Jacobson’s Progressive Muscle Relaxation has been said and little has been done. Whenever it comes to the matter of any non-pharmacological treatment, doctors usually don’t find themselves in a very comfortable position. It won’t be my tall talk, if I say that now a days we are becoming more sort of a pharmacotherapy. But pharmacotherapy is not the only modality of treatment. Many a times doctors come across anxious patients demanding some sort of relief for their anxiety. Sometimes the anxiety in such patients are more sort of a trait anxiety. One of the common trend is to prescribe Benzodiazepine to this group of patients. But if we carefully assess this patients they may not fulfill the criteria of anxiety disorder. In such cases is it justifiable to prescribe drugs like Alprazolam. Sometimes even you feel anxious or tensed for few hours, will take these drugs. What will do? Many will answer, “ Relaxation Techniques”. But how to do it? Most of us don’t know. Unless we don’t know it, how can we teach others. Here is a brief description of one of such relaxation technique, that I am using quite successfully for the treatment of anxious patients or even normal people with tension

Introduction; It is a technique of relaxation

History:
Progressive muscle relaxation is a technique of stress management developed by American physician Edmund Jacobson in the early 1920s.

Principles:
It is often seen that anxiety is associated with increased muscular tension. Therefore it can be argued that since muscular tension accompanies anxiety, one can reduce anxiety by learning how to relax the muscular tension.

Positioning:

It can be done either in:
Sitting: Sit in a comfortable chair – reclining arm chairs are ideal.
Lying: One can also lie on a bed.

Technique:

Take a deep breath; let it out slowly. What you’ll be doing is alternately tensing and relaxing specific groups of muscles. After tension, a muscle will be more relaxed than prior to the tensing. Concentrate on the feel of the muscles, specifically the contrast between tension and relaxation. In time, you will recognize tension in any specific muscle and be able to reduce that tension.
Breathe slowly and evenly and think only about the tension-relaxation contrast. Each tensing is for 10 seconds; each relaxing is for 10 or 15 seconds. Count “1,2, 3…..” until you have a feel for the time span. Note that each step is really two steps – one cycle of tension-relaxation for each set of opposing muscles.

1. Hands. The fists are tensed; relaxed. The fingers are extended; relaxed.

2. Biceps and triceps. The biceps are tensed (make a muscle – but shake your hands to make sure not tensing them into a fist); relaxed (drop your arm to the chair). The triceps are tensed ; relaxed (drop them).

3. Shoulders. Pull them back relax them. Push the shoulders forward ; relax.

4. Neck (lateral). With the shoulders straight and relaxed, the head is turned slowly to the right, as far as you can; relax. Turn to the left; relax.

5. Neck (forward). Dig your chin into your chest; relax.

6. Mouth. The mouth is opened as far as possible; relaxed. The lips are brought together or pursed as tightly as possible; relaxed.

7. Tongue (extended and retracted). With mouth open, extend the tongue as far as possible; relax (let it sit in the bottom of your mouth). Bring it back in your throat as far as possible; relax.

8. Tongue (roof and floor). Dig your tongue into the roof of your mouth; relax. Dig it into the bottom of your mouth; relax.

9. Eyes. Open them as wide as possible (furrow your brow); relax. Close your eyes tightly (squint); relax. Make sure you completely relax the eyes, forehead, and nose after each of the tensings.

10. Breathing. Take as deep a breath as possible – and then take a little more; let it out and breathe normally for 15 seconds. Let all the breath in your lungs out – and then a little more; inhale and breathe normally for 15 seconds.

11. Back. With shoulders resting on the back of the chair, push your body forward so that your back is arched; relax. Be very careful with this one, or don’t do it at all.

12. Butt. Tense the butt tightly and raise pelvis slightly off chair; relax. Dig buttocks into chair; relax.

13. Thighs. Extend legs and raise them about 6in. off the floor or the foot rest but don’t tense the stomach relax. Dig your feet (heels) into the floor or foot rest; relax.

14. Stomach. Pull in the stomach as far as possible; relax completely. Push out the stomach or tense it as if you were preparing for a punch in the gut; relax.

15. Calves and feet. Point the toes (without raising the legs); relax. Point the feet up as far as possible (beware of cramps – if you get them or feel them coming on, shake them loose); relax.

16. Toes. With legs relaxed, dig your toes into the floor; relax. Bend the toes up as far as possible; relax.

Other per-requisites:
1. Get as comfortable as possible – no tight clothes or shoes and don’t cross your legs.
2. Don’t tense muscles other than the specific group at each step. Don’t hold your breath, grit your teeth, or squint.

Contraindications:
Fracture, Muscular tear, Spondylosis

Efficacy: It is one of the most widely used technique. In my practice life I have found it very helpful in reducing anxiety in anxious patients.