Effects of a Muscle Relaxation Technique on Catatonia Symptoms Associated With Schizophrenia: A Case Report

Catatonia is characterized by the loss of voluntary control over the workings of the mind and body. It disrupts daily life by manifesting as idle posture, heightened muscle tone, and repetitive purposeless movements. However, specific physiotherapy methods addressing these symptoms are yet to be established. This case report describes a 63-year-old man hospitalized for schizophrenia who was then diagnosed with stuporous catatonia based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, characterized by catalepsy, mutism, and difficulty performing daily activities. This case report aimed to evaluate the effectiveness of a specific muscle relaxation technique, squeeze-hold (SH), in treating catatonia associated with schizophrenia and its impact on daily activities. The patient exhibited catalepsy, mutism, and difficulty in performing daily activities. The SH technique employed temporarily obstructs muscle blood flow to induce ischemia, resulting in the relaxation of vascular smooth muscle due to CO₂ retention. Furthermore, shear stress upon reperfusion stimulates nitric oxide production in the vascular endothelium, enhancing blood flow. Following weekly SH on the bilateral thighs, the muscle tone in the lower extremities was alleviated within two weeks, and the patient no longer required a wheelchair by the eighth week. In addition, responsiveness to verbal commands improved. As muscle tone in the lower limbs improved, the patient regained ambulation, and his improved responsiveness facilitated independent eating during activities of daily living (ADLs), potentially enhancing motivation and spontaneity. These findings suggest that muscle tone relaxation due to enhanced blood flow and increased CO₂ concentration from blood flow restriction may have promoted β-endorphin secretion, thereby improving symptoms via brain-derived neurotrophic factor expression through PGC-1α activation. In conclusion, the SH muscle relaxation technique effectively alleviated catatonic symptoms, and improved muscle tone and daily functioning in patients with schizophrenia-associated catatonia. These findings suggest that this physiotherapy approach may be a valuable addition to catatonia treatment, potentially contributing to physical and psychiatric rehabilitation. This case report illustrates the efficacy of a muscle-tone-focused treatment approach in physical therapy for catatonia and posits its contribution to the reacquisition of psychiatric function and ADLs.