Progressive Muscle Relaxation for PTSD: Step-by-Step Guide

Trauma lives in the body. Years of hypervigilance create chronic muscle tension that persists long after the danger has passed. Your shoulders stay hunched. Your jaw clenches without awareness. Your stomach holds knots of anxiety that never fully release. Progressive Muscle Relaxation (PMR) offers a systematic way to release this held tension and teach your body what relaxation actually feels like. This body-based approach complements other somatic practices—see somatic experiencing for trauma recovery for a broader framework.

This guide provides a trauma-adapted PMR protocol, explains why it works, and helps you navigate the unique challenges trauma survivors face when attempting body-based relaxation techniques.

Progressive Muscle Relaxation is a technique [developed by physician Edmund Jacobson in the 1920s]¹. The basic principle is simple: by deliberately tensing a muscle group and then releasing it, you can achieve a deeper state of relaxation than you would through passive relaxation alone¹.

Jacobson discovered that muscle tension and anxiety are physiologically linked¹. When you are anxious, your muscles tense. When your muscles are tensed, your brain interprets this as a signal that something is wrong, increasing anxiety. This creates a feedback loop that maintains both psychological and physical tension.

PMR interrupts this loop by creating deliberate, controlled tension followed by release. The contrast between tension and relaxation helps you notice what true relaxation feels like, something many trauma survivors have never experienced or have forgotten.

Complex PTSD creates unique patterns of chronic muscle tension[^7]:

Protective tension: Your body learned to brace against anticipated attack or criticism. Shoulders raised toward ears. Arms held close to the body. Core muscles tight.

Startle response armoring: Trauma survivors often maintain constant low-level activation of muscles involved in the startle response, including the neck, upper back, and shoulders².

Dissociation-related numbness: Some trauma survivors lose awareness of body sensations entirely, including tension³. PMR helps rebuild this awareness.

Incomplete fight-flight responses: Trauma often involves thwarted defensive responses. The energy mobilized for fighting or fleeing remains trapped in muscles as chronic tension.

PMR addresses these patterns by systematically moving through the body, bringing awareness to areas of held tension and training the muscles to release.

Understanding why PMR works can increase your confidence in the practice.

When you tense a muscle group for several seconds and then release it, several physiological processes occur:

Golgi tendon organ activation: These specialized receptors in your tendons detect tension levels⁴. When you create strong deliberate tension, the Golgi tendon organs signal the muscle to relax, producing a reflex relaxation that goes deeper than you could achieve through willing the muscle to relax⁴.

Lactic acid clearance: Tensing and releasing improves blood flow to muscles, helping clear metabolic waste products that contribute to tension and discomfort.

Proprioceptive reset: The contrast between tension and relaxation helps recalibrate your body's sense of its own state³, allowing you to notice tension you had normalized.

PMR activates the parasympathetic nervous system⁵, the rest-and-digest state opposite to the fight-or-flight sympathetic activation of trauma. Research shows that PMR reduces cortisol levels, decreases blood pressure and heart rate, and improves autonomic nervous system regulation⁶, making it an effective tool for managing PTSD symptoms:

• Reduces cortisol levels (the primary stress hormone)⁶
• Decreases blood pressure and heart rate⁶
• Increases heart rate variability (a marker of nervous system flexibility)
• Reduces activity in the amygdala (the brain's alarm center)

For trauma survivors stuck in chronic sympathetic activation, PMR provides a concrete skill for shifting nervous system state.

Standard PMR instructions must be modified for trauma survivors. The following adaptations increase safety and effectiveness.

Traditional PMR often begins with the hands or face. For trauma survivors, beginning with feet and lower legs is often safer. These areas are:

• Less associated with trauma memories for most people
• Further from the core, where vulnerability is often felt
• Less likely to trigger dissociation

Many relaxation scripts instruct you to close your eyes. For hypervigilant trauma survivors, closing eyes can trigger anxiety rather than relaxation³. Keep your eyes open, with a soft gaze, until you feel safe enough to close them. Some trauma survivors never close their eyes during PMR, and that is perfectly fine.

Standard PMR instructions often say to tense muscles to about 70-80% of maximum. For trauma survivors, this intensity can trigger fight-flight activation or dissociation. Start with very light tension, perhaps 20-30% of maximum. You can always increase intensity as you become more comfortable with the practice.

Some muscle groups may be triggering for certain trauma survivors:

• Throat/neck: May trigger choking memories or feelings of vulnerability
• Chest: May intensify panic sensations
• Pelvis/hips: May be triggering for sexual trauma survivors
• Fists: May activate fight responses

You can skip any area that feels unsafe. You can also modify by using very light tension or simply bringing awareness to the area without tensing at all.

