Positional release technique

A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT

1. Positional Release Technique Radhika Chintamani

2. Contents Definition History Introduction Mechanism Rationale Effects of PRT Tender points: definition, jump sign, trigger points, rules to treat TrPs, General principles, comfort zone 4 phases of PRT Important points of PRT

3. DEFINITION Positional release therapy is indirect technique which places the body into a comfortable position and employs tender points to identify and monitor the lesion .

4. HISTORY PRT was first developed in 1950 by Dr. Lawrence Jones , an osteopathic physician. He first termed it positional release technique then later coined it as Strain Counter Strain (SCS). In 1969 Harold V. Hoover used the term “Dynamic Neutral”. Further , Charles Bowels (1969) discussed Dynamic Neutral and stated that - “Dynamic Neutral is a state in which tissues find themselves when the motion of structure they serve is free, unrestricted and within the range of normal physiological limits .”

5. Later Jones, developed strain counter strain in more depth during 1981; in which; Jones tried finding a comfortable position for the patient in which pain was either zero or was very minimal Patient was in the same position for a short time On recovering back to the normal position subject found relief which was lasting Thus; he stated the term counterstrain with its meaning. He gave the aims of the technique as: “To relieve musculoskeletal pain and somatic dysfunction through indirect manual manipulation .”

6. INTRODUCTION PRT is a passive technique used to treat musculoskeletal pain and neurological imbalance due to hypertonic , contracted dysfunctional condition would not enforce lengthening or stretching, but would attempt to (depending on which PRT variation was selected) change the tissue according to ARTT criteria. This technique is used in all three planes of motion. It positions the body to enhance tissue function and release tension by inducing a little discomfort allowing spontaneous resolution of tense and dysfunctional state of tissues.

7. It is a form of manual medicine that resolves pain and dysfunction through positioning a part of body or tissue in a comfortable zone such that restriction during movement caused either by muscular changes or bony lever are placed in such a way that the position induces release of strain on muscle so that the vicious pain cycle is reduced. The technique facilitates tissue regeneration, growth, and repair so that body learns to self correct .

8. MECHANISM Indirect and passive method Severe tender points are located They are palpated as to guide position of comfort POC produces optimum relaxation of the involved tissues, allows optimal relaxation and reduce inappropriate proprioceptive activities Decrease in muscle tension, fascial tension and joint hypermobility . Improvement in functional range of motion and decrease in pain.

9. RATIONALE FOR PRT Somatic dysfunction : this is impaired or altered function of related components of the somatic system. Diagnostic test for somatic dysfunction includes : T: Tissue texture change. ( feel) A : Asymmetry or positional change ( look) 3. R : restriction of motion ( movement) 4. T : Tenderness

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11. The tissue : comprises of muscle, fascia, bone, and interconnections between them. Restriction or dysfunction in one area or type of tissue can result in reactions or symptoms in other areas or tissues of the body. The significance of tender points : occurs usually in somatic tissues. In PRT tender points are used primarily as diagnostic indicators of the location of the dysfunction. Proprioceptive neuromuscular feedback : Based on the work of Irvin Korr ; Abnormal Neural basis forms the basis of joint dysfunction incriminating the muscle spindle. Korr’s Revelations : Dysfunction that characterizes the osteopathic lesion does not arise in joint, but are imposed by muscles that traverse the joint

12. EFFECTS OF PRT Normalization of muscle hypertonicity and fascia tension: by placing the muscle for certain duration in position of comfort Reduction in joint hypomobility: removing the painful barrier for the joint movement, thus inducing mobility Increase circulation: by reducing the tender points and removing the barrier for blood flow Reduce swelling Decrease pain: by modulating pain pathway Increase strength

13. Tender points Trigger points Tender points are the areas which are painful on superficial or deep palpation Usually occurring in muscle, at muscle-tendon junction, bursa or fat-pad. Trigger points are the areas which are painful on superficial or deep palpation occurs along with a local muscle twitch on palpation U sually occurring in muscle and at muscle-tendon junction.

14. Assessment of tender points Tender points are – tender upon palpation , small (<1cm), round , tense , oedematous regions located deep in muscle, tendon , ligament or fascial tissues. Jump sign: Jones described a body map of tender point given in the next page

15. Grade 0- no pain No tenderness Grade 1 - Complain of pain Mild Sensitive Grade 2 – complains of pain and winces Moderate sensitive Grade 3 – winces and withdrawal sign Highly sensitive Grade 4 – patient wont allow to palpate Extremely sensitive Grades of tenderness

16. 1. If the point is palpated and there is an observable jump sign , the point is extremely sensitive 2. The point is very tender but there is no jump sign. Scanning evaluation

17. 3 . Moderate amount of tenderness, then the point is moderately sensitive 4. No tenderness.

18. Trigger points as described by Travell and Simon A focus of hyperirritability in a tissue that, when compressed , is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness and, sometimes, to referred autonomic phenomena and distortion of proprioception . Types include: Myofascial Cutaneous Fascial Ligamentous P eriosteal trigger points.

19. Release Phases of Tender Points By: Weiselfish and D Ambrogio PHASE I PHASE II Length tension change in muscle tissue. 90sec for orthopedic patient 3min for neurologic patient. Fascial release component. 5-20 min. Immediate response: Body must be returned to neutral position slowly for first 15 of motion. If taken quickly the ballistic proprioceptors may be reengaged and protective muscle spasm may occur. Immediate response is or 70% of improvement. 40 % of patient experience soreness in next 24-48hrs. Frequency , duration and scheduling of Rx: F= Local dysfunction: 2-3times/week. D= local dysfunction: 90sec/tender points . Post treatment soreness for next 24-48 hours: hydrotherapy recommended

20. Trigger points as described by Travell and Simon

21. RULES OF TREATING TENDER POINTS Treat the most secure tender points. Treat the more proximal or medial tender point first. Treat the area of greater accumulation of tender points first. When tender points are in row, treat the one near middle of the row first. GENERAL PRINCIPLES: Anterior tender points are treated in flexion. Posterior tender points are treated in extension. If a tender point is on or near the midline, it is treated with more pure flexion for anterior points and with more pure extension for posterior points. If tender points is lateral to midline, it is treated with addition of side-bending, rotation, or both. The anterior/flexion and posterior/extension must be followed.

22. 4 Phases Of PRT Phase I Phase II Phase III Phase IV Acute phases Treating structural dysfunction Restoration of functional movement Normalization of life activities and return to activity

23. Important points of PRT Scan the body, grade the severity of the tender points and record the findings. Follow the general rules. Monitor the tender points while finding the position of comfort. Maintain contact of tender point while in POC. Hold the position of comfort until release is felt. Return to neutral slowly. Recheck the tender points and use other reality checks. Warn the patient the possible reaction and to avoid the strenuous activity after treatment. Treat 3 times per week and allow the body to adapt to the treatment.

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