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Top-10 Positional-Release Therapy Techniques to Break the Chain of Pain, Part 1

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Timothy Speicher at Positional Release Therapy Institute
Timothy Speicher
  • Positional Release Therapy Institute
David Draper at Brigham Young University
David Draper
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ATHLETIC THERAPY TODAY SEPTEMBER 2006 69
David O. Draper, EdD, ATC, Column Editor
Top-10 Positional-Release Therapy Techniques
to Break the Chain of Pain, Part 1
OSITIONAL-RELEASE therapy (PRT) is a
treatment technique that is gaining popu-
larity. The purpose of this two-part column
is to briefly explain the theory and appli-
cation of PRT. Then, we will present our top-10 list of
what we think are the most commonly treated tender
points by athletic therapists, five in Part 1 and five in
Part 2, along with general tips, patient self-treatments,
and adjunctive techniques.
PRT, originally termed strain–counterstrain,1 is a
therapeutic technique that uses tender points and a
position of comfort (POC) to resolve the associated
dysfunction. Essentially PRT is the opposite of stretch-
ing. For example, if a patient had a tight, tender area
on the calf, the clinician would dorsiflex the foot to
stretch the calf in an effort to reduce the tightness and
pain. Unfortunately, this might lead to muscle guarding
and increased pain. Using the same example, a clini-
cian who employs PRT would place the tender point
in the position of greatest comfort (plantar flexion),
shortening the muscle, in an effort to relax the tissues
and decrease the tender point.2-4
Dr. Lawrence H. Jones, an osteopathic physician,
was the first to publish a map of tender-point (TP) loca-
tions and their associated treatment positions.1 Jones
proposed that when a muscle is strained by a sudden
unexpected force, its antagonist attempts to stabilize
the joint, resulting in a counterstrain of the muscle in a
resting or shortened position. Before the antagonist is
counterstrained, gamma neural activity is heightened
as a result of its shortened position, making the spindle
more sensitive—propagating development of restric-
tion, sustained contraction, and TP development.1 The
application of PRT relaxes the muscle-spindle mecha-
THERAPEUTIC MODALITIES
Tim Speicher, MS, ATC, CSCS • Sacred Heart University
David O. Draper, EdD, ATC • Brigham Young University
© 2006 Human Kinetics · ATT 11(5), pp. 36-38
nism of the counterstrained tissue, decreasing afferent
gamma and alpha neuronal activity, thereby breaking
the sustained contraction.1 Jones’s original work and PRT
theory have been modified by several practitioners.5-10
The prevailing theory underlying PRT involves
placing tissues in a relaxed shortened state, or POC,
for a period of time (≈90 s) to decrease gamma gain
in order to facilitate restoration of normal tissue length
and tension.1,8-12 Simply put, PRT works to “unkink”
muscle and fascia much like one would a knotted
necklace, by gently twisting and pushing the tissues
together to take tension off the knot. When one link
in the chain is unkinked, others nearby untangle. For
example, when a dominant TP on the posterior tibialis
is treated, the release of an entire chain of TPs along
the length of the muscle can release. Apparently, once
the muscle spindle is unkinked, gamma activity and
neurochemical equilibrium are restored.1,5,11-14
A gentle and passive technique, PRT has been
advocated for the treatment of acute, subacute, and
chronic somatic (whole-body) dysfunction for all
ages.1,7-10 Formal courses are offered in PRT, which
are helpful in gaining competence more quickly, but
the technique is also covered in several texts7-10,15 that
enable self-study.
PRT is an ideal treatment for athletic therapists
to use because injuries with a specific mechanism
respond well to it. There are relatively few contraindi-
cations, including open wounds, sutures, healing frac-
tures, hematoma, hypersensitivity, systemic or local
infection, malignancy, aneurysm, acute rheumatoid
arthritis, and pain during treatment positioning. As a
precaution, monitor the vertebral artery for occlusion
during cervical positioning.
P
70 SEPTEMBER 2006 ATHLETIC THERAPY TODAY
General Treatment Rules for PRT
The following treatment rules should be followed for
PRT:
• Consider the root of the body’s dysfunction.
• Ensure patient and clinician comfort.
• Flex anterior structures; extend posterior struc-
tures.
• Treat dominant TPs first, then proximal, followed by
medial.
• Fasciculation at the TP is the strongest when in an
optimal POC.5
• Treatment should not cause pain.
• After 90 s, slowly release the POC to avoid reengaging
the myotatic reflex.
