ARTICLE IN PRESS
J ournal of Bodywork and Moveme nt The rapie s (2009) 13, 115116
EDITORIAL
Ligame nt s and posit ional re le ase t e chnique s?
The echoes of t he 1st World Congress on Fascia
Re se arch cont inue t o nd t he ir way int o t he pages
of JBMT, as we cont inue t o publish papers eme rging
from t hat import ant event in Oct ober 2007. In t his
issue t here are more import ant papers, including
Solomonows Ligament s: A source of musculoskele-
t al disorders.
This review of t he anat omy, physiology and
pat hophysiology of ligame nt s, includes some sur-
prising (t o t his reader) ne w clinically import ant
informat ion. Ligame nt s it seems are far from simply
be ing rest raining st ruct ures t hat are st rat egically
placed t o support and st abilise joint s, while
maint aining normal t racking during moveme nt . In
addit ion t he y are sensory organs t hat provide
proprioce pt ive input t o t he CNS, as well as having
reexive inuence s on associat ed muscles, which
t herefore become major e le ment s in t he st abilisa-
t ion of joint s.
As Solomonow shows, when normal funct ion is
dist urbedby t rauma for exampleinst abilit y re-
sult s, wit h serious implicat ions for t he safet y of t he
joint s, as well as creat ing dist urbed mot or and
sensory effe ct s.
It become s clear in t his subst ant ial revie w t hat a
ligame nt s funct ion, when unde r t ension, or when it
is st ret ched, is complet ely different from t hat
which applies whe n it is slack.
Solomonows clear st at eme nt (2009) t hat liga-
ment s are complet ely non-funct ional in compres-
sion or whe n short e ned below t he ir rest ing le ngt h
offers a pot ent ia l explanat ion for t he mechanisms
involve d in at least one version of posit ional release
met hodologyas discusse d lat er in t his e dit orial.
The behaviour of ligame nt s are comple xwit h
many eleme nt s ent e ring t he equat ionfor exam-
ple t he phenomena of cre e p and hyst ere sis. The
way load is applie d t o ligament s, in t e rms of t he
spe ed wit h which t his occurs, as well as repe t it ions,
and ambient t e mperat ure, all inuence re sponse s,
and the review paper det ails t hese wit h clarit y.
1360-8592/ $ - see front mat t er & 2009 Else vie r Lt d. All right s rese rved.
doi:10. 1016/ j. jbmt . 2009. 01. 001
Journal of
Bodywork and
Movement Therapies
www. else vie r. com/ jbmt
Ult imat e ly, exce ssive e longat ion of ligame nt s
leads t o inst abilit y, laxit y and t he pot ent ial for
injury. There are opt imal re st requireme nt s, t o
he lp prevent such damage, and t he research int o
t hese is discusse d.
These issues are part icularly import ant for t hose
working wit h t he effect s of cumulat ive micro-
t rauma.
Over all, moderat e repet it ive st imulat ion of
ligame nt s coupled wit h appropriat e rest and
recovery allows t he t issue t o hypert rophy, increase
it s st re ngt h and prot e ct joint st abilit y in persons
exposed t o more demanding physical act ivit y.
Converse ly of course, inact ivit y can lead t o
de gene rat ion, while st at ic or repet it ive loading
produce s microt rauma and inammat ion. What
eme rges from t his de t ailed evaluat ion of ligame nt
be haviour is t hat normal funct ion depends on a
dosedurat ionrest -repet it ion formulahow much
load? for how long? and how oft e n?wit h t he
durat ion of rest periods be ing crit ical.
Posit ional re le ase implicat ion
Posit ional release t echnique (PRT), as use d in
ost eopat hy, involve s t he placeme nt , for brief
pe riods, of soft t issues or joint s, int o posit ions of
ease, t o encourage se lf-regulat ing inue nces t o
operat e more efcient ly, result ing in great er range
of mot ion, reduced pain, et c. Howeve r just what
t he underlying me chanisms of PRT are remains a
mat t e r for debat e and rese arch.
The ways in which t he e ase posit ion is achieved
varie s, alt hough placing re st rict e d or dysfunct ional
t issue s int o a comfort st at e always involve s
indirect approache s, which at t e mpt t o dise ngage
from re st rict ion barriers.
For example, in St raincount e rst rain met hodol-
ogy, a palpat ed sensit ive point is used as a monit or
t o guide t he t issues t owards ease, via fee dback
 ARTICLE IN PRESS
116
from t he pat ie nt . As t he report ed pain le vel
reduces (from a st art ing point of 10 t o 3 or
less), t he t issues be ing palpat ed are felt t o become
slacke r and le ss t ense (Jones, 1977).
The e ase posit ion is t hen held for 90 s or so,
before being gent ly released.
In Funct ional posit ional release a similar end-
point of comfort or e ase is achieve d, howeve r
wit hout use of pat ie nt fe edback, purely by t he
palpat ed sense of t he t issues relaxing from t he ir
previously hype rt onic st at e as t hey are carefully
posit ioned (Johnst on, 1964).
