这部分对体位放松技术进行了概述，包括它的历史及发展、基本实践应用和步骤、支持它应用于躯体功能障碍缓解等的理论和研究成果等。PRT是它的前身拮抗松弛术的分支，二者就像父母与孩子，虽看起来有相似之处，但随着时间的推移，差异就不断地表现出来。本部分也阐明了PRT与SCS之间的差异，解释了从业者如何简单、有条理地使用PRT处理多种损伤。大量已有的和新兴的理论及依据都可以解释PRT是如何减轻和消除躯体功能障碍的。
体育运动中的体位放松技术
人民邮电出版社
北京
图书在版编目（CIP）数据
体育运动中的体位放松技术 / （英）蒂莫西·E.施派克（Timothy E. Speicher）著；汪敏加，刘冬森译.--北京：人民邮电出版社，2020.6
ISBN 978-7-115-52389-1
Ⅰ.①体… Ⅱ.①蒂… ②汪… ③刘… Ⅲ.①放松（体育）-研究 Ⅳ.①G808.1
中国版本图书馆CIP数据核字（2020）第065484号
◆著 [英]蒂莫西·E. 施派克（Timothy E. Speicher）
译 汪敏加 刘冬森
责任编辑 王若璇
责任印制 周昇亮
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Copyright © 2016 by Timothy E.Speicher
All rights reserved.Except for use in a review,the reproduction or utilization of this work in any form or by any electronic,mechanical,or other means,now known or hereafter invented,including xerography,photocopying,and recording,and in any information storage and retrieval system,is forbidden without the written permission of the publisher.
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本书为物理治疗师、按摩师、运动教练、运动防护师等专业人士，以及有意从事相关职业的学生提供了体位放松技术实践应用的重要参考。本书共分为2个部分。第1部分包含2章，基于体位放松技术的相关研究，阐述了该技术的原理、实践意义和应用指南等。第2部分包含9章，分别对足部、踝关节和小腿、膝关节和大腿、骨盆、脊柱、肩关节、肘关节和前臂、腕关节和手部、颅骨的主要结构的解剖学和运动学特征、触诊流程、体位放松技术应用流程和自我治疗流程进行了讲解，同时介绍了常见损伤的诊断和治疗方法。对于每一位有意学习体位放松技术及使用该技术帮助急性和慢性躯体功能障碍患者的读者来说，本书都将提供有益指导。
本书具有可配合图书一起使用的同主题视频课程，详情请见“人邮体育”平台。
视频课程与图书中标有如下图所示标识部分的内容配合使用。
视频课程为独立知识产品，本书定价中不含视频课程。
例：
视频3.1：足骨间背侧肌PRT应用流程
本书内容旨在为大众提供有用的信息。所有材料（包括文本、图形和图像）仅供参考，不能替代医疗诊断、建议、治疗或来自专业人士的意见。所有读者在需要医疗或其他专业协助时，均应向专业的医疗保健机构或医生进行咨询。作者和出版商都已尽可能确保本书技术上的准确性以及合理性，并特别声明，不会承担由于使用本出版物中的材料而遭受的任何损伤所直接或间接产生的与个人或团体相关的一切责任、损失或风险。
我想将这本书献给我的终身伴侣，斯蒂芬妮（Stephanie）。如果没有她坚定的支持，我就没有能力完成这本书。当我追逐梦想时，她付出了很多。我也想将这本书献给我的两个女儿，摩根（Morgan）和马莉（Marley），她们在无形中为我提供了能量，帮助我完成了这本书。我还想将这本书献给我的母亲，没有她，我生活中的一切都是不可能发生的。
