Stress management modalities/Progressive muscle relaxation

What is progressive muscle relaxation?
The development of progressive muscle relaxation (PMR) is commonly attributed to Edmund Jacobsen, however similar techniques have been a part of yoga practice for thousands of years. Progressive muscle relaxation techniques involve concentrating on muscles of the body and relaxing them. Techniques may be considered contract-relax or pure-release techniques depending on whether the muscle is tensed prior to relaxation.

Benefits
In the short-term PMR results in both relaxation of the muscles focussed on, and general relaxation.

If PMR is practised over a longer time period, the practitioner will develop an increased awareness of muscular tension and the ability to let go of this muscular tension at will. These somatic skills may be applied to real world contexts such as


 * Letting go of the shoulders when you are feeling stressed
 * Letting go of unnecessary tension in the arms and shoulders during computer work

Methods
Most progressive muscle relaxation techniques can be considered as either contract-relax or pure-release methods. In both of these approaches the practitioner typically concentrates on one area of the body at time and focusses on letting go of the muscular tension before moving onto the next area. PMR techniques are typically associated with the breath.

Contract-relax methods involve the client concentrating on an area of the body, tensing the muscles in that area (typically on the in-breath), then letting go of the tension (typically on the out-breath).
 * Example of a contract-release progressive muscle relaxation exercise in mp3 format(published by David McQuillan under the CC-BY license)

Pure-release methods involve the client concentrating on the tension in an area of the body (typically during the in-breath), then letting go of this tension (typically on the out-breath).
 * Example of a pure release progressive muscle relaxation exercise in mp3 format (published by David McQuillan under the CC-BY license)

Contract-release methods are easier for the client to perform particularly if the client has a fairly low level of body awareness. They also may lead to greater relaxation as a result of post-isometric relaxation effects. This approach to PMR may not however be appropriate with some clients such as those who present with heart conditions or muscle pain.

Pure-release methods are safe for use with the clients that contract-release methods are not appropriate for. The other benefit of pure-release methods are that they are more easily applied in day-to-day life. If you notice that your shoulders are tight while you're working in an open office, breathing into the tension in your shoulders and letting your shoulders drop is less noticible than lifting your shoulders up high as you tense the muscles, then dropping them down. It's often a good idea to start clients with contract-release methods, then to progress them onto pure-release methods once they gain body awareness.

Use of these methods with clients
Clients should initially be instructed in a face-to-face context. This allows the practitioner to ensure that the client is performing the techniques correctly before they go on to use them in their lives. In a massage therapy context, the client can be instructed to use these techniques during the massage while the therapist monitors their performance.

Once the client has been taught how to peform the technique they should be directed to practice these techniques in their own time. Recorded instructions are useful to help your clients perform the techniques appropriately.

Practice guidelines
In general, progressive muscle relaxation needs to be performed for ten minutes daily over a period of about two weeks before competency is attained. Once the therapist has reached competency this level of competency, they should be able to begin instructing others in the use of the technique. Once the client has reached this level of competency, they can be directed to apply progressive muscle relaxation in real world contexts such as those described above.

Although the client will gain the somatic skills described above to some degree, these skills will develop over time as the client applies them in their lives. The speed of development will depend on the individual's initial level of body awareness and control as well as the frequency of practice. As the somatic skills associated with progressive muscle relaxation practice (described previously) develop, the practitioner of progressive muscle relaxation techniques becomes able to chain muscle groups together into regions. An advanced practitioner becomes able to in the space a breath tune into the tension in their body, breathe into it and let it drop with the outbreath.

Contraindications
The isometric contractions involved in contract-relax methods can temporarily increase blood pressure. When a client presents with a history of cardivascular illness particularly hypertension and/or CVA, contract-relax techniques should not be applied unless their primary healthcare provider is consulted first.

The isometric contractions involved in contract-relax methods may aggravate active and/or latent trigger points. This is unlikely to occur if the client is careful to limit the strength of the contraction to at or before the point at which the pain causes the client to tense up. For this reason it's preferable to use pure release methods when pain is involved unless you have confidence that the client will keep their muscle contractions to an appropriate level.

Stress is often associated with emotional overload. When this is the case, working with the breath can bring up these unprocessed emotions. Past emotional traumas are also typically stored in the form of muscular tension within the body. Relaxation of chronically held muscles can result in a release of the stored emotional energy. The practitioner should bear this in mind, and when a client's case history indicates that emotion and/or relationships have been key, this chance should be discussed with the client.

Mental illness - As discussed previously, progressive muscle relaxation can bring up emotional issues. When a client presents with a history of mental illness, it is advisable to work in conjunction with a psychological health professional.