The Case For Positional Release

In 1955, an osteopathic physician named Lawrence Jones stumbled onto something that would eventually challenge the dominant logic of manual therapy. A patient with a severe back spasm had failed to improve under any standard treatment. Jones found him in a contorted position of apparent comfort, left him there for some time, and discovered that when the man straightened up, the spasm had released. Jones spent the following decades mapping what he had found, identifying roughly two hundred tender points across the body and the corresponding positions of ease that could resolve them. He called the technique strain-counterstrain.
The logic of it runs against most people’s instincts about pain treatment. The reflex of conventional care is to push into restriction, to stretch the tight tissue, to mobilize the stuck joint. Strain-counterstrain does the opposite. It passively shortens the affected muscle, dampening the faulty proprioceptive signals driving the spasm, rather than fighting against them. The involved tissue is slackened, allowing local inflammation trapped within the painful tissue to dissipate, and following the release there is an immediate reduction of pain and tension. The body is not conquered. It is given permission to let go.
What this means in practice is a treatment that is, by the standards of manual therapy, almost absurdly gentle. The therapist identifies the tender points where pain concentrates, guides the patient toward the position of maximum ease, and holds that position, allowing the tissue to release without force. Osteopathic students learn the shorthand “fold and hold.” Hold for ninety seconds. Then slowly, slowly return to neutral. The gentleness is not a sign of weakness. It is the point.
This matters for a particular class of patients: those in acute pain, those who have failed more aggressive treatments, those whose nervous systems have become so sensitized that touch itself provokes guarding. Strain-counterstrain is especially useful for people with chronic pain who prefer gentle techniques or do not respond to other treatments, and its contraindications are few. You cannot use it on a fracture or a significant ligament tear, and the patient must be able to relax into the position of ease. Outside those limits, it works across most of the body and most presenting complaints. Headaches, neck pain, sciatica, shoulder impingement, piriformis syndrome, ankle problems, myofascial pain that has defeated everything else.
One of its practical advantages is that it manages pain quickly and without medication, and therapists often use it before strengthening or stretching exercises to reduce protective guarding and allow those exercises to proceed with less pain. This sequencing matters. A patient who guards against pain during exercise learns poor movement patterns and gets less from the rehabilitation work. Breaking the spasm first, through counterstrain, creates a window in which good movement can happen.
The research picture is honest rather than triumphant. Meta-analysis suggests that positional release reduces pain upon palpation of tender points, though the evidence is of low quality and study designs vary enough to limit strong conclusions. A 2017 randomized controlled trial found that a single counterstrain intervention did not produce statistically significant improvements in cervical range of motion compared to sham treatment, though both groups improved substantially once they received full osteopathic care. The technique is fourth among osteopathic manipulative approaches in clinical use, which suggests that practitioners find it valuable even where the research has not caught up.
What the research struggles to capture is the cumulative and clinical reality of the work. A patient with myofascial pain unresponsive to medications, injections, and months of conventional physical therapy sitting up from the table with less pain and more range of motion is a fact, even if it resists the preferred design of a blinded randomized trial. The blinding problem is genuine: it is difficult to construct a convincing sham version of a hands-on positional technique in the way you can blind a drug trial. This limits the evidence base without necessarily limiting the treatment.
There is also something in the philosophy of it that suits people who have spent time thinking about how the body works. The Alexander Technique and strain-counterstrain share a common recognition: the body will often organize itself well if you stop interfering with it. Both practices treat the nervous system as the real site of the problem. Tight muscles are not problems in themselves. They are the output of a nervous system that has received a signal, accurate or not, that tension is required. Changing the signal changes the output. You do not have to force the tissue. You have to convince the system that the threat has passed.
Jones argued that the original strain, often a sudden movement that forced a muscle into an extreme position, triggered a reflex arc that never quite resolved. The muscle shortened under strain, the spindle registered the change, and the nervous system locked in a protective contraction that outlasted any useful purpose. The counterstrain position reproduces the original position of shortening just enough to reset the spindle without triggering the protective response. Hold. Release. Move on.
Whether every element of that theory survives scrutiny is less important than what the technique produces. It produces relief. It produces range of motion. It produces patients who were stuck and then were not. It asks almost nothing of the person on the table, requires no pain, carries no significant risk, and can be applied from the skull base to the plantar fascia. For a form of treatment, those are serious virtues. Lawrence Jones found something real in that clinic in 1955, working with a patient no one else could help. The profession has been catching up ever since.
What would be alternatives for releasing muscular spasms?
The honest answer is that several techniques work through different routes, and matching the technique to the type and location of spasm matters more than picking a single favorite. Here is a survey of the main options.
Trigger point dry needling probably has the strongest reputation for stubborn, deep spasms that resist gentler approaches. A thin needle goes through the skin into the muscle at the point of tenderness, releasing the muscle and improving muscle function. The needle produces a local twitch response, a brief involuntary contraction that seems to exhaust and reset the offending tissue. Many people who have not responded to any manual technique respond to this. The sensation is strange rather than painful, and the results can be fast. It requires a trained physical therapist or acupuncturist, and not every state allows PTs to perform it, so you have to check local licensing.
Muscle energy technique (MET) works through the opposite logic from counterstrain but complements it well. The therapist places the patient in a specific position and asks them to generate gentle pressure against resistance. It is gentle and safe and can be quite effective. The isometric contraction followed by relaxation exploits what neurologists call post-isometric relaxation: after a muscle contracts against resistance, it tends to release further than it would through passive stretching alone. Where counterstrain is entirely passive, MET asks the patient to participate, which suits different tissue types and different presentations.
Myofascial release targets the connective tissue layer rather than the muscle fiber. Mild to moderate pressure applied to the fascia helps release it in all planes of movement, allowing the underlying muscle to move more freely. It works more slowly than counterstrain, often requiring sustained pressure for several minutes rather than ninety seconds, but it addresses a different layer of the problem. A spasm held long enough lays down fascial restriction, and no amount of neurological resetting through counterstrain will fully resolve that. Myofascial release gets at the structural residue that outlasts the nervous system problem.
Joint mobilization addresses the fact that many apparent muscle spasms are protective responses to restricted joints rather than primary muscle problems. If a vertebral segment is stuck, the surrounding musculature contracts to guard it. Releasing the joint often drops the muscular holding without any direct work on the muscle. This is why chiropractors and osteopaths frequently find that manipulation alone resolves what looks like a pure muscle problem. The spasm was downstream of something structural.
IASTM, or instrument-assisted soft tissue mobilization, uses metal tools with beveled edges to work into fascia and connective tissue. It reaches tissue depths that hands cannot easily access and is particularly useful for chronic holding patterns and scar tissue from old injuries. The tools detect and treat fascial restrictions that hands might miss, applying focused pressure to break down scar tissue and promote organized healing through increased blood flow. It is more aggressive than myofascial release and not appropriate for acute presentations, but for chronic muscular problems with a structural history it can reach places nothing else does.
Reciprocal inhibition is a self-help tool. If you contract the muscle opposing a spasming muscle, the nervous system should inhibit the spasming one. A therapist compresses the spasming muscle while activating the antagonist, shutting off the spasming muscle and helping the spasm relax. A runner with a gastrocnemius spasm activates the tibialis anterior. The principle applies across the body and can be done without a practitioner in many situations.
Counterstrain resets the nervous system signal. Needling exhausts the trigger point. Joint mobilization removes the upstream restriction generating the spasm in the first place. The three cover different phases of the same problem, and most chronic muscular presentations have all three layers running simultaneously.