Afacilit at e d version of t his approach also exist s
(discusse d below), and t he evide nce provided by
Solomonow may have implicat ions for it s met ho-
dology, over and above t he various hypot he se s t hat
curre nt ly e xist as t o t he me chanisms involve d
which range from circulat ory e nhancement , t o
neurological reset t ing (Dambrogio & Rot h, 1997;
Chait ow 2007).
More rece nt ly Melt zer and St andle y (2007) having
not ed t hat , while clinical st udies support t he
efcacy of posit ional release met hods, lit t le is
known regarding t he cellula r re sponse t o t issues
being placed in ease. St udie s were t herefore
undert aken t o invest igat e human broblast prolif-
erat ion and int erle ukin secret ory prole s, in
response t o modelled repet it ive mot ion st rain, as
well as t o modelled indirect ost eopat hic posit ional
release me t hods.
Their ndings were t hat t he result ing dat a:
suggest s t hat broblast proliferat ion and expre s-
sion/ secret ion of pro-inammat ory and ant i-in-
ammat ory int erleukins may cont ribut e t o t he
clinical efcacy of indire ct ost eopat hic manipula-
t ive t e chniques.
Is t he re also a ligame nt ous e xplanat ion?
Some years ago Schiowit z (1990), who deve loped
t he facilit at ed posit ional re le ase (FPR) model,
added various modicat ions t o t he prot ocols brie y
out lined above, incorporat ingfor example
compre ssionor dist ract ionof t he t issue s being
placed int o an ease posit ion.
Some of t hese facilit at ed posit ions necessarily
involve crowding joint s, or slight ly dist ract ing
t hem, t o achieve a sense of palpat ed ease in
associat ed musculat ure . In FPR met hodology t he
posit ion of e ase is he ld for a relat ively brief (5 s or
so) period, whe re as in t radit ional posit ional release
met hodology, 90 s is recomme nded (Jone s, 1977;
Dambrogio & Rot h, 1997).
In response t o pe rsonal e nquiry as t o t he
pot ent ial effect of 20 N (approx 4 kg) of compre s-
Edit orial
sive force , applied t o a joint for a brie f (6090 s)
pe riod, Professor Solomonow has responded (per-
sonal communicat ion January 8, 2009):
If you apply only 6090 s of relaxing compre ssion
on a j oint, I would say t he est ablishe d me chan-
ism will conrm t hat an hour plus of relaxat ion of
muscle s may re sult . This may come not only from
ligame nt s, but also from capsule s and t endons.
Int ere st ingly, light (non-t raumat ic) st ret ching of
a ligament will have a similar effect (Solomonow,
2009).
Howeve r, Solomonow caut ions: St ret ching of
ligame nt s for muscle re laxat ion should be done
when one knows which muscles are cont rolle d by
which ligament s t o maximize t he effe ct (personal
communicat ion January 8, 2009).
It may be of int e re st , in widening t he pe rspe ct ive
on t hese approaches, t hat in physiot herapy met h-
odology t he use of some aspect s of unloading
t aping mirrors many of t he crowding element s of
PRT (Morrisse y, 2007)l.
Bot h ease and unloading should produce a
slackening of (some ?) ligame nt s (and possibly
light ly st ret ch ot hers). The quest ion t hen is, does
t he slackening of ligame nt s involved in t he
posit ioning of j oint s during FPR (or unloading
t aping), have sufcient re exive inuence on
associat e d musculat ure t o account in part at
least -for t he e ffect s of posit ional re lease?
Re fe re nce s
Chait ow, L. (Ed. ), 2007. Posit ional Release Te chnique s, 3rd e d.
Churchill Livingst one, Edinburgh.
DAmbrogio, K., Rot h, G. , 1997. Posit ional rele ase t echnique.
But t e rwort h He nemann, Bost on.
Johnst on, W. , 1964. St rat egy of a Funct ional Approach in Acut e
Kne e Problems. Acade my of Applied Ost e opat hy Yearbook,
Colorado Springs.
Jone s, L. , 1977. St rain and Count e rst rain. Academy of Applie d
Ost e opat hy, Colorado Springs.
Schiowit z, S. , 1990. Facilit at e d posit ional rele ase . Journal of t he
Ame rican Ost e opat hic Associat ion 90 (2), 145.
Melt zer, K., St andley, P., 2007. Modelled repetitive mot ion st rain
and indirect osteopathic manipulat ive techniques in regulat ion
of human broblast proliferat ion and interleukin secret ion Jnl.
American Ost eopat hic Associat ion 107 (12), 527536.
Morrissey, D. , 2007. Unloading and proprioce pt ive t aping. In:
Chait ow, L. (Ed. ), Posit ional Release Techniques, 3rd e d.
Churchill Livingst one, Edinburgh.
Solomonow, M., 2009. Ligament s: a source of musculoske let al
disorde rs. Journal of Bodywork and Movement Therapie s 13
(2), 136154.
Le on Chait ow
Universit y of West minst er, UK
E-mail address: leonchait ow1@mac. com