• 70–100% pain reduction is expected and desired
with the first treatment.
• Rest tissues for 24 hr before resuming vigorous activ-
ity.
• Use established treatment positions as guides—feel
for the POC.
Procedures for PRT
The procedure for applying PRT is as follows:
1. Palpate surrounding and opposing tissues to locate
dominant and other TPs.
2. Document TPs on a standardized scale (extremely
sensitive, very sensitive, moderately sensitive, no
tenderness).
3. Do not try to break up the TP with hard pres-
sure—only dimple the skin (≈1 kg of force).
4. Use one or two finger pads to monitor fasciculation
and TP.
5. Fine-tune position with rotation.
6. Hold the POC until fasciculation decreases signifi-
cantly or ceases.5
7. Average position hold time is 90 s to 3 min.
8. Transient periods of brief tingling, numbness, and
temperature changes might occur.
9. Treat dominant TP and three to five additional TPs
for one session.
10. Release tissue or joint slowly and reassess.
11. Continue with two or three treatments a week for
6 weeks (on rest days or after physical activity).
If desired pain relief is not attained, reposition and
try again. It is normal to experience muscle soreness up
to 48 hr after treatment as a result of fascial unwinding
of the tissue and release of proinflammatory chemical
mediators.8
Top 10
The sidebar lists the top 10 TPs most commonly treated
by athletic therapists. Figures 1–5 correspond to num-
bers six through ten in the top 10 list.
Clinical Implications
PRT is a valuable clinical tool for the treatment of
somatic dysfunction, but it is not a panacea. It is most
effective when integrated into an overall treatment
plan. Once tissue tension and length are restored and
pain is decreased, the muscle fibers can again func-
tion normally to aid healing. If a muscle is kinked
Top 10 Tender Points Treated by Athletic
Therapists
10. Biceps (Figure 1)
9. Intercostals (Figure 2)
8. Hip flexor (Figure 3)
7. Plantar fascia (Figure 4)
6. Trapezius (Figure 5)
5. Lumbar
4. Posterior tibialis
3. Cervical/Scapular
2. Iliotibial band5
1. Patellar tendon
Figure 1
Biceps. The patient is supine, shoulder abducted with elbow
flexed, dorsum of the hand rests on forehead. Fine-tune with shoulder
abduction or rotation.
ATHLETIC THERAPY TODAY SEPTEMBER 2006 71
for a period of time, weakness is likely to occur, so
strengthening is integral to rehabilitation.
References
1. Jones LH. Spontaneous release by positioning. D.O. 1964;Jan:109-
116.
2. Wang CK, Schauer C. Effect of strain counterstrain on pain and
strength in hip musculature. J Man Manipulative Ther. 2004;12(4):215-
223.
3. Alexander KM. Use of strain–counterstrain as an adjunct for treatment
of chronic lower abdominal pain. Phys Ther Case Rep. 1999;2(5):205-
208.
4. Flynn TW, Lewis C. The use of strain–counterstrain in the treatment
of patients with low back pain. J Man Manipulative Ther. 2001;9(2):92-
98.
5. Speicher TE. Positional release therapy techniques. Paper presented
at: Rocky Mountain Athletic Trainers’ Association Clinical Symposium;
April 22, 2006; Salt Lake City, Utah.
6. Speicher, TE. Positional release therapy techniques. Paper presented
at: National Athletic Trainers’ Association Annual Clinical Symposium;
June 15, 2005; Indianapolis, Ind.
7. Chaitow L. Positional Release Techniques. 2nd ed. London, UK: Churchill
Livingstone; 2002.
8. D’Ambrogio K, Roth, G. Positional Release Therapy: Assessment
and Treatment of Musculoskeletal Dysfunction. St Louis, Mo: Mosby;
1997.
9. Deig D. Positional Release Technique: From a Dynamic Perspective.
Boston, Mass: Butterworth & Heinemann; 2001.
10. Giammatteo T, Weiselfish-Giammatteo S. Integrative Manual Therapy:
For the Autonomic Nervous System and Related Disorders. Berkley, ■:
North Atlantic Books; 1998.
11. Korr IM. Proprioceptor and somatic dysfunction. J Am Osteopath Assoc.
1975;74:638-650.
12. Korr IM. The neural basis of the osteopathic lesion. J Am Osteopath
Assoc. 1947;48:191-198.
13. Bailey M, Dick L. Nociceptive considerations in treating with counter-
strain. J Am Osteopath Assoc. 1992;92(3):334, 337-341.