Between each muscle group, ground yourself before moving on:

• Notice what you can see around you
• Feel your contact with the chair or floor
• Orient to the current moment

This prevents the inward focus of PMR from triggering dissociation or flashback.

Choose a time and place where you feel relatively safe:

• A room where you can lock the door
• A time when you will not be interrupted
• A position where you can see the door (for those with hypervigilance)
• With enough light to see your surroundings (not complete darkness)

The following script guides you through a full PMR session. Read through it first to familiarize yourself, then practice with eyes open, checking back at the script as needed. Eventually, you may memorize the sequence or record yourself reading it.

Find a comfortable position, either sitting in a supportive chair or lying on your back. If lying down feels vulnerable, sitting is fine. If sitting, place your feet flat on the floor about hip-width apart. Let your hands rest on your thighs or the arms of the chair.

Take a moment to orient to your surroundings. Notice three things you can see. Feel the support of the chair or floor beneath you. Notice the temperature of the air on your skin.

Take three slow breaths, letting each exhale be slightly longer than the inhale. Not deep breaths that feel forced, just slow and easy.

Remind yourself: You are in control. You can stop at any time. You can open your eyes at any time. Nothing bad is happening right now.

Feet: Curl your toes downward as if gripping the floor with your feet. Hold this light tension for 5 seconds, noticing what it feels like. Now release. Let your feet go completely limp. Notice the difference between tension and relaxation. Breathe.

Ground: Look around the room. Notice one thing you can see. Feel your feet on the floor.

Calves: Point your toes away from your body, gently tensing your calf muscles. Hold lightly for 5 seconds. Release. Let your lower legs feel heavy and relaxed. Notice any warmth or tingling as blood flows more freely.

Ground: Notice the weight of your legs. Feel the support beneath you.

Thighs: Press your legs together slightly, tensing the inner thigh muscles. Hold gently for 5 seconds. Release. Let your legs fall open slightly to a comfortable position. Notice the relaxation spreading through your upper legs.

Ground: Feel the chair or surface supporting your legs. Take one easy breath.

Hamstrings and glutes: Press your heels gently into the floor, tensing the backs of your thighs and your buttocks. Hold for 5 seconds. Release completely. Notice your legs sinking into the support beneath you.

Ground: Look around. Notice something in the room that reminds you of safety.

Abdomen: Gently tighten your stomach muscles, as if bracing for a light tap on your belly. Use only light tension. Hold for 5 seconds. Release. Let your belly soften. Many trauma survivors hold constant tension here; notice if relaxation feels unfamiliar or vulnerable. You are safe.

Ground: Place one hand on your belly if that feels comfortable. Feel it rise and fall with your breath.

Lower back: Gently arch your lower back slightly, creating tension in the lower back muscles. Very light tension only. Hold for 5 seconds. Release. Let your spine settle into neutral.

Ground: Notice three points of contact between your body and the surface beneath you.

Hands: Make gentle fists, curling your fingers toward your palms. Light tension only. Hold for 5 seconds. Release. Spread your fingers wide, then let them relax.

Ground: Look at your hands. Wiggle your fingers. You are here, now, in this room.

Forearms: With your arms resting comfortably, gently bend your wrists toward your forearms, tensing the muscles on the inside of your forearms. Hold for 5 seconds. Release. Then gently extend your wrists back, tensing the outer forearms. Hold, release. Let your arms feel heavy.

Biceps: Bend your elbows slightly, creating light tension in your biceps. Hold for 5 seconds. Release. Let your arms rest heavily.

Shoulders: This area often holds significant trauma tension. Very gently raise your shoulders toward your ears. Only a small movement. Hold for 5 seconds. Release, letting your shoulders drop. Notice them moving away from your ears.

Ground: Roll your shoulders back once, opening your chest. Breathe.

Neck (optional, skip if triggering): Gently press your head back into the chair or pillow behind you, tensing the back of your neck. Very light pressure only. Hold for 5 seconds. Release. Let your head feel supported.

Ground: Turn your head slowly left, then right. Notice what you can see on each side.

Jaw: Many trauma survivors clench their jaw constantly. Gently clench your teeth together. Notice the tension in your jaw muscles. Hold for 5 seconds. Release. Let your jaw drop open slightly. Let your tongue rest on the floor of your mouth.

Face: Gently scrunch your face, squeezing your eyes closed, wrinkling your nose, pursing your lips. Hold for 5 seconds. Release. Let your face go smooth and soft. Let your forehead feel wide and open.

Ground: Open your eyes if they were closed. Take in the room around you. You are here. You are safe.

