If, as SCS suggests, the position of ease equals the position of strain - then they need return to flexion in slow motion until tenderness vanishes from the monitor/tender point and/or a sense of ‘ease’ is perceived in the hypertonic tissues. By adding ‘fine-tuning’ positioning to the position of ease achieved by flexion, greater reduction in pain can usually be achieved. This position is held for 60 to 90 seconds before slowly returning to neutral at which time a some resolution of hypertonicity and pain should be felt.
The position of strain is often an exact duplication of the position of exaggeration of distortion - as in example 1.
These two elements of SCS are described as examples only, since it is not a frequent occurrence to have patients describe precisely in which way there symptoms developed. Nor is obvious spasm such as torticollis or ‘lumbago’ the norm. Ways other than ‘exaggerated distortion’ and ‘replication of position of strain’ are needed to enable identification of positions of ease.
3. Jones’ Tender Points5
Through years of clinical experience Jones compiled lists of tender point areas relating to strain of most of the joints and muscles of the body. These 'proven'(by clinical experience) points are usually found in tissues shortened at the time of strain, rather than those which were stretched.
New points are periodically reported - for example recent sacral foramen points relating to sacroiliac strains.6
Jones provided directions for achieving ease tender points being palpated involving maintenance of pressure on the tender point, or periodically probing it, as a position is achieved in which:
a/ there is no additional pain, and
b/ the monitor point pain reduces by at least 75%.
This is then held for an appropriate length of time (90 seconds according to Jones, however there ways of reducing this).
The person with acute low back pain, locked in flexion,will have a tender point in the abdominal muscles short at the time of strain (when the patient was in flexion). The position which removes tenderness from this will, as in previous examples, require flexion and probably some rotation and/or side-bending.
The problem with Jones’ formulaic approach is that the mechanics of the particular strain with which the operator is confronted may not always coincide with Jones’ guidelines. An operator relying on Jones’ formulae may find difficulty in handling a situation in which the prescription fails to produce results. It is suggested that a reliance on palpation skills and other positional release variations offers a more rounded approach to dealing with strain and pain.
4. Goodheart’s Approach7,8
George Goodheart D.C. (the developer of Applied Kinesiology) has described an almost universally applicable formula which relies more on the individual features displayed by the patient, and less on rigid formulae as used in Jones’ approach.
Goodheart suggests that a tender point be sought in the tissues opposite those 'working' when pain or restriction is noted. If pain or restriction is reported or is apparent on any given movement, the antagonist muscles to those operating at the time pain is noted will be those that house the tender point(s).
In examples 1 and 2, of a person locked in forward bending with acute pain and spasm, using Goodheart's approach, pain and restriction would be experienced as the person moved into extension from their position of enforced flexion.