14. McPartland JM. Travell trigger points—molecular and osteopathic
perspectives. J Am Osteopath Assoc. 2004;104(6):244-249.
15. Jones L, Kusunose R, Goering E. Jones Strain Counterstrain. Boise,
Idaho: Jones Strain Counterstrain, Inc; 1995.
Tim Speicher is a clinical assistant professor at Sacred Heart University
in Fairfield, CT.
David Draper is a professor of athletic training and sports medicine in
the Department of Exercise Sciences at Brigham Young University.
Figure 2
Intercostals. The patient is seated in side position and rests
uninvolved side arm on athletic therapist’s knee. Trunk is flexed toward
tender-point side, rotation and flexion toward tender-point side, head
is toward tender-point side or resting on athletic therapist’s leg, unin-
volved arm hangs at side.
Figure 3
Hip flexor. Patient is supine, hips and knees flexed, ankles
crossed or uncrossed, therapist supported or with physioball. Vary
amounts of hip flexion, lateral flexion, and trunk flexion; move toward
or away from tender point.
Figure 4
Plantar fascia. Patient is prone with knee flexed to ~60°,
dorsum of foot on athletic therapist’s shoulder or knee, marked meta-
tarsal and ankle plantar flexion, calcaneus is compressed toward toes.
Move calcaneus into varus and valgus for fine-tuning.
Figure 5
Trapezius. Patient is supine with head laterally flexed toward
tender point, shoulder abducted to 90°. Shoulder flexion or extension
and rotation are used to fine-tun
... Dr. Lawrence H. Jones, an osteopathic physician, was the first to publish a map of TP locations and their associated treatment positions.Jones1964 (10)proposed that when a muscle is strained by a sudden unexpected force, its antagonist attempts to stabilize the joint, resulting in a counterstrain of the muscle in a resting or shortened position. Before the antagonist is counterstrained, gamma neural activity is heightened as a result of its shortened position, making the spindle more sensitive-propagating development of restriction, sustained contraction, and TP development. ...
... Before the antagonist is counterstrained, gamma neural activity is heightened as a result of its shortened position, making the spindle more sensitive-propagating development of restriction, sustained contraction, and TP development. (10)The application of PRT relaxes the muscle-spindle mechanism (5), decreasing abberent gamma andalpha neuronal activity, thereby breaking the The 18 th International Scientific Conference Faculty of Physical Therapy Cairo, 16-17 March, 2017 3 sustainedcontraction. (13)(14)(15)(16)(17)(18)The prevailing theory underlying PRT involvesplacing tissues in a relaxed shortened state, or POC,for a period of time (≈90 s) to decrease gamma gain in order to facilitate restoration of normal tissue length and tension. ...
... (13)(14)(15)(16)(17)(18)The prevailing theory underlying PRT involvesplacing tissues in a relaxed shortened state, or POC,for a period of time (≈90 s) to decrease gamma gain in order to facilitate restoration of normal tissue length and tension. (10,(17)(18)(19)(20)(21) The purpose of the study was to compare between the efficacy of muscle energy technique and positional release technique on pain and functional activities in patients with adhesive capsulitis. ...
The 18 th International Scientific Conference Faculty of Physical Therapy Cairo
Article
Full-text available
  • Mar 2017
Background: Adhesive capsulitis is a condition of the shoulder of unknown etiology. It is characterized by pain, loss of function and restriction of both passive and active range of motion (ROM). Both positional release and muscle energy techniques considered effective manual therapy techniques in treatment of many musculoskeletal conditions. Till now the difference in efficacy between both techniques is not known. Objectives: The purpose of this study was to compare between the efficacy of positional release and muscle energy techniques on functional ability of the shoulder in adhesive capsulitis. Methods: Thirty patients from outpatient clinic of Bolak Eldakror hospital had participated in this study; they were randomly assigned in two groups (group A& B). Group A consisted of 15 patient (5males and 10 females) with mean age 50.80±6.48 years, received positional release technique and conventional physical therapy program. Group B consisted of 15 patients (6males, 9 females) with mean age 51.13±5.77 years, received muscle energy technique and conventional physical therapy program. Results: The results revealed that there was a significant difference in the post treatment values (P<0.05) where the t-value was (7.22) and p-value was (0.0001) between Group A and Group B in favor of group B. Conclusion: Both positional release and muscle energy techniques were shown to be effective in improving functional ability of shoulder in Adhesive Capsulitis, but muscle energy technique was better than positional release technique.
