Positional release therapy provides massage therapists with a fabulous technique to relieve pain and tension at a focal tender, tight or trigger point—without the use of compressive force. This technique provides significant relief in a short amount of time and can be skillfully interjected at any point in a massage with minimal disruption to the flow of the work.
In this article, I will introduce you to positional release therapy, its benefits, its optimal use, and answers to some of the challenges positional release can pose.
Positional Release Therapy: An Antidote to Deep Tissue Work
For many therapists, deep tissue massage has become a mainstay in an effort to bring relief to the client. Not only that, many clients believe that without deep pressure they are not going to get relief. This takes a toll on the client and the therapist.
Clients may have discomfort or even pain from deep work. They can leave a session feeling worse than when they came in from repetitive stimulation of trigger points without effective release. This leads to client frustration and dissatisfaction with results from their massage. Therapists have shortened careers from injuries and equal frustration with not getting the results they want for their clients.
I was drawn to positional release therapy in massage school by its simplicity of use and the effects that it has on focal muscle tension and pain. I have been practicing positional release for over 20 years and have taught positional release to other therapists for the last six years.
It is a wonderful experience to see the relief that clients get from this technique and the joy massage therapists have learning and practicing this work. It is so effective, that the most common question I get from a client when rechecking the trigger point after a positional release is, “Are you sure that was the place that was hurting me?”
Positional release (also known as strain-counterstrain) is a technique that engages the proprioceptors of the muscles to cause release of muscle tension and pain at a focal tender, tight or trigger point in the affected tissue. This is accomplished via accurate palpation of the trigger point and passive concentric shortening of the muscle to create slack and achieve complete relief of pain and tension at that point.
By placing and passively holding the affected muscle in a pain free position, a feedback loop or reset via the proprioceptors results in relief of pain and tension at the trigger point and improves circulation, which break the spasm/inflammation cycle that is thought to perpetuate the trigger point. This is accomplished via the effects of positional release on the muscle spindles, Golgi tendon organs and circulation-inflammation.
Complete Relief
It is not hard to imagine how different the experience of this type of relief is for a client. Positional release therapy can bring immediate, complete relief. And just as important, this relief can bring a stop to referred pain, muscle spasm, and guarding that are associated with the trigger point that was released.
Positional release is somewhat time-consuming in a session. It typically takes from three to five minutes to accomplish. It requires some time and some effort to achieve that just-right shortening of the affected muscle to achieve the complete relief at the trigger point that is required to obtain a full and deep release.
Just like any skill, it is important to use positional release when it will be of best effect. One practical indicator of when to use positional release is simply that other methods are not getting a good result in a timely manner. Tension in a muscle that is not softening or when typical trigger point techniques are ineffective or not well tolerated by the client are great opportunities to introduce positional release.
The clinical applications of positional release therapy are great. When there is an obvious trigger point, such as when the client complains of a specific focal pain or referred pain, this complaint can be addressed quickly, right at the beginning of the session to bring pain relief.
When tension is not being relieved through massage, a focal trigger point that may be maintaining that tension can quickly be released allowing the session to progress. Chronic muscular problems that are being maintained by guarding and dysfunctional muscle recruiting due to a trigger point can be greatly relieved.
Positional release of a focal trigger point can be the lynchpin to a full and broadly beneficial release. When used in context of a full session, positional release can speed relief of pain and greatly enhance a client’s progress.
5 Challenges of Positional Release Therapy
Positional release has basic steps, indications and contraindications that can give the massage therapist another great tool. Some therapists can get a little frustrated when they first start out with the skill and so I would like to comment on a few areas to provide some encouragement.
Here are a few potential challenges:
1. Language. Language about trigger points has made finding them mysterious for some therapists. “Is it a knot?” “Is it tension in the fibers?” “I don’t feel trigger points!”
Some therapists shy away from positional release as a technique because of lack of confidence or experience. Each massage therapist has their own language and sense of palpation for what feels tight and where something hurts.
It is unnecessary to distinguish between classic Travell-and-Simons trigger points, versus tight points or knots, versus tender points when applying this technique. Positional release can effectively relieve them all.
A therapist who will tune in to their own sensation of tension in the tissue and link that with the client’s sensation of tension and pain can hone in on an accurate location of a trigger point.
2. Painful Palpation. Many therapists are used to releasing trigger points using strong pressure.
Positional release works when the trigger point is completely out of pain. This makes sense. The nervous system reacts to pain, typically, with tension. The absence of pain allows the proprioceptors of the muscle to reset muscle tension and bring about relief of pain.
If palpation is too strong and causes any pain during the positional release, it will be ineffective. I have seen many therapists break the pressure habit with a little practice and awareness.
3. Therapist Strength. The strength of the therapist and client resistance can also lead to some frustration with effective positional release. Positional release requires that the therapist hold the client in a passive position during the release. This is just as important to an effective release as the absence of pain.
We all remember the discussions during massage school about how difficult it can be for some clients to allow the therapist to move them. Body weight of the client and strength of the therapist can also be a factor. If the client senses a lack of support, their ability to remain passive can be more difficult. Here is where discernment becomes key.
A good positional release class will teach workarounds for these types of situations. The therapist is never in a position where they have to force a situation or compromise their own physical safety.
4. Session Flow. Another challenge I have often heard is the concern with “interrupting” the flow of a session. Positional release can be applied with minimal interference to a session. First, it can be done right at the beginning of a session and followed by a more relaxing massage. This is a great way to incorporate positional release, because the client’s pain has been addressed and they can now relax and enjoy the session more.
Other times, a trigger point will become evident during a session. A skillful therapist can apply slack to the affected muscle and rely on their own palpation of release while the client is barely disturbed. With more sensitive positioning and concern with modesty, the client can remain covered. Palpation for positional release can even be done over clothing.
5. Fine-Tuning. The last area of challenge is also the one I enjoy most when teaching: fine-tuning. Positional release is most effective when the concentric shortening completely relieves pain and tension at the TP. It can be frustrating when creating the slack necessary for the release and feedback from the client says there is not complete relief.
What is missing? Often it is a lesser-known movement of a muscle.
Think about all the muscles of the body. Most muscles have multiple planes of motion. A muscle may have a primary movement of flexion or extension, but also abduct or adduct, or internally or externally rotate. I always have my anatomy textbook handy. I have honestly said to clients at times, “I just want to make sure I remember all of the ways this muscle works so I can get the best release.”
The starting point for any positional release is to know all of the movements of the affected muscle. This allows the therapist to engage any of the planes of movement of a particular muscle to fine tune for a complete release at the trigger point.
Stand Out with Positional Release Therapy
Positional release has been a mainstay in my practice from the beginning. When I retired this past July, one of the hardest skills to find in a therapist as I referred my clients out was positional release.
This is a technique that will make your work as a therapist stand out. It is a game-changer for the therapist and the client. You will have a skill than can bring immediate relief, quickly. The client sees and feels that you have focused on what is hurting them, with great results.
Clients love this technique and appreciate the value. Just as importantly, you will preserve your own body for a long-lasting career in massage.
About the Author
Mary Henderson began her career in massage therapy in 2001. She has been an NCBTMB Approved CE Provider since 2016. She taught cupping massage and positional release classes in New England for six years. Her passion in teaching is to train massage therapists in skills that will give their clients great results with less stress on themselves and their clients. Henderson retired from active teaching in June 2022 and is available for individual consultation in positional release and cupping massage.