最后，我想将这本书献给我的导师和朋友，他们在没人相信我的时候，选择支持我、鞭策我。最重要的是，在我需要改变时，他们会为我提供指引。
如果没有学者、研究人员和从业者为体位放松技术的发展和建立奠定基础，就没有这本书的存在。然而，所有我直接或间接接触到的都是这本书的一部分；此外，还有成千上万的我有机会向其学习的学生、贡献出关键理解的未知作者、不断挑战我的课程的参与者以及让体位放松技术研究所变得更好的教学人员。感谢研究所里那些提供了超出我预料的坚定支持与奉献的教学人员。同时，感谢我之前的教学助理凯尔·托格森（Kyle Torgerson）和安迪·皮金（Andi Pigeon）担任模特，感谢布拉德·卡罗尔（Brad Carroll）和迪纳·加尔布雷（Teara Galbraith）的摄影协助。
此外，人体运动出版社的专业人士的支持、耐心与专业知识也很重要，没有他们，就不可能有这本书。他们鼓励我打开思路，采用新方式展示材料；他们鞭策我超越自己的极限，并且在我最需要的时候，总能给我支持与激情。
这本书为康复从业者、教育者、学生等提供了关于体位放松技术（PRT）实践应用的循证信息。它肯定了那些支持将体位放松技术应用于不同患者群体的证据与理论，更为重要的是，它提供了一种用体位放松技术评估与治疗肌筋膜功能障碍的简单方法。体位放松技术是一种轻柔、被动的技术，一直被主张用于处理出现在所有年龄段的急性、亚急性及慢性躯体功能障碍（Speicher & Draper,2006）。
体位放松技术这个词，其前身是拮抗松弛术（SCS），它使用一种舒服的姿势解决组织功能障碍问题（如疼痛、紧绷和痉挛）。劳伦斯·琼斯（Lawrence Jones）博士是一位在20世纪50年代首先开发PRT的骨科医生，他最初称PRT为体位放松技术，后来创造了拮抗松弛术这一术语（Jones,1964）。琼斯推测，组织功能障碍是由应变-抵消应变机制所引起的。他提出，当组织不得不快速地适应一个突然的应变时，受到应变的组织的拮抗肌会抵消相应的应变，以稳定关节、肌肉或其他受影响的结构；随后，拮抗肌成为功能障碍的根源，需要被处理。当他绘制他的患者的疼痛点图时，他发现，压痛点（TPs，tender points）（筋膜限制）通常会出现于特定的位置，他认为这与神经根的支配相关。随着技术的发展，许多从业人员与研究人员改进了琼斯最初的理论与技术。
这本书分享了理论与技术的多次发展及其基于的证据，为有抱负和有经验的PRT从业人员提供学习和应用这一技术从而改善患者状况的简单方法。我的早期职业为研究治疗方法的大学教授，那时我偶然接触到了体位放松技术。先前的一个教授给我留下了列有安布罗西奥（D'Ambrogio）和罗思（Roth）的体位放松技术文本的大纲（D'Ambrogio & Roth,1997）。作者称，在第一次应用时，体位放松技术能减缓75%~100%的疼痛感。我觉得这个结果好得有点不真实。但是，由于我学习并研究神经科学，我认为，虽然效果有些言过其实，但是有其可信之处。我想，如果患者的疼痛可以得到这么大幅度的缓解，那我们就找到了妙法！因此，我在我的田径运动员患者及我的学生身上进行尝试。不幸的是，疼痛的减缓程度并未像之前所称的那么大。但是，我确实取得了一些小小的成绩，多年来我一直在治疗方法与安布罗西奥与罗思的压痛点图表上全情投入，并最终坚持了下来。
我从学术会议和专题研讨会的文集和培训中发现，还没有一种系统而直接的方法可以用来学习和应用这种技术，特别是对于运动群体而言。我的出发点不仅仅是将体位放松技术以更好的方式应用于改善我的患者的状况，而且还要将它以更好的方式教给我的学生，这样他们便可以在最初的尝试中体验到成功。我希望他们和他们的患者能够获得我花10年才能获得的成功。基于我的体位放松技术的临床实践、研究与教学，我在这本书中提出了一种新的范例，以便读者理解、学习以及应用这种技术。无论你是第一次接触体位放松技术的新手，还是经验丰富的从业者，这本书都有助于你打造自己的“工具箱”，从而改善你的应用效果。
这本书采用什么结构
