Copyright ÂŠ 2011 by Dr. Phang Cheng Kar, M.D.
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National Library of Malaysia Cataloguing-in-Publication Data Phang, Cheng Kar, 1974Progressive Muscle Relaxation: Made Clear & Simple By Phang Cheng Kar ISBN 978-983-43735-3-5 1. Muscles; 2. Relaxation; 3. Stress management; 4. Psychology I. Title 613.79
AN ANXIOUS MIND CANNOT EXIST IN A RELAX BODY -Dr. Edmund Jacobson(1888 – 1983)
This book is dedicated to all those who have benefited from the practice of PMR & taught me how to teach PMR effectively A great teacher is one who was once confused and knows what can be confusing for the students -Zhen-Phang-
Frequently Asked Questions
hen we are under stress, one of the changes in the body is muscular tension, especially those around the neck, shoulders and face. This can lead to physical pain, restlessness, tiredness and more stress. When the breathing muscles are tensed, it can also lead to difficulty in breathing. Oxygenation of the brain will be poor, and this naturally worsens the stress reaction. One effective way to overcome this is by using a relaxation technique known as Progressive Muscle Relaxation (PMR). PMR was first introduced by an American physician by the name Dr. Edmund Jacobson. This is an effective technique for relaxing the muscles in the body, which in turn calms the mind. Since its introduction in the nineteen thirties, there have been many versions of PMR. The one introduced here consists of 10 basic postures, and each posture involves alternatively tensing and relaxing a different group of muscles in the body. The subsequent figures and instructions will guide you on the basic steps involved in PMR.
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BASIC STEPS 1. Squeeze the oranges Clench your fists… Imagine squeezing oranges for juice… Feel the tension around the fists…
Count 1 – 10 slowly… Open your fists and let go the tension… Feel the waves of relaxation… Repeat this 2x
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2. Tortoise Imagine that you are a tortoise, push your head into the shell and shrug your shoulders… Feel the muscular tension around the neck and shoulders…Count 1 – 10 slowly… Let go & return to neutral position… Feel the waves of relaxation Repeat this 2x 3. Superman Push you hands behind to squeeze the shoulder blades together…and extend your stomach forward… Feel the muscular tension around the area between your shoulder blades and stomach…Count 1 – 10 slowly… Let go & return to neutral position… Feel the waves of relaxation…
Repeat this 2x
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4. Push the ceiling Imagine that the ceiling is falling down… Straighten your hands with palms facing upward, fingers pointing towards the centre and imagine pushing the ceiling…
Arch your body a bit towards the back and feel the muscular tension around the hands, neck and chest… Count 1 – 10 slowly… Let go & return to neutral position… Feel the wave of relaxation… Repeat this 2x
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The next three postures are for relaxing the facial muscles. They may not be cosmetically appropriate but are certainly effective for facial relaxation. 5. Aaahhhh! Open your mouth as wide as possible and imagine making the sound, “Aaahhhh!”… Feel the muscular tension around the mouth… Count 1 – 10 slowly… Let go & return to neutral position… Feel the wave of relaxation… Repeat this 2x
6. Eeeehhh! Clench your teeth and imagine making the sound, “Eeeehhh!”…Feel the muscular tension around the jaw… Count 1 – 10 slowly… Let go & return to neutral position… Feel the waves of relaxation…Repeat this 2x PMR Made Clear & Simple - 5 -
Pull your nose longitudinally and imagine making the sound, “Oohhhhhh!”… Feel the muscular tension around the nose… Count 1 – 10 slowly… Let go and return to neutral position… Feel the waves of relaxation… Repeat this 2x The next three postures are for relaxing the legs and can be very helpful after standing or walking for a long time. 8. Grab tissue paper with toes Imagine trying to grab a piece of tissue paper or cloth with your toes on both legs… Feel the muscular tension around the toes…Count 1 – 10 slowly… Let go & return to neutral position…Feel the waves of relaxation…Repeat this 2x PMR Made Clear & Simple - 6 -
9. Touch your toes with hands Touch your toes with hands or try to flex your ankle towards the body… Feel the muscular tension around the calves…Count 1 – 10 slowly… Let go & return to neutral position…Feel the waves of relaxation…Repeat this 2x 10. Touch the wall with your toes
Imagine touching an imaginary wall in front of you with your toes... Feel the muscular tension around the upper part of the feet… Count 1 – 10 slowly… Let go & return to neutral position… Feel the waves of relaxation… Repeat this 2x
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PMR TIPS 1. Try to practice regularly, e.g. once in the morning and before sleep. Try not to practice after meals as it may interfere with relaxation response. PMR can be done in various positions sitting, standing or lying, and with or without eyes closed. 2. Remember to spend enough time in the relaxation phase (i.e. let go and return to neutral position). Allow yourself at least 10-15 seconds before doing the next tensing. 3. You may do only selected postures for specifically relaxing certain parts of the body, e.g. 2, 3, 4 for neck and shoulder areas, after feeling tired using the desktop for a long time. 4. Certain postures are prone to muscle cramp, e.g. 8 and 10. Be gentle with yourself. Do not practice if you have physical injury, e.g. spinal problem. If you are not sure, consult your doctor.
