Relaxation And Biofeedback For Neck Pain
Relaxation training is a skill, much like playing a musical instrument, that develops with practice. It can provide the ability to exert control over many of the functions regulated by the nervous system that contribute to pain and suffering. The individual learns about the relationship between pain and stress, the physiological and emotional changes that are result from prolonged stress such as chronic pain. The goals of relaxation training include reduction of maladaptive neuromuscular behaviors, such as bracing against pain or tensing specific muscle groups in response to stress, and the reduction of negative arousal in general, leading to decreased anxiety and depression, to improved stress management, and to an enhanced perception of self worth through the the ability to affect physical and emotional states.
Biofeedback training and relaxation training are not identical. Relaxation training refers to a variety of exercises which require a regular, devoted, practice regimen to be successful. Biofeedback refers to the instrumentation that can be used in conjunction with relaxation training and provides immediate information (feedback) as to the production of the desired physical change.
Although biofeedback instruments are valuable assistive devices, it is through the patient’s effort, not use of the equipment, that skill develops. The three types of biofeedback most commonly used in training with chronic pain patients are:
A. Electromyogram (EMG) training where two electrodes (sensors) are placed at an appropriate distance on the skin over the site being measured, with a third electrode (sensor) placed on a neutral point, usually over a bone, to serve as an electrical reference point. This type of feedback monitors skeletal muscle tension, part of the voluntary nervous system. This type of feedback is used for specific muscle tension disorders such as neck pain or tension headaches, as well as for general relaxation training for insomnia, anxiety, and general psychosomatic disorders such as hypertension, ulcers, or colitis.
B. Thermograph training monitors fluctuations in peripheral temperature (in the finger, hand, or foot) through attachment of a sensor that is a heat sensitive semiconductor. The goal is the voluntary raising of skin temperature, thus reversing the peripheral vasoconstriction, controlled by the autonomic nervous system, that occurs under stress. Migraine headaches and vascular problems, such as Reynauds syndrome are best treated with thermograph feedback.
C. Galvanic Skin Response (GSR) where nervous system activity can be monitored through minute electrical changes in the skin cells. GSR training is often used in conjunction with EMG and temperature training for decreasing nervous system activity and thus decreasing anxiety or phobic states.
Before being introduced to the use of the biofeedback equipment, patients are taught Breathing Exercises using diaphragmatic breathing and are assigned a home-practice regimen. As the foundation of all relaxation techniques, diaphragmatic breathing is easy to learn and has immediate benefits. They are reminded that, of all the functions under control of the autonomic nervous system, only breathing is subject to one’s immediate, although partial, conscious control. By slowing and deepening one’s breathing, imitating the relaxed breathing before onset of sleep, one can influence other functions mediated by the autonomic nervous system and with practice can produce a generalized result. Further, deep breathing from the diaphragm better oxygenates the blood and eliminates the reflexive tensing of the neck, shoulders, and upper chest consequent to the quick, shallow breathing associated with stress and anxiety. Patients practice for 20 minutes two to three times daily to develop an ability to perform this exercise.
Chronic pain patients are also taught to monitor muscle tension or bracing in response to pain or stress throughout the day and are instructed to use breathing for short, stress-reducing applications.
The primary relaxation training exercises include autogenic relaxation, progressive relaxation, imagery, and visualization.
A. Autogenic relaxation is a passive relaxation technique that encourages blood flow to the extremities. This exercise consists of repeating to oneself a series of statements promoting the sensations of heaviness and warmth, focusing individually on four areas of the body: (1) feet, calves, thighs, and buttocks; (2) chest, stomach, and lower back; (3) hands and arms; and (4) shoulders, neck, throat, face, and head.
B. Progressive relaxation is an effective to identify and release muscle tension. The exercise involves contracting and holding tense, then slowly releasing that tension, in the same four major muscle groups used in autogenic relaxation. Patients must be cautioned against overtensing any injured area and the muscles surrounding it. This exercise is particularly helpful with patients who unknowingly engage in bracing patterns, such as teeth clenching which contributes to their pain syndrome. For the neck, many people hold tension in the neck and upper shoulders (trapezius levator scapulae). This raises the shoulders by using these muscles which can become strained. You can raise the shoulders while inhaling using diaphragmatic breathing and then slowly exhale and allow the shoulders to drop and relax. As the shoulders fall, you should lift the head and slightly pull the chin inward towards the neck.
C. In using imagery as a relaxation technique, the patient selects an image or symbol that represents the pain and then visualizes a therapeutic image or process that releases the pain. Using a deep relaxation technique, such as diaphragmatic breathing, the positive image is visualized as replacing the pain image. For example, pain might be visualized as the color red, and the calming color of blue is imagined as slowly absorbing the red.
D. Visualization is an extension of the use of imagery. The patient first uses a deep relaxation technique in preparation and then imagines a pain reducing scenario. The scenario may initially be given by the therapist or presented on tape and the patient being encouraged to develop their own. The patient can imagine reducing the pain sensation, for example, by picturing it as sound emanating from a radio which they walk to and adjust the volume. They can fill their senses with the distraction of a special place, such as a lemon grove in bloom through which they are strolling. Visualization techniques range from scenes that relocate the pain, anesthetize the pain, or allow the individual to change the pain sensation or to disassociate from the pain. The goal of the exercise can be general relaxation and reduction of nervous arousal as well as reduction of pain.
The next part is Active Adaptation for Neck Pain.