POSITIONAL RELEASE

THERAPY
 INTRODUCTION
Dr. Lawrence H. Jones, an osteopathic physician, was
the first to publish a map of Trigger points locations
and their associated treatment positions.
Positional release therapy (PRT) originally termed
strain–counterstrain is a method of total body
evaluation and treatment using tender points (TPs) and
a position of comfort (POC) to resolve the associated
dysfunction.
PRT is an indirect and passive method of treatment. (the
body part moves away from the resistance barrier, i.e.,
the direction of greatest ease).
 INTRO CONT…..
All three planes of movement are used to attain the
position of greatest comfort. Once the most severe
tender points are found, they are palpated as a guide to
help find the POC.
The POC produces optimal relaxation of the involved
tissues.
 INTRO CONT…..
PRT has been advocated for the treatment of acute,
subacute, and chronic dysfunction (whole-body) for all
ages.
 PRT is an ideal treatment for athletic therapists to use
because injuries with specific mechanisms respond well
to it.
There are relatively few contraindications, including
open wounds, sutures, healing fractures, hematoma,
hypersensitivity, systemic or local infection,
malignancy, acute rheumatoid arthritis, and pain during
treatment positioning.
As a precaution, monitor the vertebral artery for
occlusion during cervical positioning.
 Treatment should not cause pain.
 After 90s, 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 hrs before resuming vigorous
activity.
 PROCEDURE
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 pressure—
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.
 PROCEDURE CONT…
6. Hold the POC until fasciculation decreases
significant.
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).
 TOP 10 TENDER POINTS
 Biceps
 Intercostal
 Hip flexor
 Plantar fascia
 Trapezius
 Lumbar
 Posterior tibialis
 Cervical/Scapular
 Iliotibial band 6
 Patellar tendon
 TECHNIQUE

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-tune.
 TECHNIQUE CONT.…
Biceps.
The patient is supine,
shoulder abducted with
elbow flexed, dorsum of
the hand rests on
forehead. Fine-tune
with shoulder
abduction or rotation.
 TECHNIQUE CONT.…

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.
 TECHNIQUE CONT…

Plantar fascia.
Patient is prone with knee
flexed to ~60°, dorsum of
foot on athletic
therapist’s shoulder or
knee, marked metatarsal
and ankle plantar flexion,
calcaneus compressed
toward toes.
Move calcaneus into
varus and valgus for fine-
tuning.
EVIDENCES
 EVIDENCE 1
EFFECT OF POSITIONAL RELEASE THERAPY
AND TAPING ON UNILATERAL UPPER
TRAPEZIUS TENDER POINTS - RANDOMIZED
CONTROLLED TRIAL

AUTHOR: Jagatheesan Alagesan , Unnati S. Shah

OBJECTIVE:
This study aimed to find the effect of positional release
therapy and taping on unilateral upper trapezius tender
points.
METHOD:
60 subjects between age group 20 and 30 years having
unilateral upper trapezius tender point were randomly
allocated to 3 groups namely,
Group A receiving conventional treatment + PRT,
Group B receiving conventional treatment + Taping and
Group C is a Control group receiving conventional
treatment.
Intervention was given for 7 consecutive days as per
protocol of the group.
OUTCOME MEASURE:
ROM
PAIN
CONCLUSION:
Conventional treatment with PRT or conventional
treatment with TAPING is equally effective in Tender
Point of Unilateral Upper Trapezius Muscle as like the
conventional treatment by moist heat and shoulder
girdle exercises.
 EVIDENCE 2

EFFECT OF STRAIN COUNTER

STRAIN ON PAIN AND STRENGTH IN
HIP MUSCULATURE.

AUTHOR: WONG, CHRISTOPHER KEVIN, December

2004,

OBJECTIVE:
The aim of this study is to assessed the effect of strain
counterstrain on tender points and strength of hip
muscular.
Three group divided
Group A received SCS
Group B received exercises
Group c received SCE and exercises.
All intervention were performed twice over two week.

OUTCOME MEASURE:
PAIN
STRENGTH
CONCLUTION:
The conclusion supported that SCS reduces tender
points pain and demonstrated that SCS positively affect
strength.
 EVIDENCE 3
Effectiveness of Strain Counterstrain Technique on
Quadratus Lumborum Trigger Point in Low Back
Pain

AUTHOR: Sakina Vohra, BPTh; Varoon C Jaiswal,

MPTh, CMP, CSMT; Kiran Pawar, MPTh. 2014,

OBJECTIVE:
The aim of study is to find out whether the strain
counterstrain technique is effective on Quadratus
Lumborum Trigger points in low back pain or not.
METHOD:
50 low back pain subjects referred to physiotherapy
outpatient department were screened for MTrP in QL
muscle using the jump sign diagnostically.
An informed consent was taken from all the subjects.
Strain Counter-Strain Technique: 1 0 The patient is
prone with the trunk laterally flexed toward the tender
point side. The therapist stands on the side of the tender
point and places his/ her knee on the table then rests the
patient's affected leg on his/her thigh. The patient’s hip
is then extended and abducted, and slightly rotated to
fine-tune, this position was maintained for 90 sec. Post
this the subject is passively placed in a relaxed
OUTCOME MEASURE:
PAIN INTENSITY
FUNCTIONAL OUTCOME
CONCLUSION:
SCS technique is effective in relieving pain due to
Quadratus Lumborum trigger point, thus improving the
functional capacity and can be used in physiotherapy
management of Low Back Pain. Hence we conclude that
SCS technique can be used for the sub-groups of low
back pain.
 EVIDENCE 4
Strain-Counterstrain therapy combined with exercise
is not more effective than exercise alone on pain and
disability in people with acute low back pain: a
randomised trial.

AUTHOR: Cynan_Lewis 2011,

OBJECTIVE:
Is Strain-Counterstrain treatment combined with
exercise therapy more effective than exercise alone in
reducing levels of pain and disability in people with
acute low back pain?
METHOD:
Participants attended four treatments in two weeks. The
experimental group received Strain-Counterstrain
treatment and review of standardised exercises
(abdominal bracing, knee to chest, and lumbar rotation).
The control group performed the standardised exercises
under supervision. Following the intervention period,
all participants received exercise progression, manual
therapy, and advice.
OUTCOME MEASURE:
the modified Oswestry low back pain disability
questionnaire
VAS
CONCLUSION:
There is no advantage in providing Strain-
Counterstrain treatment to patients with acute low back
pain, although further studies could examine whether a
subset of these patients can benefit from the treatment.
 EVIDENCE 5
 TO COMPARE THE EFFECTIVENESS OF
MYOFASCIAL RELEASE TECHNIQUE VERSUS
POSITIONAL RELEASE TECHNIQUE WITH
LASER IN PATIENTS WITH UNILATERAL
TRAPEZITIS.

 AUTHOR: Ravish V. N, Shridhar, Sneha Helen

 OBJECTIVE:
The aim of study is to compare the effectiveness of
myofascial release technique versus positional release
technique with laser in patients with unilateral
trapezitis.
METHOD:
Sixty subjects with unilateral upper trapezius spasm
were randomly allocated into two groups namely Group
A and Group B and treated with LASER which was
common to both the groups Myofacial release technique
was given to group A and Positional Release Therapy
was given to the Group B respectively for Alternatively
3 days for four weeks after obtaining informed consent.
OUTCOME MEASURE:
Visual analog scale (VAS) for pain
Cervical ROM
Neck disability index
 REFERENCE
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 REFERANCE CONT…..
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 REFERANCE CONT…..
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