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5. For each posture, tense only that particular group of muscles. Do not contract other group of muscles. Once PMR is mastered, relaxing a group of muscles may automatically relax other groups of muscles too. 6. It is important to be able to feel the contrast between muscular tension and relaxation. Once muscular tension is recognized, it is easier to let go and relax. Tensing the muscles produces a „rebound effect,‟ like pulling a pendulum, and then allowing the muscles to „swing‟ into relaxation. 7. Muscular tensions can be experienced as tightness, pain, stiffness, tiredness, restlessness, tremor, etc. It will be helpful to identify your „signature muscular tension.‟ Ask yourself, “How do I usually experience muscular tension? Where is it in my body that I usually experience muscle tension? What situations usually trigger stress and my muscle tensions?” This will help us to be more effective in stress management 8. You may use other ways to enhance relaxation response, e.g. soothing music, aromatic scents, deep breathing, pleasant imagery, etc. Be creative and have fun.
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ALTERNATIVE METHODS A. PMR & DEEP BREATHING 1. As you tense a particular group of muscles, e.g. neck and shoulders as in „tortoise‟, take a slow deep breath… 2. You can easily take a slow deep breath by breathing in through the nose and allowing the tummy to slowly and fully expand…It is not necessary to count from 1- to 10… 3. When the tummy is fully expanded, relax the particular group of muscles, breathe out fully through the mouth with a sound of relief, e.g. “Ahhhhh,” and let the tummy „deflate‟… Repeat this 2x and for other postures. PMR Made Clear & Simple - 10 -
B. PASSIVE MUSCLE RELAXATION Passive Muscle Relaxation produces muscles relaxation without tensing the muscles physically. It involves the use of imagery and auto-suggestions. This method is helpful for those with muscle ache or injury, and conditions that may be worsen by straining, e.g. heart disease. 1. Sit or lie in a comfortable position 2. Gently close your eyes 3. Breath in and out easily into different groups of muscles in the body 4. Imagine the breath as having healing energy (e.g. blue and cool divine light) that can help to relax the muscles in the body 5. With each out breath, say a magic word that you associate with relaxation, e.g. Relaxâ€Ś.!
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A guided Passive Muscle Relaxation in mp3 format is available for downloading from here: http://www.4shared.com/audio/O1bUO3JX/Passive_Muscle_Relaxation.html
Another similar technique, “Body Scan & Kindness” is available for download from here: http://www.4shared.com/account/audio/NBkyTrsx/Body_scan__kindness_sh ort.html
You may want to record your own voice and insert your favorite background music for passive muscle relaxation. A simple to use software, “Audacity,” can be downloaded from http://audacity.sourceforge.net/
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C. PROGRAMMING MUSCLE RELAXATION 1. When tensing the muscles, slowly think of the word “TENSE,” and then mentally spell it by reciting each letter, “T…E…N…S…E,” 2. In the relaxation phase, think of the words, “RELAX…RELAX…RELAX,” and mentally spell out the words, “R…E…L…A…X ---- R…E…L…A…X --- R…E…L…A…X.” Allow at least 20-30 seconds for the relaxation phase or 1. When tensing the muscles, slowly think of an image that you associate with tension, e.g. burning charcoal that is getting hotter and hotter as you count from 1 to 10… 2. In the relaxation phase, think of an image that you associate with relaxation, e.g. fresh flower. Allow at least 20-30 seconds for the relaxation.