Take a moment to scan through your body from feet to head. Notice any areas that still hold tension. Without judgment, simply breathe into those areas.

Notice how your body feels compared to when you began. You do not need to feel perfectly relaxed. Any shift toward relaxation is progress.

Take three slow breaths. On each exhale, allow yourself to settle more deeply into relaxation.

When you are ready, begin to bring your awareness back to the room. Wiggle your fingers and toes. Move gently. There is no rush. Open your eyes fully if they were softly closed.

Take a moment before standing. Notice how you feel. This is information your body is giving you.

If relaxation feels impossible, you are not failing. Chronic tension has become your baseline; relaxation feels unfamiliar or even wrong. Keep practicing. Your nervous system will gradually learn that relaxation is safe. Even tiny shifts toward less tension are progress.

Some trauma survivors feel more anxious when they start paying attention to their body. This is common. Try:

• Keeping your eyes open
• Practicing for shorter periods (5-10 minutes instead of 20)
• Using even lighter tension
• Adding more grounding between muscle groups
• Practicing with a trusted person present

If you fall asleep during PMR, your body may need rest more than relaxation practice. Let yourself sleep. You can also try practicing sitting up rather than lying down, or practicing earlier in the day when you are less tired.

If you notice yourself floating away, losing time, or feeling disconnected from your body, use grounding immediately:

• Open your eyes
• Look around and name five things you see
• Press your feet firmly into the floor
• Hold something cold or textured
• Stand up and move around

You may need to work with a trauma therapist before practicing PMR independently. The 20 grounding techniques for C-PTSD guide provides additional options when dissociation interrupts PMR practice.

If tensing causes cramps or pain, use even lighter tension or skip that muscle group. PMR should never hurt. If you have any medical conditions affecting your muscles, consult your doctor before practicing.

Begin with 5-10 minutes, perhaps just covering feet, legs, and hands. Gradually add muscle groups as you become more comfortable. A 20-minute full-body session can develop over several weeks of practice.

Daily practice produces the best results⁷. Even 5 minutes daily is more effective than one 30-minute session per week. Your nervous system needs repetition to learn new patterns.

Keep a simple log noting:

• How tense you felt before practice (1-10)
• How relaxed you felt after (1-10)
• Any areas that were particularly difficult to relax
• Any challenges that arose

Over time, you will likely see improvements in both your starting tension levels and your ability to achieve relaxation.

Once you have learned the technique, you can use abbreviated versions when you notice tension:

• Tense and release your shoulders during a break at work
• Tense and release your hands when stuck in traffic
• Tense and release your jaw before difficult conversations

These mini-practices maintain your skills and prevent tension from accumulating.

• Progressive Muscle Relaxation works by deliberately tensing and releasing muscle groups, creating deeper relaxation through contrast¹
• Trauma survivors need modifications including lighter tension, peripheral starting points, open eyes, and frequent grounding³
• PMR activates the parasympathetic nervous system, counteracting chronic fight-flight activation⁵⁶
• Some muscle groups may be triggering and can be skipped or modified
• Regular practice is more effective than occasional longer sessions²
• Challenges like inability to relax, increased anxiety, or dissociation are common and can be worked through
• PMR is one tool among many and works best as part of comprehensive trauma treatment⁸. Other body-based approaches include breathwork for trauma regulation and creating a sensory toolkit for regulation.

1. Read through the protocol: Familiarize yourself with the full sequence before practicing.

2. Create a safe practice space: Identify a time and place where you feel secure enough to try PMR.

3. Start with just feet and hands: Do not attempt the full protocol initially. Practice abbreviated versions until they feel comfortable.

4. Consider recording yourself: Record the protocol in your own voice, including pauses, so you do not need to read during practice.

5. Practice for one week: Commit to daily practice, even if brief, for one week before evaluating.

6. Note your baseline: Before your first practice, rate your typical tension level so you can track changes over time.

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Books and Learning Materials:

• Somatic Experiencing Resources - Find SE practitioners for body-centered trauma therapy

Apps and Guided Sessions:

• Insight Timer - Free meditation app with PMR guided sessions
• Calm - Relaxation and meditation app with PMR exercises
• Headspace - Guided meditation and relaxation techniques
• YouTube PMR Videos - Free guided PMR sessions

Crisis Support and Professional Help:

• Psychology Today - Therapists - Find trauma-informed therapists
• 988 Suicide & Crisis Lifeline - Call or text 988 for crisis support (24/7)
• Crisis Text Line - Text HOME to 741741 for crisis counseling
• National Child Traumatic Stress Network - Resources for trauma recovery

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