Positional release

Question 1

What is positional release?

Answer 1

Technique used to help reduce pain on tender points in soft tissue

Question 2

Aim of strain-counter-strain

Answer 2

Ease tender points and reduce hypertonicity by positioning the client into a position of comfort and ease

Question 3

What does positional release work on?

Answer 3

• Hypertonic, contracted soft tissue structures
• Instead of stretching or lengthening the tissues, it relaxes them

Question 4

How is a tender point developed?

Answer 4

1. Muscle is strained by a sudden unexpected force, the antagonist attempts to stabilise the joint, resulting in a spasm (counter-strain)
2. Increased muscle spindle in the antagonist is more sensitive and triggers development of restriction, sustained contraction and tender point development

Question 5

MTrP

Answer 5

• Hyper irritable spot
• Referred pain
• Shortens muscle due to contraction within sarcomeres
• Patient can identify where the pain is
• Taut band will be palpable

Question 6

Tender Points

Answer 6

• A tender point
• Exists in shortened tissues caused by trauma or chronic shortening
• Tend to not be in areas where the patient is aware of pain
• Taut band is absent

Question 7

Where tender points can be found

Answer 7

• Muscle spasms
• Hypertonic muscles
• Surrounding tissues of muscle strain
• Chronic soft tissue dysfunction

Question 8

Identification of a tender point

Answer 8

• Localised tenderness
• Tissue temperature can either be higher or lower than the surrounding structures
• Blanching
• Often located in the antagonist to the muscle that was injured

Question 9

Effects of strain-counter-strain

Answer 9

• Increase mobility of joints
• Reduces hypertonicity
• Restores normal muscle tone
• Used to deactivate MTrP as manual therapy intervention
• Normalises neuromuscular activity
• Reduces pain
• Increases muscular strength

Question 10

Procedure of positional release

Answer 10

1. Palpate surrounding and opposing tissue
2. Document TPs on standardised scale (sensitive, very sensitive, moderately sensitive, no tenderness)
3. Do not try to break up the TP
4. Use 1 or 2 finger pads to monitor fasciculation
5. Fine-tune position with rotation
6. Hold POC until fasciculation decreases significantly
7. Average position hold time 90s to 3 min
8. Treat dominant TP an 3-5 additional Ups for 1 session
9. Release tissue or joint slowly and reassess
10. Continue with 2 or 3 treatments a week for 6 weeks

Question 11

General rules for PRT

Answer 11

• Consider route of body’s dysfunction
• Flex anterior structures, extend posterior structures
• Treat dominant Tps first, then proximal, then medial
• Treatment should not cause pain
• 70-100% pain reduction is expected
• Rest tissues for 24 hours before resuming vigorous activity

Question 12

Contra-indications

Answer 12

• Acute inflammatory conditions
• Skin conditions
• Protective spasms should not be released unless underlying pathology has been addressed
• Recent major surgery or trauma
• Increased pain during application
• Sensations such as numbness or aching, should remain at a moderate level