这本书的结构与其他体位放松技术的文本很像，但是，它与琼斯的原著中所用的几种主要的方法有所不同。此外，这些方法与技术已被修订。当你用到它时，它可以提供关于体位放松技术如何工作以及如何应用的依据。这本书不使用琼斯最初的压痛点的位置与相关的脊柱节段。相反，用于实践流程的压痛点与方法都是基于可以被触及的、传统的解剖结构。压痛点评估与处理的方法和技术，以及相关文献也都是新颖的。
第2部分的每一章都包括常见损伤的概述和它们的筋膜触发点的概括、所考虑的评估方法、关于如何将PRT应用于一些特定的解剖结构（如足底筋膜）的描述以及一些特定损伤（如足底筋膜炎）的处理方法。书中术语“近侧”和“远侧”用于指导从业者应用体位放松技术进行手法治疗。近侧手指的是离部位或组织最近的手，远侧手指的是离部位或组织最远的手。每一章也包含了评估特定解剖结构的指导和患者自我处理。这本书内容的组织以及呈现方式，与大多数健康行业从业者职前培训的结构相匹配。没有复杂的绘图方式、很难记住的缩写以及难以理解的应用。附录提供了搜索与定位评估表，以识别关键结构并进行评估与记录，同时识别肌筋膜病变模式，从而帮助制订个性化处理线路图。就每个关节而言，我建议使用数字疼痛评定量表记录处理前后的疼痛感，同时需记录疼痛的大概位置。
这本书的特别之处
这本书包含触诊指导及在别的地方找不到的辅助方法。如果没有熟练掌握的评估技能和与待处理结构相关的解剖学和运动学的知识，从业者评估和应用体位放松技术的成功率就会降低。
虽然体位放松技术可作为一个独立的处理方法，但是辅助方法通常有助于创造一个最佳的愈合环境。因此，这本书对作为体位放松技术的补充的辅助方法也进行了概述，例如超声波、电刺激、按摩、贴扎、关节松动术及治疗性运动。
我很荣幸能有机会在实践中应用与改进体位放松技术，并且我希望那些在实践应用、教学和研究中体验成功时刻的人们继续推动这一变革性技术的发展。读过这本书以后，从业者不再需要将他们大部分的患者置于疼痛之中来治愈他们。以上是我的愿景，而关于体位放松技术的研究、专业指导与实践应用将成为实现这一愿景的催化剂。
前言
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关于作者
蒂莫西·E.斯派克（Timothy E.Speicher）博士，ATC,LAT,CSCS，是体位放松技术（PRT）研究所的负责人。他被业界认为是体位放松技术的首席专家。斯派克发现并开发了肌束震颤反应法（FRM），彻底改变了体位放松技术的应用、实践和教学方式。他在犹他州奥格登研究所建立了体位放松技术研究所，提供关于肌束震颤反应法以及体位放松技术的教育，并提供相关的实践机会。
斯派克经常在专业的组织或会议上发表关于体位放松技术的演讲并在学术期刊上发表论文。2014年，他获得了循证概念构图优秀文章一等奖。该奖项由美国国家运动防护师协会（NATA）的AthliticTraining Education Journal颁发。2013年，他获得了该期刊循证类比推理优秀文章第一名的殊荣。
斯派克在不同的学术机构中担任过多个教学和科研职务，他是美国田径教练员学会的成员，也是美国国家运动防护师协会研究与教育基金会的董事会成员。目前，斯派克拥有两个教学职务：在爱达荷大学的附属学院为运动训练项目的硕士生教授神经科学，以及在洛基山大学担任助理教授，为健康科学博士提供循证医学方面的教学。
关于贡献者
里吉斯·图罗西（Regis Turocy），DHCE,MPT,PRT-c，在西弗吉尼亚大学获得理学学士学位，在匹兹堡大学获得物理治疗认证和骨科物理治疗学硕士学位，在杜肯大学获得卫生保健伦理学硕士学位和博士学位。他在骨科物理治疗和物理治疗的替代疗法方面有丰富的经验，并教授骨科手法治疗、电疗、卫生保健伦理和卫生保健辅助方法等方面的课程。他曾在许多区级、州级和国家级的会议上进行教育性的演讲。一直以来，图罗西博士致力于体位放松、神经紧张和肌肉紧张技术的实践应用。