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Once mastered, simply think of the words, “RELAX…RELAX…RELAX,” or mentally spelling them or visualizing a fresh flower will automatically trigger muscle relaxation.
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1. What kind of conditions may benefit from PMR? As PMR is helpful for relaxation, any conditions that are associated with stress, e.g. headache, asthma, gastritis, chronic pain, etc. may benefit from it as a complementary treatment. I personally find it helpful to do PMR before my meditation, as it relaxes the body, allowing the mind to settle down, and eventually go deeper into states of relaxation. 2. When should I practice PMR? It is helpful to have a regular time for practicing PMR, e.g. once in the morning and before sleep. In between, whenever you detect any muscular tension, you can always do another full or partial round of PMR. It is usually not effective when you only do it during stressful period. Hence, try to have daily practice even when you are well. Be generous in your practice. So far, I have not come across anyone who has PMR Made Clear & Simple - 15 -
problem due to practicing too much. On the other hand, the usual problem is not practicing enough. 3. Do I need to follow the proper sequence? No, it is not necessary. But following a sequence may ensure that you do not miss a particular PMR posture or groups of muscles in the body. There may not be any sequence at all, as you can just do selected posture for specifically relaxing a target group of muscles, e.g. neck and shoulder. 4. Must I follow the exact counts in tensing and relaxing? No, it is not necessary. The counting is just a guide. Once you are familiar with PMR, you can event drop the counting. However, do ensure that there is sufficient time for the relaxation phase. With regular practice, you will just intuitively know how much time is needed for each phase. Listen to your body, as it has the wisdom to decide what is just right for you.
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5. How do I know whether my muscles are tensed? Muscular tensions can be experienced as tightness, pain, stiffness, tiredness, restlessness, tremor, etc. Sometimes, we may not know that we are tensed up until we do the tensing-relaxing of PMR. The “Wowwwwhhhh!” feeling during the tensing phase and “Aaahhhhhhh” feeling during relaxing phase are good indications that the muscles are tensed and need relaxation. 6. How do I know whether I am relaxed? Signs of relaxation include muscles feeling light or soft, heart rate is slower, breathing becomes abdominal (slow and deep), increased saliva flow, subjective sensation of lightness, floating or sinking, smooth forehead, jaw slightly open, dropped shoulders, reluctance to move or speak, etc. You do not need to have all the signs. Your „signature signs‟ may also be different from those listed. With regular practice, you just know that relaxation response has taken place, and you are benefiting from PMR.
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7. What are the advantages of PMR as compared to other relaxation techniques, e.g. deep breathing and pleasant imagery? PMR is particular helpful when stress is associated with muscular tension. Many people find it easier to do PMR as it is more tangible as compared to other techniques that require more mental concentration. I personally find it very helpful to combine PMR with deep breathing, pleasant imagery and auto-suggestion. But it may be difficult for beginners and anxious individuals, in view of the need for greater mind-body coordination. 8. It works but the muscular tension returns. What can I do? You can do more PMR or other relaxation techniques. But a probably more helpful way is to identify the situations and negative thought patterns that often trigger stress and muscular tension in you. Once identified, you can adjust them to reduce the chances of stress response. For instance, you may notice that you become easily tensed up when sleep deprived and drinking too much of coffee. All you need to do is to ensure adequate sleep and non-excessive coffee intake. As for thoughts, you may realize that it is your perfectionism that put you under constant stress. What is then needed will perhaps be balancing the perfectionism with more spontaneity, fun and play. PMR Made Clear & Simple - 18 -
9. What is the difference between Yoga stretch and PMR? As far as I understand, they are quite similar in terms of their desired effect of relaxation. However, Yoga postures can be more challenging, and may be associated with other physical and psychospiritual benefits. If you are more comfortable with Yoga stretch for muscle relaxation, just go ahead. Massage may also be helpful for muscle relaxation. 10. What if my attention drifts away or I fell asleep while doing passive muscle relaxation? The unhelpful thing to do is to criticize or condemn yourself, “Why can‟t you do such a simple thing?!…You are really USELESS!” All you need to do is just gently bring your attention again and again back to the practice i.e. instructions and body awareness in the guided relaxation. Research by Dr. Herbert Benson (M.D.) has shown that it is this repetitively effort that helps to elicit a relaxation response. If you had fallen asleep, that is good, it means you are relaxed.
