Relaxation

Relaxation

Carolyn McManus, PT, MS, MA

Most people with chronic pain notice that they carry a lot of tension in their body. For example, no matter where your pain is located, you may notice that your neck or shoulders feel tight. Pain creates overall body tension because our muscles tighten as we 'brace' against pain. Tight muscles make pain worse. How?

  • Tight muscles 'pull' on the body. For instance, tight shoulders can pull on the neck, irritating joints and nerves to the scalp. This can create tension headaches. Tight back muscles can worsen back pain by pulling on the spine and connecting tissues.
  • Tight muscles generate chemicals that activate pain-related nerves, making pain even worse.
    Muscle relaxants, or pain medicine to ease muscle tension, are often not effective when used for a long time. They may have unwanted side-effects and cause other problems. There are better ways to manage your pain. You can learn exercises to reduce muscle tension and relax. Research shows these exercises can help you feel better and reduce pain.

Relaxation Techniques

Below is a list of suggestions to help you learn how to relax.

Deep Breathing

When you are under stress or in pain, your breathing pattern can become more shallow and faster. Many people hold their breath. This pattern of shallow breathing reinforces the body's stress reaction. In contrast, diaphragmatic or belly breathing decreases the body's stress reaction and promotes a calming of your mind and body. The instruction to observe your breathing and take a deep breath sounds simple; but it is not always easy to do when stress and pain levels are high. It does get easier with practice. Develop the habit of observing your breath and breathing deeply during times of stress. Deep breathing is a proven way to reduce your stress reaction. Below are some steps you can take to practice deep breathing.

  1.  Formal breathing practice
    a.  Sit comfortably with a good posture. Place your hand on your belly, just below your navel. As you breathe in, try to breathe into your hand. Allow your breath to move deep into your lungs and your stomach to gently move outward and your lower ribs to move out to the side slightly. It may feel like you are breathing into your waistband.
    b.  As you breathe out, allow your stomach to gently fall.
    c.  You do not have to take an extra-large breath. Your breath can be a normal size.
    d.  The key is to allow your breath to fill the bottom of your lungs. You know this is happening when your stomach slightly rises on the in breath and falls on the out breath.
    e.  Now repeat a word or phrase to yourself that helps you relax in concert with your breath. The simplest of these is "in" on the in breath and "out" on the out breath. You can use any word or phrase that has meaning for you. For example:
         i. Your own name on the in breath followed by the words "let go" on the out breath.
         ii. "May I" on the in breath, "be peaceful" on the out breath.
         iii. "Present moment" on the in breath, "only moment" on the out breath.
         iv. If you practice within a religious tradition, you can use a word or phrase from spiritual writings or the phrases "let go" on the in breath, "let God" on the out breath, or "in the Kingdom of God"..."I dwell."
    f.  Practice for 2 minutes at least once a day.
  2. Informal deep breathing
    a.  Use deep breathing when you have pain, during daily activities and when going to bed.
    b.  Wherever you find yourself, whatever the time of day, take a moment to bring your attention to your breath and take a deep breath.
    c.  Observe your breath during routine daily activities, such as sitting at a red light in traffic, standing in line at the grocery store or waiting in a doctor's office.
    d.  If your pain increases, notice your breath and breathe deeply.
    e.  When you are going to sleep, notice your breath, breathe deeply and repeat the word or phrase that helps to calm your mind and body.

Progressive Relaxation

This exercise involves gently tensing then relaxing the major muscle groups throughout your body. It promotes the body awareness you need to control your stress and tension and will help you relax.

Autogenic Training

Autogenic training promotes states of deep relaxation by inviting you to repeat key phrases to yourself. "My right arm feels heavy and warm" is an example of an autogenic phrase. You guide your awareness to different body areas, repeating these calming phrases.

Body-Scan Relaxation

Body scan relaxation involves guiding your awareness through your body in an orderly way, relaxing each body area. It is a simple and commonly used relaxation technique.

Guided Imagery

Guided imagery exercises can be taught to promote relaxation and engage the mind-body relationship in a healing process. Images can be general, for example: "Imagine yourself in a calm and peaceful place." Or they can be specific, for example: "Imagine lots of oxygen bathing an area of pain."

Movement Meditations

Movement meditations such as gentle yoga, walking meditation and Tai Chi, involve moving in a slow, controlled manner with awareness while also breathing calmly and peacefully.

Hypnotic Techniques

To bring on a state of specific focused attention using imagery.

Biofeedback

Provides a person with information about the body, such as muscle tension levels, that can be changed. The information may not usually be under voluntary control or is normally under control but regulation has broken down
Various types of biofeedback include muscle electromyography (EMG), temperature, breathing and heart rate variability.

Resources

The Relaxation & Stress Reduction Workbook by Martha Davis, Matthew McKay and Elizabeth Robbins Eshelman
• Mayo Clinic - Stress Management Assessment, www.mayoclinic.com/health/stress-management/MY00435
• University of Maryland: Stress Relaxation Techniques, www.umm.edu/sleep/relax_tech.htm
• Hobart and William Smith Colleges: Relaxation Techniques, www.hws.edu/studentlife/counseling_relax.aspx
• CD recordings of relaxation exercises, www.carolynmcmanus.com