汪敏加，北京体育大学运动康复博士、临床博士后；成都体育学院运动康复系副教授、硕士研究生导师；美国运动医学会认证生理学家（ACSM-EPC）、国家康复治疗师；参与国家击剑队、射击射箭队多个科技服务项目；参编、参译专业图书10本，主持、参与科研课题12项，发表国际、国内学术论文10多篇；主要研究方向：运动损伤的预防与康复、骨与关节退行性疾病的运动康复、产后康复。
刘冬森，运动人体科学博士；北京体育大学运动医学与康复学院讲师；长期从事高水平运动员的运动损伤管控工作，服务过花样滑冰、篮球、击剑、足球等项目运动队；曾入选亚冬会和冬奥会中国体育代表团，曾获得国家体育总局的奥运科技服务表彰；主要研究方向：高水平运动员的运动损伤管控、肌肉骨骼系统功能障碍的运动康复。
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拮抗松弛术
虽然距离琼斯发现PRT已经60多年了，但在相关领域和公众中依旧鲜有人知晓这种技术。这可能是因为最近才出现高质量的实验（Wong,2012），或者是由于最初提出的技术对于相关领域的学生和从业人员来说太难掌握和学习了（Woolbright,1991）。
从表面上看，PRT是一门简单的技术。但是，它产生的令人惊讶又影响深远的实践应用效果，困惑着从业者、患者和研究了它半个世纪的研究者们。
当用神经科学的视角对这个技术进行检验时，很难理解它如何能显著地缓解疼痛。捕捉神经活动和由此产生的组织反应十分具有挑战性，但是由于技术和捕捉方法的发展，琼斯的方法正在被积极地追随和检验。直到现在，许多人否定PRT，是因为证实PRT工作机制的方法仍旧较为局限。
豪厄尔等人（Howell et al.，2006）是第一批测试SCS处理后牵张反射变化的人。他们发现跟腱炎的患者的牵张反射在SCS应用后明显减弱，这为科斯（Koss,1975）的观点——躯体功能障碍由牵张反射增强或者超敏性（hypersensitivity）引起的，提供了支持。科尔（Korr）提出，牵张反射的增强由肌梭功能的障碍造成。他的理论基于以下假设：由于伽马放电量（梭内肌纤维的神经活性）的增加，肌梭对牵拉的敏感性增强并持续处于增强的状态，这增强了肌梭本身的敏感性，从而使得牵张反射增强并持续出现（见图1.2）。
有一个研究对一个足底筋膜炎患者进行了为期6天的SCS处理，在处理效果的随访调查中，研究者发现，在最开始的两天，患者的牵张反射明显减弱，但是与对照组相比，在后期没有差异（Wynne et al.,2006）。这个结果与豪厄尔最初的发现不一致，作者将此归因于牵张反射测试位置的不同。在这个研究中，测量牵张反射的部位是小腿三头肌，但这并不是被治疗的部位（足部）。尽管有这些结果，豪厄尔等人（Howell at al.,2006）最初的发现仍为我们提供了一个框架，不但帮助我们理解PRT如何在减轻躯体功能障碍中发挥作用，并且为PRT后续的调查研究提供了一个很好的方法学参考。然而，迄今为止，对应用方法仍缺乏科学的检验及应用的程序化步骤，这使得对初学者的教育异常艰难（Woolbright,1991）。
对组织的评估及记录
SCS的传统方法存在问题，其定位、处理和记录组织疼痛的操作程序对于初学者来说十分陌生。初学者如果可以将学习经历和一些自己熟悉的东西匹配起来，就会学得很好（Speicher & Kehrhahn,2009）。此外，当初学者进行评估时，很难定位痛点位置和把握触摸、按压的力度。同时，在按照琼斯等人所提出的应用程序进行评估与再评估时，初学者也常常因为用力过度导致患者疼痛加剧，出现反射性痉挛。
虽然琼斯（Jones,1973）最初提出的应用步骤没有被检验过，但是还一直被推崇和使用。琼斯提出，应找到舒适的身体位置来处理压痛点，操作者应在用最大压力按压压痛点时，在关节活动度范围内移动人体关节和组织。一旦找到了舒适的身体姿态，评估时发现的压痛感就会消失。勃兰特和琼斯（Brandt & Jones,1976）提出，初学者要在寻找体位的过程中反复探查压痛点，由此来找到可以使患者疼痛释放的身体姿态，有经验的从业者有能力将患者的肢体迅速摆放到能使痛点瞬间释放的身体姿态，然后再慢慢恢复到中立位。“每次置于舒适体位只需90秒，就会有积极持久的效果，前提是需缓慢复位”（Jones,Kusunose & Goering,1995）。然而，当我尝试学习或教授这些步骤时，无论进行多么缓慢的复位，我都不能每次获得持久的有益效果。即便连续数年按照推荐应用步骤进行实践、学习及教学，掌握该方法仍旧很困难。