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11. What if I have muscle cramp? This is often associated with posture number 8 and 10. â€œOoouchhh!â€? I know it is painful. You do not need to worry too much as it will usually go away within a minute. You may massage your feet to relieve the cramp. When the pain is totally gone, and when you are ready, you may repeat the posture slowly and with gentleness; it should be fine. Do remember that relaxation requires time and gentleness. If you have physical injuries, choose alternative method, e.g. passive muscle relaxation. 12. Is PMR suitable for children, the elderly and pregnant women? I find that children enjoy doing PMR. For children with special needs, it may be helpful to teach PMR slowly, e.g. only 3 postures at a time. It is fine for the elderly except that you need to be gentle, and may need to skip certain postures due to body aches or injuries, e.g. cervical and lumbar spondylosis (arthritis of the neck and lower back). Choosing passive muscle relaxation can overcome this problem. Pregnant women are prone to muscle cramps especially at the calves. So, be gentle and consider passive muscle relaxation as an alternative. PMR Made Clear & Simple - 20 -
13. How long should I practice to gain some benefit? If done correctly, you should be able to feel some relaxation effect immediately. However, I often come across individuals who are nervous and not confident with the technique. This can interfere with the relaxation response. It is helpful if you can practice whatever you know for at least a week consecutively, before concluding whether it is beneficial. If it is not, write down and discuss the challenges with someone who is familiar with PMR. The personal guidance, feedback and adjustment for your individual needs are often the most important factors for effective practice of PMR. 14. How long should I continue to practice? How long should we continue to eat? Whenever we still feel hungry, isnâ€&#x;t it? Therefore, there is always a role of PMR whenever we still experience stress. 15. Whom can I contact for more guidance in practicing PMR? You may contact me at email@example.com. Other people who may be familiar with PMR include clinical psychologist, counselor, physiotherapist, psychiatrist, etc. Feedback is also welcome. PMR Made Clear & Simple - 21 -
TESTIMONIAL Last year, I did my counseling internship in a quite challenging institution. Though my overall internship experience was rewarding and fulfilling, the journey was a very tough as well. At times, I felt overloaded with stress and anxiety. Practicing PMR and mindful breathing was really helpful to relieve my overwhelming stress. Practice the full set of PMR daily before sleep helps in improving my sleep quality. Getting a good night‟s sleep is really crucial for me, as it will ensure that I‟m in tip-top condition for work. Apart from that, I find the „Tortoise‟ posture very effective in helping me to relax my muscles around the shoulder. This helps in relaxing my mind after a long time sitting in front of the computer. Practicing PMR regularly makes the relaxation process easier. I‟m more aware of my body‟s condition. As I recognize the signal of “stressed” body, applying PMR to the stressed parts is very effective to relieve the muscular tension in just a few minutes. The relaxed body eventually helps me to remain calm and peaceful. Pheh Kai Shuen, Counselor. PMR Made Clear & Simple - 22 -
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This DVD book is produced by
KL Buddhist Mental Health Association http://www.klbmha.com FOR FREE DISTRIBUTION & FUND RAISING - not for sale or duplication without permission â€“ firstname.lastname@example.org
In memory of the late Mr. Phang Ah Keong (1944-2011) PMR Made Clear & Simple - 26 -
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Relaxation and wellness...