Positional Release Therapy (PRT) also known as strain-counterstrain is a form of bodywork aimed at resolving dysfunctions in a painless manner. It takes the force off the tissue to release it, unlike most other soft tissue techniques which apply force to stretch restricted fibres. This painless and delicate approach makes PRT suitable for treating people with acute conditions or severe pain or sensitivity.
PRT can be used as a stand-alone technique or as a complementary tool in the soft tissue therapist’s arsenal. It is very useful and applicable in cases of tight or spasmodic muscles, which are still protecting a past trauma.
Several books and other sources, including Positional Release Techniques, by Leon Chaitow, N.D., D.O provide a good overview of the history and evolution of PRT.
The American osteopath Laurence Jones discovered PRT by accident in the 1950s. His clinical experience revealed that by positioning his patients’ painful tissues in a position of comfort for 90 seconds to several minutes, their discomfort would spontaneously disappear or decrease substantially.
Jones theorised that when an individual experiences an unexpected and sudden strain, the antagonist the strained structure would resist with a counterstrain. This double balancing action would result in discrete areas of tissue tenderness. Hence, he changed the name of what he originally called PRT to strain-counterstrain.
Subsequently, he found that tender points often can be discerned only with palpation. Often, they were located around insertion and attachment sites, perhaps where the largest force of the strain is experienced. Usually, they would require treatment before the discomfort in the primary area of concern would dissipate. Finally, he also found that the tender points are usually found in the tissue that counterstrained and not the strained one. Then experience showed that simply folding the counterstrained tissue over itself would resolve the pain originating from the tender point.
Later on, in the late 1990s, Kerry D’Ambrogio, P.T., and George Roth, D.C., N.D., through their Positional Release Therapy: Assessment & Treatment of Musculoskeletal Dysfunction started advocating PRT as a complete, stand-alone therapy for treating somatic dysfunctions and other painful ailments.
The previously mentioned, Leon Chaitow, N.D., D.O., with his extensive writing, has played a key role in the formation of strain-counterstrain as a therapy.
The basic PRT technique
PRT starts with the identification of a tender point in the client’s body, which can be in the joints, muscles, or ligaments. Then the therapist applies firm constant pressure to this point until the client experiences a subjective level of discomfort between 4 and 5 on a 0-10 scale. The therapist would maintain this precise level of pressure and use this tender point to monitor the effectiveness of the technique.
The therapist then moves the tender body part away from the restricted motion barrier towards the most comfortable position. In most cases, this would be a move toward shortening the muscle. At this stage, the point should no longer feel tender. This precise position is then held for 90 seconds to several minutes.
Although initially very comfortable, this position can start producing symptoms such as heat, pulsation, vibration and other forms of discomfort when maintained over time. All these symptoms would go away and there will be a sense of relaxation and lengthening once the therapist very slowly and passively returns the client’s body part to a lengthened position. As a result, the discomfort in the tender point should have either disappeared completely or diminished by at least 70%.
The importance of client feedback and effective communication cannot be understated. Relaxation is extremely important for the PRT manoeuvre to be effective so the client needs to participate in identifying the correct position.
When dealing with a very small tender point, the therapist may be able to use their hand to squeeze the surrounding tissues into the point in what is called crowding. This may be sufficient to create a localised position of comfort and ensure a successful PRT application. For larger areas, the same thing can be achieved by using both hands to pull subsequent fibres towards the local area of tenderness and hold it there for 90 seconds or more.
How PRT works
The basic principle behind this technique can be likened to untying a knot. Instead of lengthening the loose ends of the knot further by pulling them apart we shorten them towards the middle of the knot so that we can fully release them. Similarly, the therapist shortens the client’s muscle to send a signal to the nervous system to reduce the contraction, which makes the subsequent lengthening much easier.
PRT unkinks the muscle fibres by decreasing their neural activation in two ways: 1) by mechanically shortening them and 2) by manipulating the neurochemical bonding formed by pain and inflammation (Dr. Speicher's Mechanical Coupling Theory (2006). This interruption of the inflammatory neural signalling further decreases activation at the spinal cord, brain stem and locally. This reduction in the sympathetic neurological response helps to sustain normal tissue length. Over time this leads to a progressive and permanent decrease in pain and discomfort.
Muscle spindles, proprioceptors found inside the muscle, also play a significant role in PRT. When stretched beyond a threshold they produce a reflexive contraction similar to a stretched rubber band. The prevailing theory of how tender points and trigger points (TrPs) develop attributes them to a spindly dysfunction causing sustained muscular contraction.
Usually, patients experience decreased joint stiffness and swelling, fascial tension, reduction in pain, and fewer muscle spasms. Mobility, flexibility, and range of motion would also be improved which will naturally lead to better posture.
In the short term, the patient may continue experiencing various aches or some of the initial symptoms for several days after the manipulation until the body fully adapts. This reaction does not occur in every person and goes away quickly with subsequent treatments.