库苏诺斯和戈林（Kusunose & Goering,1995）倡导的压痛点定位和评估的文献摘要以及安布罗焦和罗思（D'Ambrogio & Roth,1997）对其进一步的研究结果很难应用于临床。德安布罗焦和罗思的压痛点触诊量表（TPPS）的用法毫无进展，它仅仅用于揭示疼痛的位置和强度与琼斯压痛点位置的相关性（见图1.3）。例如，如果左前斜角肌存在痛点，那么与这个肌肉相关的处理和记录的参考点可能是AC4（第四颈椎前侧）、AC5或者AC6（第五、六颈椎前侧），它位于脊椎横突端前方。在繁杂的实践条件下找出并记住这些位置对于新从业人员来说很困难，也很耗时。此外，德安布罗焦和罗思提出的记录压痛点的方法和传统疗法的教育培训相关性不大，因为缩写晦涩难懂且繁多难记，而且这个方法还需要通过圆圈涂色（coloring circles）来表示疼痛的级别。学生们经常会问，为什么不能仅仅记录为前斜角肌疼痛级别8/10，而是要记录为极度疼痛的左侧AC6。作为一名教师和体位放松技术应用者，找到传统压痛点位置，在评估定位时过度用力按压并用现有的图表技术记录疼痛程度，对我和我的学生们来说都是一个巨大的挑战。此外，王和肖尔·阿尔瓦雷茨（Wong & Schor Alvarez,2004）发现，用TPPS来判断髋和内收肌的压痛点信度（K=0.228~0.327）和效度（r=0.321~0.451）都非常低。
（源自：D'Ambrogio & Roth,1997.）
书中提出的新方法简化了疼痛评估和记录的过程，并且与传统疗法的训练及学生、从业者的经验具有更强的相关性。我主张应用传统肌肉骨骼术语（比如前斜角肌、腹肌、起点、止点、外上髁）来代替琼斯的压痛点定位。不论是新入行者还是经验丰富的从业者，回忆和应用熟悉的基本的术语都会更简便一些。此外，我主张使用数值疼痛评定量表（NPRS）代替德安布罗焦和罗思的TPPS或者视觉模拟量表（VAS），来记录触诊时的疼痛等级。
实践中，最普遍用于评估并记录压痛点和扳机点的方法是视觉模拟量表、组织痛觉测验法，以及数字疼痛评分表。
视觉模拟量表
视觉模拟量表被提倡用于表格化记录压痛点和扳机点触诊疼痛（Wong & Schauer-Alvarez,2004），但是威廉姆森和霍加特（Williamson &Hoggart,2005）提出，数值疼痛评定量表（NPRS）比VAS更有临床意义，因为临床医生和患者发现NPRS更容易被使用和理解。此外，还有研究者（Delaney & McKee,1993；Jensen et al.,1986；Takala,1990）提倡应用组织痛觉测验法（tissue algometry）评估扳机点的压力敏感性和压痛点，因为这种方法可以测定临床医生施加压力的程度，并可以量化患者压力敏感性的初始值和最大可耐受值的数据。
组织痛觉测验法
虽然组织痛觉测验法被用于测量斜方肌扳机点可耐受的压力敏感性有高评判间信度（ICC=0.82~0.92）及测量者内信度（ICC=0.80~0.91）（Delaney & McKee,1993），洛弗莱斯和斯派克（Loveless & Speicher,2012）并没有发现使用组织痛觉测验法测定斜方肌活性肌筋膜扳机点的方法和VAS（r=14）或NPRS（r=30）之间存在有效的相关性，但是他们发现，VAS和NPRS之间存在有效的相关性（r=91）。组织痛觉测验法的末端是压力计，将其置于软组织上，以测试遏制疼痛反应所需要的力的数值。虽然从研究的角度来看，组织痛觉测验法捕捉扳机点敏感度的测试手段是比较客观的，但是从临床角度来讲，它还是很难应用的，因为在评估期间，组织痛觉测验法的末端容易滑离扳机点，并且皮下组织较薄的骨骼区域常常会比较痛。
