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

1. Janine Ferro, 

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.  Normalization of muscle hypertonicity
 Normalization of fascial tension
 Increased circulation
 Reduced swelling
• Reduction of joint hypomobility
• Decreased pain
• Increased strength

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.  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.  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.  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.  Belief that musculoskeletal pain is from:
• 1) Myofascial elements
• 2) Proprioceptive &
neuromuscular responses
• 3)Trauma to fascial matrix

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. “ 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.  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.  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.  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.  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.  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.  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.  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.  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.  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.  Maintain POC for 90s<5-20min
• Tissue undergoes a neuromuscular release
• Changes in length-tension relationship of muscle
• Fascial release component

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.  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.  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