View
... Dr. Lawrence H. Jones, an osteopathic physician, was the first to publish a map of TP locations and their associated treatment positions.Jones1964 (10)proposed that when a muscle is strained by a sudden unexpected force, its antagonist attempts to stabilize the joint, resulting in a counterstrain of the muscle in a resting or shortened position. Before the antagonist is counterstrained, gamma neural activity is heightened as a result of its shortened position, making the spindle more sensitive-propagating development of restriction, sustained contraction, and TP development. ...
... Before the antagonist is counterstrained, gamma neural activity is heightened as a result of its shortened position, making the spindle more sensitive-propagating development of restriction, sustained contraction, and TP development. (10)The application of PRT relaxes the muscle-spindle mechanism (5), decreasing abberent gamma andalpha neuronal activity, thereby breaking the The 18 th International Scientific Conference Faculty of Physical Therapy Cairo, 16-17 March, 2017 3 sustainedcontraction. (13)(14)(15)(16)(17)(18)The prevailing theory underlying PRT involvesplacing tissues in a relaxed shortened state, or POC,for a period of time (≈90 s) to decrease gamma gain in order to facilitate restoration of normal tissue length and tension. ...
... (13)(14)(15)(16)(17)(18)The prevailing theory underlying PRT involvesplacing tissues in a relaxed shortened state, or POC,for a period of time (≈90 s) to decrease gamma gain in order to facilitate restoration of normal tissue length and tension. (10,(17)(18)(19)(20)(21) The purpose of the study was to compare between the efficacy of muscle energy technique and positional release technique on pain and functional activities in patients with adhesive capsulitis. ...
The 18 th International Scientific Conference Faculty of Physical Therapy Cairo
Article
  • Mar 2017
Background: Adhesive capsulitis is a condition of the shoulder of unknown etiology. It is characterized by pain, loss of function and restriction of both passive and active range of motion (ROM). Both positional release and muscle energy techniques considered effective manual therapy techniques in treatment of many musculoskeletal conditions. Till now the difference in efficacy between both techniques is not known. Objectives: The purpose of this study was to compare between the efficacy of positional release and muscle energy techniques on functional ability of the shoulder in adhesive capsulitis. Methods: Thirty patients from outpatient clinic of Bolak Eldakror hospital had participated in this study; they were randomly assigned in two groups (group A& B). Group A consisted of 15 patient (5males and 10 females) with mean age 50.80±6.48 years, received positional release technique and conventional physical therapy program. Group B consisted of 15 patients (6males, 9 females) with mean age 51.13±5.77 years, received muscle energy technique and conventional physical therapy program. Results: The results revealed that there was a significant difference in the post treatment values (P<0.05) where the t-value was (7.22) and p-value was (0.0001) between Group A and Group B in favor of group B. Conclusion: Both positional release and muscle energy techniques were shown to be effective in improving functional ability of shoulder in Adhesive Capsulitis, but muscle energy technique was better than positional release technique.
View
... Dr. Lawrence H. Jones, an osteopathic physician, was the first to publish a map of TP locations and their associated treatment positions.Jones1964 (10)proposed that when a muscle is strained by a sudden unexpected force, its antagonist attempts to stabilize the joint, resulting in a counterstrain of the muscle in a resting or shortened position. Before the antagonist is counterstrained, gamma neural activity is heightened as a result of its shortened position, making the spindle more sensitive-propagating development of restriction, sustained contraction, and TP development. ...
... Before the antagonist is counterstrained, gamma neural activity is heightened as a result of its shortened position, making the spindle more sensitive-propagating development of restriction, sustained contraction, and TP development. (10)The application of PRT relaxes the muscle-spindle mechanism (5), decreasing abberent gamma andalpha neuronal activity, thereby breaking the The 18 th International Scientific Conference Faculty of Physical Therapy Cairo, 16-17 March, 2017 3 sustainedcontraction. (13)(14)(15)(16)(17)(18)The prevailing theory underlying PRT involvesplacing tissues in a relaxed shortened state, or POC,for a period of time (≈90 s) to decrease gamma gain in order to facilitate restoration of normal tissue length and tension. ...
... (13)(14)(15)(16)(17)(18)The prevailing theory underlying PRT involvesplacing tissues in a relaxed shortened state, or POC,for a period of time (≈90 s) to decrease gamma gain in order to facilitate restoration of normal tissue length and tension. (10,(17)(18)(19)(20)(21) The purpose of the study was to compare between the efficacy of muscle energy technique and positional release technique on pain and functional activities in patients with adhesive capsulitis. ...
