The response to positional release of a chronically fibrosed area will be less dramatic than from tissues held in simple spasm or hypertonicity. Nevertheless, even in chronic settings, a degree of release and ease can be produced, allowing for easier access to the deeper fibrosis.

Treatment of painful tissue using positional release, is possible whether using reducing levels of pain in the palpated point as a guide or whether the concept of assessing a reduction in tone in the tissues is being used (as in example 5 above).

Anything from 20 to 60 seconds are suggested for holding the painless position of ease.

7. Facilitated Positional Release (FPR)¹¹

This involves the positioning of the distressed area into the direction of its greatest freedom of movement starting from a position of ‘neutral’.

The seated patient’s sagittal posture would be modified to take the body or the part (neck for example) into a more 'neutral’ position - a balance between flexion and extension - following which an application of a facilitating force would be introduced. No pain monitor is used but rather a palpating/ listening hand is applied (as in Functional technique) which senses for changes in tone in distressed tissues as positioning is performed. The final ‘crowding’ of the tissues, to encourage a ‘slackening’ of local tension, is the facilitating aspect of the process. ‘Crowding’ might involve compression applied through the long axis of a limb, or directly downwards through the spine via cranially applied pressure.

The position of ease is usually suggested at just 5 seconds.

8. Induration Technique¹²

Marsh Morrison DC suggested very light palpation, using extremely light touch, as a means of the feeling a 'drag' sensation (see March issue of JACM) alongside the spine (as lateral as the tips of the transverse processes). Drag results from hydrosis, the physiological response to increased sympathetic activity, an invariable factor in skin overlying trigger and other forms of reflexively active myofascial areas. Once drag is noted pressure into the tissues normally identifies pain.

The operator stands on the side of the prone patient opposite the side in which pain has been discovered in paraspinal tissues.The point is held by firm thumb pressure while, with the soft thenar eminence of the other hand, the tip of the spinous process most adjacent to the pain-point is very gently eased towards the pain (ounces of pressure only) crowding and slackening the tissues being palpated, until pain reduces by at least 75%.

Somewhere within an arc involving a half circle, an angle of push towards the pain will be found to abolish the pain,lessening any palpated tension. This is held for 20 seconds after which the next point is treated. A full spinal treatment is possible using this extremely gentle approach which incorporates the same principles as SCS and Functional technique.

9. Integrated Neuromuscular Inhibition Technique¹³

INIT involves using the position of ease as part of a sequence which commences with the location of a tender/pain/trigger point, followed by application of ischemic compression (this is optional and is avoided if pain is too intense or the patient too fragile or sensitive) followed by the introduction of positional release (as in number 6 above).After an appropriate length of time during which the tissues are held in ‘ease’ the patient is asked to introduce an isometric contraction into the affected tissues for 7 to 10 seconds after which these are stretched (or they may be stretched at the same time as the contraction - if fibrotic tissue calls for such attention).