Positional Release Therapy


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PowerPoint inservice to co-workers on Positional Release Therapy (PRT)

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  • It’s a technique similar to counterstrain and the use of tender points like in accupuntcure
  • Need to re-establish an optimal physical relationship between body parts and all will be restored to perfect working order- Remodel to relieve structured stress- -Stretch shortened tissue -strengthen hypotonic muscles -surgically repairing damaged tissues
  • The body attempts to create a full range of gross motion by compensating for areas of relative fixation. This results in excessive motion in regions of the body that extend from the focus of dysfunction. Excessive force, due to strain or repetitive motion against the restriction barrier, may cause local inflammation and pain. The increased mechanical deformation and stretch within these tissues may result in the release of pain-producing chemical mediators. Thus pain may be expressed within tissues, which are, secondary areas of involvement.
  • Tender points can result in distortions in the biomechanical integrity of the matrix
  • Proprioceptors in joints-RuffiniGolgi Tendon Organs- Ms. tendinous junctionsMs. Spindles- most sensitive and respond to change in position, load, and velocity
  • Facilitated Segment- impulses extend beyond normal sensorimotor pathways, CNS misinterprets info b/c of overflow of neurotransmitter substance w/in involved segment
  • Biceps tendon- POC reached in elbow flexion, fine tune w/ pronation/supinationPositioning beyond places the antagonistic ms/opposing fascial structure under increased stretch to cause proprioceptor/neural spillover which in turn causes reactivation of the facilitated segment
  • Positional Release Therapy

    1. 1. Janine Ferro, 
    2. 2. 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
    3. 3.  Normalization of muscle hypertonicity Normalization of fascial tension Increased circulation Reduced swelling • Reduction of joint hypomobility • Decreased pain • Increased strength
    4. 4.  “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
    5. 5.  Structural Model • Has been met with limited success-  Often unable to restore normal ideal structure FunctionalModel- 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
    6. 6.  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
    7. 7.  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
    8. 8.  Belief that musculoskeletal pain is from: • 1) Myofascial elements • 2) Proprioceptive & neuromuscular responses • 3)Trauma to fascial matrix
    9. 9.  Muscle • Response to injury is protective muscle spasm • Regulated by local proprioceptors & monosynaptic reflexes FascialSystem- 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
    10. 10. “ Small, palpable nodule, usually located in the subcutaneous, muscular, or fascial tissues” • 1) Hyperirritable area • 2) Found in mechanically stressed tissues Fascialsystem- is a continuous network that surrounds & penetrates all structures of the body • Tender point is viewed as a point of constriction within this network
    11. 11.  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
    12. 12.  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
    13. 13.  Chemical mediators present during injury • Kinins, histamines, etc. • Produce muscle guarding reactions & somatic dysfn. Segment – overload of a segment Facilitated 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
    14. 14.  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
    15. 15.  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!
    16. 16.  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
    17. 17.  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
    18. 18.  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
    19. 19.  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.
    20. 20.  Maintain POC for 90s<5-20min • Tissue undergoes a neuromuscular release • Changes in length-tension relationship of muscle • Fascial release component
    21. 21.  Fascial Release- release phenomenon should occur  1) relaxation and softening of tissues  2) pulsation or vibration  3) heat  4) changes in breathing patterns
    22. 22.  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
    23. 23.  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