The 18 th International Scientific Conference Faculty of Physical Therapy Cairo
Article
  • Mar 2017
Background: Adhesive capsulitis is a condition of the shoulder of unknown etiology. It is characterized by pain, loss of function and restriction of both passive and active range of motion (ROM). Both positional release and muscle energy techniques considered effective manual therapy techniques in treatment of many musculoskeletal conditions. Till now the difference in efficacy between both techniques is not known. Objectives: The purpose of this study was to compare between the efficacy of positional release and muscle energy techniques on functional ability of the shoulder in adhesive capsulitis. Methods: Thirty patients from outpatient clinic of Bolak Eldakror hospital had participated in this study; they were randomly assigned in two groups (group A& B). Group A consisted of 15 patient (5males and 10 females) with mean age 50.80±6.48 years, received positional release technique and conventional physical therapy program. Group B consisted of 15 patients (6males, 9 females) with mean age 51.13±5.77 years, received muscle energy technique and conventional physical therapy program. Results: The results revealed that there was a significant difference in the post treatment values (P<0.05) where the t-value was (7.22) and p-value was (0.0001) between Group A and Group B in favor of group B. Conclusion: Both positional release and muscle energy techniques were shown to be effective in improving functional ability of shoulder in Adhesive Capsulitis, but muscle energy technique was better than positional release technique.
View
... 3,7 The therapeutic intervention used in this case, positional release therapy (PRT), was originally known as strain-counterstain. 7,8 Positional release technique is geared at resetting the local nervous system by decreasing the strain around the tender point. These tender points are hypothesized to develop due to the initial Bianco (Lucas.bianco@sluhn.org) is corresponding author. ...
... strain or sprain to the injured area followed by the antagonist contraction to protect other tissues. 8 Positional release technique has been shown to be an effective treatment to decrease pain and improve function in patients with patella tendonalgia and torticollis. 9,10 Through the neurological and chemical reset of the PRT, patients with MCL sprain may be able to quickly restore function. ...
Conservative Approach to Treating American Football Players With Medial Collateral Ligament Grade 2 Sprain During the Season
Article
  • Aug 2023
Context: The medial collateral ligament is the most commonly injured ligament in the knee. The high-speed pivoting and agility movements that are common in the sport of American Football put participants at an increased risk for a valgus force stress from contact or noncontact injuries. Positional release therapy (PRT) also considered strain/counterstrain focuses on releasing the tension in a tissue through unloading the involved body part. Case presentation: Two male student-athletes participating in football with a mean age of 20.5 years were diagnosed by a physician with medial collateral ligament grade 2 sprain. Both patients sustained their injuries in a regular season game with a contact valgus force from an opposing player. Management and outcomes: After the initial 72 hours of compression, elevation, and cryotherapy, the patients were both treated with PRT followed by progressive loading exercises. Following 4 treatment sessions of PRT over the next 6 days, the patients started with quadriceps engagement exercises, single-leg squats to 60° knee flexion, side steps, triceps dips, slow controlled lunges, and toe walk. The patients progressed to full body weight squats, single-leg landing, step-up tri-extension, and sidekicks with a leg on table. Then, the patients completed function movements and sports-specific exercises. Conclusions: In this case series, 2 patients competing in intercollege American Football were treated with PRT and progressive loading exercises to facilitate return to unrestricted activities and improve outcome measures. Commonly, a grade 2 medial collateral ligament sprain is conservatively treated with return to sport taking 20 days on average. In this type 2 case series, the clinician found success utilizing PRT early in the recovery process, which in these 2 cases lead to restoration of function, outcome measure improvement, and an expedited return to sport. The expedited return to sport occurred at an average of 18 days for these patients.
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... Do not strain to disrupt the Trps with firm pressure-first dent the skin (1 kg of force). Grasp the position of comfort until fasciculation declines considerably or ends altogether [11]. In neuromuscular inhibition technique a trigger point is situated by palpation, nearly all frequently with the fingers. ...
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... PRT involves applying targeted pressure and positioning the patient in a comfortable posture to address related dysfunction. This gentle approach may be particularly appealing to patients seeking immediate pain relief [18]. During PRT for CGH, the practitioner positions the area of pain in a comfortable posture. ...
