Massage Therapy Journal Spring 2024

58 • Massage Therapy Journal

AMTA Continuing Education

counterstrain was developed by Dr. Lawrence Jones in 1955. This technique is considered both gentle and noninvasive. The goal is to decrease pain while increasing tissue mobility of the client. PRT involves finding a tender area or trigger points in the soft tissues and then manipulating them into a position of ease to reduce discomfort and tension. 20, 21, 22 The basic hypothesis of how positional release techniques have an effect on soft tissues is that they interrupt the pain-spasm cycle. By introducing the affected muscle or tissue to a less painful and more comfortable position, the technique encourages relaxation and decreased muscle tension. This can aid in the reduction of pain and discomfort. Some common contraindications and cautions around positional release techniques include: • Anticoagulant or antiplatelet medications • Open wounds • Local bacterial infections • Bruises • Local skin diseases • Areas of decreased sensation • Fragile skin A common positional release protocol to use with your clients: 1. Locate a trigger point or tender area of soft tissue. 2. Gently initiate a pain response with direct pressure. The pain should not be more than a seven out of 10 on the numeric pain scale. 3. Gently move the tissue, limb and/or the body until the pain has decreased to a two or three out of 10 while continuing palpation of the tender area. 4. Hold your pressure anywhere from 60 to 120 seconds until the target tissue softens and relaxes. 5. Slowly release the pressure and passively stretch the area. 6. Reassess to notice any changes in the tissue texture. Fascial Mobilization Techniques. Fascial mobilization techniques go by many different names: myofascial release, fascial release

and functional technique, to name a few. These techniques utilize a consistent pressure application and lengthy application time. Fascial mobilization techniques can be applied in either a direct or indirect fashion. Direct fascial massage can include compressive strokes, J-strokes or skin rolling. This type of massage generally uses much more force than its indirect counterpart. Indirect fascial techniques typically are gentler and are utilized for two to five minutes. It is recommended that massage lubricants are not used with these techniques. Lubricants can inhibit the therapist’s ability to pick up or hold the tissue. With direct fascial methods , the goal is to increase tissue mobility and blood flow in a focused area by utilizing a force that takes the tissues into bind. These techniques generally utilize more pressure on the tissue than indirect fascial techniques. These techniques can be uncomfortable, so staying in contact with the client on their pain tolerance is important. Some common contraindications and cautions around direct fascial methods include: • Anticoagulant or antiplatelet medications • Local bacterial infections • Bruises • Local skin diseases • Areas of decreased sensation • Fragile skin Some common direct fascial methods to use with your clients: Pressure/compression utilizes either a static compressive or gliding force on the skin to mobilize the deeper tissue layers. Forearms, fingers, fists, palms or elbows can be used for this technique. This can be used on skin, superficial fascia or deep fascia. 1. The tissue is assessed for mobility in different directions to locate the bind. 2. Engage the desired tissues. 3. Apply the force in the direction of the bind. 4. Either sink in with compression or glide over the skin.

5. Repeat three to five times. 6. Reassess tissue for mobility.

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