What is Positional Release Therapy?
Positional Release Therapy (PRT) also known by its parent term, strain counterstrain, is a form manual medicine that resolves pain and tissue dysfunction. Through positioning the body and tissue in positions of comfort, the neurological system can be manipulated to interrupt the pain spasm cycle and over time, to reset the resting length of tissue in a "normal" range, which promotes increase in strength, performance and function. Essentially, PRT is the opposite of stretching. Much like unkinking a knot from a chain necklace, PRT works in the same fashion; tissues are pushed together, twisted, compressed and manipulated to take tension off "neurological chain links." The therapy is pain-free and is suited for all ages and most painful conditions.
The primary goal of PRT is to promote a positive healing environment by correcting musculoskeletal and neurological imbalances to facilitate tissue regeneration, growth, and repair in order for the body to self-correct itself. Dr. Speicher has advanced this technique though his research and clinical practice into a full body therapy for integration into a comprehensive treatment plan.
PRT was first developed in 1950 by Dr. Lawerence Jones, DO, an osteopathic physician. He first termed it positional release technique then later coined it strain counterstrain due his theory that the body developed tissue restrictions or tenderpoints (discrete areas of myofascial dysfunction) in tissues not directly insulted. Therefore, a patient might suddenly strain their back, but the hip flexors opposing the back would be counterstrained--which resulted in these tissues being the primary problem of the patients pain, needing release before the back pain would resolve.
How does PRT work?
Osteopathic therapies primarily involve the use of the hands to manipulate tissues. According to Dr. Speicher's Mechanical Coupling Theory (2006), PRT works to unkink the tissues muscle fibers by decreasing the neural activation of them by both mechanically shortening them and also by changing the neurochemical bonding formed due to pain and inflammation. Further, the interruption of the neural signal created by pain and inflammation either acute or chronic, decreases neural activation at the spinal cord, brain stem and at the local tissue level. Decreasing the sympathetic drive or gain of the neurologic system over time helps to sustain a normal tissue length, thereby, eliminating or decreasing pain permanently.
However, PRT is often only one part of the treatment process that must be implemented. Once a tissue is released and pain is eliminated, it must often be restored or rehabilitated and then the new tissue length sustained. When tissues are painful, contracted or inflammed, they weaken and loose size, atrophy. The tissue spasm not only causes pain, but inside the twisted tissue are blood vessels and nerves that also become compressed, decreasing blood flow and neural activiation, which decreases tissue health.
Will It Work For Me?
PRT is suited for any patient who has a history of either acute or chronic pain. Ideally, knowing the cause or mechanism of injury or the pain (e.g., fall, vehicular accident, sporting injury or an unexpected demand on the body) is helpful to isoloate and identify tissue restrictions that may have developed. However, often tissue restrictions or tenderpoints (TPs) often develop from athletic or exercise related participation, stress, a surgical intervention, breast augmentation or visceral dysfunction. Our practitioners however will evaluate you and work with your physician to determine if your symptoms are related to an underlying disease process or are associated with an athletic related injury.
How Long Do The Treatments Take?
The first session usually takes 90 minutes and involves an evaluation component. During this first session the clinician and patient get to know each other and a comprehensive health history is obtained as well as an orthopedic evaluation is conducted if warranted. This discussion is followed by a half hour of therapy.
Follow-up sessions, usually an hour to two in length, are encouraged for maximum benefit of the therapy. For most dysfunctions, 6-8 treatments are needed.
The typical treatment approach/regimen involves the following:
- Initial Evaluation and treatment (1 hour)
- Biomechanical evaluation (1 hour) - if necessary
- Charting of myofascial restrictions (1-2 hours)
- Treatment 1-2 times a week (1-2 hours per session)
- A course of treatment typically lasts 6-8 weeks
- Therapeutic exercise 2-3x week (done at home)
Is PRT Safe for me?
Positional Release Therapy is safe and effective for most patients because there is no force utilized. It is a passive pain-free therapy. However, there are a few general contraindications or conditions that prevent the use of PRT: systemic malignancy, abdominal or thoracic aneurysms, acute rheumatoid arthritis, open wounds, sutures, healing fractures, hematoma, skin hypersensitivity, or infection.