Effectiveness of Nonpharmacological Measures on Improving Headache Score, Strength, Pain, and Quality of Life in Cervicogenic Headaches: A Systematic Review
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Full-text available
  • Mar 2024
Cervicogenic headache (CGH) is a common condition affecting a significant portion of the population and is effectively managed through various interventions, including nonpharmacological approaches. Physical therapy plays a crucial role in CGH management, with numerous studies supporting its effectiveness. This systematic review aimed to evaluate the effectiveness of specific nonpharmacological physical therapy interventions for CGH. A comprehensive search was conducted across various databases (PubMed, Medline, PEDro, and Cochrane Library) for randomized controlled trials (RCTs) published between January 2017 and January 2023 investigating the effectiveness of specific nonpharmacological physical therapy interventions for CGH. We employed manual searches to capture potentially missed studies. Independent reviewers screened all studies based on predefined eligibility criteria. Extracted data included methodology, specific interventions, outcome measures (headache score, strength, pain, and quality of life (QOL)), and study conclusions. Eight RCTs were identified as meeting all inclusion criteria and were thus included in the data synthesis. The findings from these trials revealed a diverse range of nonpharmacological physical therapy interventions, including but not limited to manual therapy, exercise therapy, and multimodal approaches. Specifically, the interventions demonstrated significant improvements in headache scores, strength, pain levels, and overall QOL among individuals with CGH. These results underscore the multifaceted benefits of physical therapy in managing CGH and highlight its potential as a comprehensive treatment option. This review identified eight relevant RCTs investigating nonpharmacological interventions for CGH. Despite the promising findings, this review acknowledges several limitations, including the limited sample size and the heterogeneity of interventions across studies. These limitations emphasize the necessity for further research to elucidate optimal intervention strategies and refine treatment protocols. Nevertheless, the comprehensive analysis presented herein reinforces the pivotal role of physical therapy in not only alleviating pain but also enhancing function and improving the QOL for individuals suffering from CGH.
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... Positional Release Therapy was developed by Lawrence H. Positional Release Technique (PRT) originally termed as starin-counterstrain is a therapeutic technique that uses tender points or Trigger points and a position of comfort to resolve the associated dysfunction 13 . PRT is a method in which muscles are placed in a position of greatest comfort, and this causes normalization of muscle hyper tonicity and fascial tension. ...
To Compare the Effectiveness of Positional Release Technique Versus Kinesio Taping in Patients with Upper Tapezius Trigger Points
Article
Full-text available
  • Jan 2023
Background: Muscles of the neck and shoulder region always function as a unit, and there is no movement in theupper extremity that would not be reflected in the neck musculature. Neck muscles show a strong tendency todevelop hyper tonus and spasm. The principal muscle to carry the load is trapezius which may get tender pointor spasm more frequently. The study aimed to find the effects of Positional Release Technique (PRT) and KinesioTaping (KT) in Upper Trapezius Trigger Points (Trigger points).Method: A total of 30 patients were taken with mean age of 26.16 and were allocated into two groups, Group APositional Release Group and Group B Kinesio Taping Group. Pain intensity level, Range of Motion (ROM) anddisability was measured using numeric pain rating scale (NPRS), Universal goniometer and neck disability index(NDI), respectively at baseline, 1st week after treatment and at the end of treatment.Conclusion: There was significant improvement in both PRT and KT groups. Statistical comparison of the resultshowed that Group A had greater improvement in pain and ROM as compared to Group B. PRT along withStandard PT treatment and therapeutic exercises appeared to be more effective than KT to reduce pain and increaseROM in patients with upper trapezius Trigger points.
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... Each positional release (Table 3) lasted 30 seconds to several minutes, but the positioning and duration of the releases were determined according to the fasciculatory response method, first introduced for clinicians using PRT by Speicher and Draper in 2006. 30,31 With the fasciculatory response method, the painful or hypertonic tissue is placed in a shortened position; when a ''tissue twitch'' or fasciculation is felt, the clinician manipulates the tissue into the position that produces the strongest fasciculation and holds this position until the fasciculation Abbreviations: IFC, interferential current; PRT, positional release therapy. a 0 ¼ no pain, 10 ¼ worst imaginable pain. ...
