) The selected age a t which the sum assured is payable. A L L . M E M B E R S W IL L R E C E IV E A C E R T I F I C A T E O F E N R O L M E N T G I V I N G F U L L D E T A IL S O F C O N T R I ­ B U T IO N S A N D B E N E F IT S . I n th e ev e n t o f a m e m b e r le aving th e S o cie ty , th e e n ro lm e n t w ill be co n v e rte d in to a n o rd in a ry policy w ith th e u n d e rw rite rs . - B enefits a n d c o n trib u tio n s will re m a in u n c h a n g e d b u t f u tu r e c o n trib u tio n s w ill re q u ire to b e p a id d ire c t t o th e u n d e r w rite rs . - S u ch a p olicy o n th e life o f a fem ale m e m b e r m a y , in c e rta in circ u m s ta n c e s , be co n v e rte d in to a p o licy o n th e life o f h e r h u s b a n d i f he is in s u ra b le a n d n o t m o re th a n 10 y e a rs h e r s e n io r ’ The Fund is similar to that which has operated fo r the benefit o f members o f the South African Nursing Association fo r many years and the Executive o f your Society hope that all members will give the Fund their fu ll support. CUT HERE. To the T R U STEES G R O U P E N D O W M E N T FUND, S.A. SO C IET Y O F P H Y SIO T H E R A PY , P .O . BOX 1106, PR ET O R IA . Please supply me with details. N a m e ........................................................................ A d d re ss.................................................................... D ate of B irth........................................................... W here employed.................. ................................... H ow much can you afford to pay each m o n th : R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )