Bodies are like a mystery novel: Problems are clues, the body responds honestly, and I (the therapist) must be present in the moment so I won’t miss a clue. Every client is my teacher. Every session is my classroom. During a session, the questions I ask myself are: How will I be challenged? How will this body teach me a new way to communicate? What are the unique patterns of compensation this body has created to keep moving? How does it respond to treatment? Will I be able to apply what I learn to the other bodies I encounter?
My search to find techniques to decrease my clients’ pain led me to develop Structural Relief Therapy from two osteopathic techniques: muscle energy technique and strain-counterstrain, which is now called positional release therapy.
Here are the basic principles of Structural Relief Therapy:
1. Assess the tight tissue gently.
2. Find the Structural Relief Therapy tender point. (This is not the same as the myofascial trigger point.)
3. Position the body passively to eliminate the pain of the tender point.
4. Hold the position for 90 to 120 seconds.
5. Return the body to neutral slowly.
6. Reassess the tissue.
Structural Relief Therapy is a tool that does not create any additional pain for the client. There is no rubbing, deep pressure, stretching or pulling. It gently stops involuntary muscle contraction,which increases range of motion and decreases pain. Structural Relief Therapy challenges what we accept as the standard treatments for the body.
When you feel a tight muscle and it releases quickly and easily with tissue work, it usually means that tightness originated from emotional tension or emotional stress. When you apply deeper pressure to muscles that do not release easily or completely, this means involuntary muscle contraction is present. Muscle strands develop involuntary contraction from accidents, sleeping or prolonged postures combined with an emotional response or event.
An emotional response creates tension or contraction of muscles. Imagine your fearful emotional response in an accident. This is your body’s fight-or-flight response creating muscle tension; it wants to stop your body from being thrown around. After the fall or impact, the body is left with unfinished neurological loops of contraction. It is like your body was all set to run, but couldn’t flee. This also happens when we dream.
We work out our daily emotional issues in our dreams, and our body responds.Watch dogs dream. They move, and you can imagine what they are dreaming about from their movements. Our body reacts to our dreams, too.
Another example of a condition that creates involuntary muscle contraction is repetitive movement from work. Imagine someone sitting at a computer working on a project or a cashier scanning groceries. They came to work knowing their loved one is sick, or they had an argument, or the boss has added to their stress. Their bodies are full of tension and their repetitive movements create compensation,which creates muscle strands of involuntary contraction. This leads to more compensation patterns of movements thatwill eventually cause stress on the attachments of themuscles. This stress, especially on the long tendons in the forearm, creates injury to the attachments and causes pain, nerve entrapment—and, you guessed it, more compensation.
Intellectually, we understand compensation, but let’s review it practically.When your body is in pain, it immediately compensates to avoid the pain. Everyone has stubbed their toe and then walked differently so the toe does not hurt. Follow this upward and we are walking on our knee, hip and pelvis differently, therefore affecting the upper body. (I have traced many thoracic outlet conditions to a stubbed toe or other foot-or-ankle injury.)
Let’s think about what else is created in the body by compensation. Involuntary contracting strands of muscles cause the antagonist muscle strands to be overstretched. The muscles are having a tug of war, both sides trying to rebalance the body. This overstretching creates tightness and burning. Your client points to the overstretched areas and we use deep pressure to try and relieve the problem. Applying more stretch and pain will make the body give up the contraction so you will stop the treatment. But within an hour or so, the involuntary contraction recovers and the condition returns.
Here is a typical example: When you sit at a desk for several hours, your mid-back begins to feel tight. When you feel this tightness, notice you have begun to slump forward and it is really the muscles of the chest that are contracting. But it is the muscles of your middle back being overstretched that creates the noticeable conditions. We unconsciously lift our arms over our head and lean backwards over the chair because our body knows the anterior muscles are tight. We have been taught to stretch tight muscles. This only helps for a few minutes and the involuntary contraction of the muscles reconnects and your pain and tightness soon returns.
Here is an easy Structural Relief Therapy position to relieve your middle-of-the-back tightness. (See photo above.) Try pushing away from your desk, and with your arms hanging by your sides, let your whole torso move into a forward collapsed position—like falling asleep with your chin on your chest. Let yourself relax into this position, stretching your middle back. Your breath will be shallow. Start counting to 120 slowly. Next, slowly sit up and take a deep breath. Notice how your head sits more upright and relaxed on your shoulders and the burning in your middle back is lessened or gone.
Try this assessment for your client presenting with sciatic pain (see photo below): Place your open hand over his gluteus maximus with your fingers pointing superior, toward his shoulder. Apply equal pressure through the palm of your hand and fingers, gently compressing through the gluteus maximus to feel the band of tightness of the piriformis. Now compare from left to right. Notice that the tight, contracted piriformis is commonly on the opposite side from where the client reports his condition. It is usually the overstretched piriformis rubbing against the sciatic nerve that creates pain.
Movement or exercise overrides involuntary contraction but, at rest, the muscle strands will once again involuntarily contract. This is why clients feel tighter in the morning or after a long period of inactivity. These muscles will also test weak because the strands that are stuck in partial contraction cause the muscles to be fatigued. This is why exercise does not always resolve muscle weakness.
You have to be asking, “How long will this reprogramming last?” Structural Relief Therapy addresses the most recent involuntary muscle contraction, so a series of sessions is usually necessary and appropriate for clients with complex and chronic conditions. This is how I have been able to trace compensation from other areas of the body that started days, months or even years ago.
Birth of a Technique
In the 1970s, I took an eight-week course, studied on my own and became licensed. I knew massage should be part of the health care field. I began volunteering in the physical therapy department at Everett Providence Hospital in Seattle, Washington. Later, I joined a health care team of medical professionals at the Everett Providence Hospital Pain Control Center, an alternative program to help clients cope with constant pain from many unsuccessful surgeries. They could not tolerate more pain from deep-tissue massage; Swedish massage slowly decreased their tension but had no lasting results.
Massage was not covered by insurance in the early 1980s. To help correct this, I became a member of the Washington State Board of Massage. While there, our legislature temporarily included massage therapists as health care professionals. I resigned from the board, rewrote our law and with the American Massage Therapy Association’s help, became a lobbyist to promote a state law that made massage therapy a health care profession.
Searching for more education, Loren Rex, D.O., challenged everything I thought about the body. He turned my whole approach upside down and inspired me to feel and discern the different types of soft tissues before I began treatment.
In 1997, a colleague convinced me to share my knowledge. I developed an easy protocol to understand and use with clients. Students who had taken positional release therapy, muscle energy release therapy, Ortho-Bionomy and Onsen convinced me what I was teaching was different and easier. With their encouragement, I refined the curriculum and changed the name to Structural Relief Therapy.
Integration with Massage
Structural Relief Therapy integrates easily into a massage practice and is not intended to replace other forms of treatment.
Massage therapist Mikie Block of Medical Lake, Washington, says she works Structural Relief Therapy into almost every massage session. Block is also an assistant instructor in the technique.
Before she learned the technique, Block said, “Clients would keep coming back for the same reason, and I found that my technique was not lasting—I needed more tools in my tool box.
“Integrating Structural Relief Therapy enabled me to assess the root of the problem and affect deeply to get more structural problems resolved so that the tissue could accept the bodywork,” she said.
Structural Relief Therapy is not imposed on the client, but rather allows the body to be the boss and communicate via the Structural Relief Therapy tender points into the passive positions it needs. You can also teach your clients Structural Relief Therapy positions for self-treatment between appointments.
Over my 25-plus years of using Structural Relief Therapy, I have come to believe it reprograms the jammed signals of the muscles to and from the brain via the autonomic nervous system. Leon Chaitow, D.O., stated in a 2007 muscle energy technique class, “We can only speculate on how these techniques work, but we can be content that they are effective.”
Bodies present the ultimate mystery—and we need every type of tool to help the body restore itself to health.Most everything we learn in massage techniques is based on some form of stretch; Structural Relief Therapy is based on shortening muscle fibers to stop muscle contraction.
Taya Countryman, L.M.P., has practiced massage therapy since 1977. She has been an instructor since 1992 and specializes in clients experiencing complex and chronic medical conditions. She received the Outstanding Service to the Massage Profession 2003 and Service to the Chapter 2006 awards from the Washington chapter of the American Massage Therapy Association. For more information, visit structuralrelieftherapy.com.