The Role of Positional Release Therapy in Treating Recalcitrant Brachial Plexus Neuritis: A Case Report
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Full-text available
  • Oct 2021
A 17-year-old female soccer player presented with severe right shoulder pain and scapular winging due to brachial plexus neuritis. The patient was diagnosed with Parsonage-Turner syndrome, a rare condition often resistant to traditional physical therapy, which typically persists for 6 months to years, at times requiring surgical intervention. Over the course of 6 weeks, the patient received positional release therapy once a week coupled with electrical modalities, massage, and a daily home exercise program. This case report is unique because we believe we were the first to use positional release therapy for treatment and the patient's condition resolved more quickly than is typically reported.
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... It was a therapeutic technique that uses the tender points (Tps) and a position of comfort (POC) in a muscle to resolve the somatic dysfunction of the muscle. Positional release technique was opposite to the stretching mechanism (Speicher and Draper, 2006). Positional release technique was used to normalize the muscle tone, decreases the fascial tension, improve joint mobility and increase localized circulation (D'ambrogio and Roth, 1997). ...
A comparative study on the effectiveness of Mulligan mobilization versus Positional release therapy technique in patients with Adhesive capsulitis
Article
Full-text available
  • Jan 2021
Adhesive capsulitis is a painful condition in which the movement of the shoulder becomes limited and functional activity is affected. Adhesive capsulitis occurs when the shoulder joint capsule become thick, stiff and inflamed. The aim of the study is to compare the effectiveness of Mulligan movement with mobilization versus Positional release technique on shoulder range of motion and functional activity in patients with adhesive capsulitis. 30 patients were randomly divided into two groups. Group A (N = 15) received Mulligan mobilization technique and Group B (N = 15) received positional release therapy. The shoulder range of motion (Abduction, External rotation, Internal rotation) was measured by goniometer, the functional activity by SPADI questionnaire. The results showed that significant differences in shoulder ROM Abduction (t = 14.18, p = 0.000), Internal rotation (t = 13.80, p = 0.000), External rotation (t = 15.87, p = 0.000) and SPADI questionnaire (t = 13.94, p = 0.000) were observed in group A patients when compared to group B. In conclusion the Mulligan mobilization technique was effective to improve the shoulder ROM and reduce functional disability in patients with adhesive capsulitis compared to Positional release technique.
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SolarSPELL health and education: global solutions with local impacts
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Full-text available
  • Oct 2022
Background People in remote regions of developing nations have poor health outcomes with lower life expectancy and quality of life compared to higher-resourced areas. Remote communities typically lack stable access to high-quality health services. International humanitarian and development organizations including the United States Peace Corps have a longstanding history of delivering critical services. However, limited infrastructure including access to reliable electricity or internet restricts development workers’ ability to provide effective health services to rural communities. Technology that enhances health education and service delivery in remote communities may improve health outcomes by impacting health knowledge and behavior. Methods We partnered with U.S. Peace Corps to provide portable, solar-powered educational learning libraries (SolarSPELL; www.solarspell.org) to remote communities in Pacific Island nations beginning in 2015 with Peace Corps Vanuatu educational volunteers and expanded in 2017 to include health volunteers (SolarSPELL Health). We conducted ethnographic observation and interviews with Vanuatu Peace Corps volunteers, Ministry of Health officials, and local residents of rural communities. We then conducted a comprehensive evidence review to identify current best practices for assessing and treating the most common conditions. We designed simple 2-page documents with assessment and treatment guidelines, reflecting evidence-based best practices, local culture, and resource availability. Each document was accompanied by a whiteboard video featuring simple drawings and narration designed for Peace Corps volunteers and local community members. Results We report on findings from a pilot study focused on education for treating low back pain. Preliminary findings indicate significantly increased knowledge for Peace Corps volunteers (p<.01), along with non-significantly increased self-efficacy scores (p=.169). Interview data indicate high levels of satisfaction with the SolarSPELL technology, and widespread community utilization among Peace Corps volunteers and community residents. Conclusions Tailored health content on the SolarSPELL platform increases knowledge about critical health topics among Peace Corps volunteers in under-resourced rural communities. The platform and education may have a positive impact on self-efficacy. However, high baseline levels of self-efficacy noted among Peace Corps volunteers may explain the failure to reach statistically significant increases in self-efficacy scores. This finding merits further study. Future work includes measuring individual and community health outcomes, quality of life, and cost benefit resulting from reductions in lost work and transfers for advanced health services. We plan continued implementation and content expansion of SolarSPELL Health in Vanuatu and additional global sites.
