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The most difficult and important factor in the creation of a restful atmosphere, and one which determines the ultimate success or failure of the treatment, is the manner and bearing of the physiotherapist. She must inspire confidence, as fear, in one form or another, is at the root of much of the tension which she can help to relieve. Her appearance must be tidy and her dress suitable, she must be punctual and move calmly without hurry or hesitation. Her manner must be courteous, pleasant and understanding and her voice low–pitched and clear. A simple explanation of the routine and any instructions required are given to the patient in language and terms which he can understand, so that any anxiety or fear of the unknown is removed. It must be remembered that situations and routines with which one becomes very familiar often appear strange and terrifying when encountered for the first time. Conversation, apart from these instructions, should direct the patient’s thoughts to contemplation of restful and pleasant topics.
Confidence in the physiotherapist and the treatment is gradually built up over a period of time, immediate results are not to be expected and are rarely achieved, often because of psychological factors beyond the control of the physiotherapist or patient. In successful cases a habit of relaxation is built up in place of a habit of tension, but the formation of new habits takes time. Regular and frequent practice on the part of the patient is essential, until finally he becomes an expert in the art of ‘Letting go’ or relaxing, and the normal rhythm of life, in which activity alternates with relaxation, can be re–established.
The position of tension of the whole body is defined in detail, viz. raised shoulders, bent–up elbows and hands, head and trunk flexed, etc. The patient changes the position of every joint in turn, by exact voluntary orders which he is taught to give to his own body, e.g., ‘Stretch the fingers out long’, ‘Stop’, ‘Feel the straightened–out fingers and the fingertips touching the support’.
Rhythmical passive movements of the limbs and head may assist the degree of general relaxation in some cases. These movement are generally given as a sequel to massage. Group movements of joints, e.g. flexion and extension of hip, knee and ankle, are preferable, but a very high standard of performance on the part of the physiotherapist is required to obtain results. The rhythm of small pendular movements pleases some patients.
The ability to promote a state of relaxation depends very largely on the individual physiotherapist and the particular patient with whom she is dealing, and details of successful methods employed vary widely. Ideal conditions are rarely obtainable and, indeed, are hardly desirable, for many patients must eventually learn to relax where and when the opportunity presents itself, e.g. in the train or on a mountain top after a strenuous climb. General relaxation can sometimes be carried out effectively in groups, as in the case of pregnant women, who tend to relax easily, and with some asthmatic and bronchitis sufferers who have had previous individual instruction.