Positional Release Technique: Dr. Nistara S. Chawla Miap, CSTMT MPT Neurology

POSITIONAL RELEASE
TECHNIQUE
Dr. Nistara S. Chawla
MIAP, CSTMT
MPT Neurology
A Method of total body evaluation and
treatment
• Utilizes 1) tender points and
2) a position of comfort
• Indirect technique- applies force away
from resistance
• Resolves associated dysfunction
 Normalization of muscle hypertonicity
Normalization of fascial tension
 Increased circulation
 Reduced swelling
• Reduction of joint hypomobility
• Decreased pain
• Increased strength
 “Dysfunction within the body”
Traditionally looked at with a Structural
Model
• Associated with 1) anatomic, 2) postural
deformations, 3) degenerative
changes
• Treated in order to reshape the structure to an
ideal
 Structural Model
• Has been met with limited success-
 Often unable to restore normal ideal structure
 Functional Model- Biomechanical
disturbances are caused by intrinsic
properties of the affected tissues
 1) Result of trauma & inflammation
 2) Seen as direct expression of the tissue
process at
structural & biochemical levels
 Expressed as:
• 1) Reduced joint play
• 2) Loss of tissue reilience, tone, or elasticity
• 3) Temperature & trophic changes
• 4) Loss of overt ROM & postural asymmetry
 Sees the body as an expression of its
function:
• Posture- Manifestation of the degree of balance
within the tissues
• Emphasis on interaction of all body parts during
physiologic & non-physiologic motion
 Belief that musculoskeletal pain is from:
• 1) Myofascial elements
• 2) Proprioceptive &
neuromuscular responses
• 3)Trauma to fascial matrix
 Muscle
• Response to injury is protective muscle spasm
• Regulated by local proprioceptors & monosynaptic
reflexes
 Fascial System- vast network that 1)
contains, 2) supports, and 3) connects
tissues throughout the body
• Stress on this system from injury can result
in
fascial tension
 “ Small, palpable nodule, usually
located in the subcutaneous, muscular,
or fascial tissues”
• 1) Hyperirritable area
• 2) Found in mechanically stressed tissues
 Fascial system- is a continuous network
that surrounds & penetrates all structures
of the body
• Tender point is viewed as a point of
constriction
within this network
 Characteristics:
• Tense, tender, edematous area
• Tension felt in surrounding areas
• Up to 4x as tender as normal tissue
 Thought of as an outward sign of an
underlying lesion, not as the pathology or
dysfunction
 Force that produces injury results in:
• 1) Protective muscle spasm due to an
increased neural impulse
• 2) Increased resting tone of the muscle
• 3) Imbalance between agonist/antagonist
• 4) Creates a self-perpetuating cycle of
proprioceptive dysfunction
 Chemical mediators present during injury
• Kinins, histamines, etc.
• Produce muscle guarding reactions & somatic dysfn.
 Facilitated Segment – overload of a segment
of the spinal cord with excessive afferent
impulse
• Impulses from proprioceptors & nociceptors
outnumber available pathways, may spill over to other
pathways
• Misinterpreted by the CNS
 Indications:
• Any patient with distinct physical mechanism of injury
• Insidious onset with a mechanical stress association
(repetitive stress)
 Contraindications:
• Open wounds
• Sutures
• Healing fractures
• Hematomoa
• Skin hypersensitivity
• Systemic/ localized infection
 Palpation to find tender points
• 1) May be in area of overt pain
• 2) May be in related areas
 Ex: Scapular stabilizers tender with anterior
shoulder pain
 Ex: Iliopsoas tender with low back pain
 Thorough evaluation of tender points
should be part of the eval. Process
• 1st see how much pressure you can apply
• Practice & clinical experience!
 Scanning Evaluation (SE)- reveals
most clinically significant points
Global vs. Local Tx:
• Global- interrelated lesions
 1-3 points/treatment 2-3x/wk
 Need the most dominant TP as it’s the source of
dysfunction
• Local- 6-8points, 2-3x/wk
 Document severity of tender points
• Severe- causes a “jump sign”
• Very Tender- no “jump sign”
• Moderate- subjective to patient
• No Tenderness
 Prioritize
• Severity- most to least severe
• Position- proximal to distal, medial to lateral, by
severity
 In a row, the point in the middle is first for treatment
VIDEO TIME
https://www.youtube.com/watch?v=0itbQ3-
Uqp8
 Locate tender point
• Maintain palpation & passively move patient into
position of comfort (POC)
 Point of the POC is to dec. irritability of the tender point
& to normalize the tissues associated w/ the dysfn.
• Monitor patient response to tender point
 Reach position of 1) no tenderness
2) Monitor with feedback
 Moving into the POC
• Feel a relaxing of the tissues/softening of the
muscle tone
• Patient should note elimination of
tenderness
• Should NOT be painful, especially in other
areas
 Correct POC within 5-10 degrees
• Once POC is reached, fine tune it with small
movements for within 2-3 deg.
 Maintain POC for 90s<5-20min
• Tissue undergoes a neuromuscular release
• Changes in length-tension relationship of muscle
• Fascial release component
 Fascial Release- release phenomenon
should occur
 1) relaxation and softening of tissues
 2) pulsation or vibration
 3) heat
 4) changes in breathing patterns
 During the 90s of POC:
• Patient may question if the AT is still palpating
• Once response is achieved, slowly
passively move patient back into neutral
• Recheck tender points
 Post-treatment:
• Return to neutral position slowly
• May have inc. soreness 24-48hrs after
 1) Reducing muscle spasm
2) Reducing Pain
 3) Improving ROM
 Phase 1- Acute injury
• Add other modalities
 Phase 2- Treat structural dysfunction
• Acute & chronic injuries- add mobility & strengthening
exercises
 Phase 3- Restore function movement
• Add cardio & progress other exercises
 Phase 4- Normalization of ADLs w/ goals
THE END

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