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Effect of Strain Counterstrain on Pain and Strength in Hip Musculature
Article
Full-text available
  • Oct 2004
This randomized, controlled study assessed the effect of Strain Counterstrain (SCS) on tender points (TP) and strength of hip musculature. The convenience sample included 49 volunteers (15 men, 34 women; 98 limbs), aged 19-38 years, with hip weakness and corresponding TPs. A visual analog scale was used to assess pain; a digital handheld dynamometer was used to assess strength. Participants were randomly assigned to three intervention groups: SCS, Exercise (EX), and SCS+EX. All interventions were performed twice over two weeks; pain and strength were measured three times, both before and after intervention began. The SCS and SCS+EX groups demonstrated increased strength (p
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The Use of Strain-Counterstrain in the Treatment of Patients with Low Back Pain
Article
Full-text available
  • Jan 2001
Strain-Counterstrain (S-CS) is a manipulative technique routinely used by manual practitioners to treat somatic dysfunction. However, no peer-reviewed literature to support or refute its use has been reported. In the four clinical cases reported, S-CS was initially provided as the sole treatment for low back pain. The S-CS intervention phase for each case took approximately one week and consisted of 2 to 3 treatment sessions to resolve perceived “aberrant neuromuscular activity.” Outcome measures were derived from the McGill Pain Questionnaire and the Oswestry Low Back Pain Disability Questionnaire. All patients registered reductions in pain and disability following S-CS intervention. No experimental evidence for the effectiveness of S-CS is offered, although outcomes do suggest that a controlled study is warranted to examine the effectiveness of S-CS for the treatment of low back pain.
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Nociceptive considerations in treating with counterstrain
Article
Full-text available
  • Dec 2021
  • J Am Osteopath Assoc
The proprioceptive mechanistic model of somatic dysfunction proposed by Korr is accepted as the neurophysiologic basis of counterstrain by the developer of that manipulative technique. We suggest that the physician should also take into account the physical damage, if any, that the original trauma produced. We propose that with tissue injury, nociceptive reflexes could produce patterns of motion restriction opposite that predicted by a solely proprioceptive model. A nociceptive component is suggested as an explanation for the origin and maintenance of somatic dysfunction and its response to the counterstrain technique. In actuality, both proprioceptive and nociceptive responses may occur in dysfunctional states. Other physiologic responses also may be involved. These views are consistent with clinical experience.
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Travel trigger points - Molecular and osteopathic perspectives
Article
Full-text available
  • Jun 2004
The proposed etiology of Travell trigger points (TrPs) has undergone a fundamental revision in recent years. New research results suggest that TrPs are evoked by the abnormal depolarization of motor end plates. This article expands the proposed etiology to include presynaptic, synaptic, and postsynaptic mechanisms of abnormal depolarization (ie, excessive release of acetycholine [ACh], defects of acetylcholinesterase, and upregulation of nicotinic ACh-receptor activity, respectively). This working hypothesis regarding the etiology of TrPs has changed the approach to treating TrPs. As an example, Travell and Simons abandoned the application of ischemic compression to TrPs; instead the authors adopted several techniques associated with osteopathic medicine (ie, muscle-energy, myofascial, counterstrain; high-velocity, low-amplitude). Scientists are now proposing and reporting the results of new approaches using capsaicin, a vanilloid-receptor agonist, and ACh antagonists (eg, dimethisoquin hydrochloride, botulinum toxin, quinidine, linalool). The purpose of this article is to review these new concepts and describe new resulting approaches to the treatment of TrPs.
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Proprioceptors and somatic dysfunction
Article
  • Apr 1975
Functional properties of osteopathic lesions, as clinically described, are reviewed in relation to the physiology of proprioceptors. It is shown that muscle spindles in which the 'gain' has been turned up by intensified activity in their gamma motor innervation may, together with other sensory inputs, account for many of the motion characteristics and palpatory features of the osteopathic lesion. 'Turning down' of the gain seems to be a common denominator in a variety of osteopathic manipulative procedures. Possible origin of the high gain is discussed.
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Positional Release Technique: From a Dynamic Perspective
  • Jan 2001
  • D Deig
Deig D. Positional Release Technique: From a Dynamic Perspective. Boston, Mass: Butterworth & Heinemann; 2001.
Integrative Manual Therapy: For the Autonomic Nervous System and Related Disorders. Berkley, ■: north Atlantic Books
  • Jan 1998
  • T Giammatteo
  • Weiselfish-Giammatteo S
Giammatteo T, Weiselfish-Giammatteo s. Integrative Manual Therapy: For the Autonomic Nervous System and Related Disorders. Berkley, ■: north Atlantic Books; 1998.