克里斯·卡斯特尔博士（Chris Castel,2011）提出，扳机点痛觉测验法的应用可能会产生阵痛或疼痛减轻的效果，但如果这种效果引起了剧痛和局部缺血性压迫，便很有可能影响治疗的有效性。基梅尔、米勒和诺德斯特龙（Gemmell,Miller& Nordstrom,2008），以及阿奎莱拉等人（Aguileraet al.,2009）发现，在斜方肌的扳机点处施加局部缺血性压力可以明显地缓解疼痛，他们将其归因于一种潜在的镇痛效应。近15年来，我也观察到新手和经验丰富的从业者在评估和治疗部分PRT时，运用可能导致局部缺血的手法按压压痛点的方法，即使在再三强调不能这么做之后，依旧有人这么做。这个现象和潜在镇痛效应就是我不提倡用组织痛觉测验法评估压痛点和扳机点，或者在体位摆放的过程中实施触诊的原因。
数字疼痛评分表
NPRS被建议用来代替使用圆圈填色的TPPS或者记录无数字曲线的VAS，来表示疼痛等级。NPRS将主观疼痛分为0~10级（0表示无痛，10表示可想象的最糟糕的疼痛）。虽然NPRS有助于捕捉压痛点和扳机点的压痛，但它还是不能解决如何避免在为患者定位时施加过大的按压力度的问题。尽管如此，像琼斯经历过的许多偶然性发现一样，解决这个难题的方法也来自自我实践中的一个偶然发现。
面对一名前斜角肌疼痛的患者，在接近最大化放松的时候，我记录到一次局部痉挛反应，或者称为肌束震颤。然而，当我尝试用琼斯的触诊技术确定最佳治疗体位时，局部抽动消失了。我发现，一旦前斜角肌放松，就会产生肌束震颤或振动的组织抽搐或痉挛。当我将舒适体位变化到别的体位时，肌束震颤就会减弱。反之，肌束震颤的振幅和频率都会增加。肌束震颤不仅为我明确了最佳定位，也告诉我保持体位的时长，这与琼斯建立的90秒原则（90-second rule）有很大的不同。如果在肌束震颤停止之前就改变了舒适的体位，虽然已经持续了90秒，TP的缓解也往往非常轻微。然而，如果一直保持舒适的体位，直到肌束震颤明显减弱或是完全消失，那么在记录中，大部分患者会表现为触诊痛感完全消失。这些观察结果促使我开始应用肌束震颤反应法——在完整的关节活动范围内移动从而确定最佳体位和时机，在扳机点或者压痛点最痛的点位上实施轻微按压（1千克）。早在1949年，胡弗（Hoover）就提出，当组织在活动范围内处于一个放松的姿态时，组织的束缚就会放松。这就是他所说的功能技术（functional technic），但是它不涵盖肌束震颤反应的应用。
肌束震颤反应法
在多年研究和应用肌束震颤或痉挛反应缓解组织疼痛后，我认为肌束震颤反应法是指导PRT中体位摆放和持续时间的最好方法。我在2006年首次提出肌束震颤反应法（FRM）（Speicher &Draper,2006）这个名称。在评估阶段，医生用非常轻的力度就可能感觉到肌束震颤反应，但是如果没有感觉到，当找到最佳体位时，软组织就会出现肌束震颤的振幅和强度增强的情况。这个反应一旦发生，体位应保持，直到肌束震颤减弱为止。在这之后，组织就会恢复到中立休息体位，等待二次评估。
肌束震颤的表现如下。
●过大的指压力量会带来阻滞。
●如果一开始没出现肌束震颤，将组织放置在最放松的体位时，一般持续短时间（30~60秒）就会出现肌束震颤。
●无论什么位置，深呼吸都会刺激肌束震颤的产生或者增强。
●当肢体处于最佳体位时，在关节、组织不同部位的筋膜上进行按压、牵引或平移，会使肌束震颤增强。
●如果组织或者肢体在回复至中立位的过程中再次出现肌束震颤，那么在触发肌束震颤的位点应再次应用技术进行处理。
●经常由其他部位肌筋膜引发（例如，神经挤压）或是受其他区域的TP或MTrP的影响——如果组织在五分钟后无法停止肌束震颤。
●肌束震颤反应终止和释放的时间与患者出现疼痛的时间相关。
FRM的发现和使用解决了PRT实践应用方面的很多困难。FRM帮助操作者确定最佳体位，并且不会引起患者明显的不适。明显的不适要么使组织紧张抵抗，要么产生镇痛效应，干扰治疗效果。此外，不引起患者的不适感，才能建立起患者的信任。FRM还为定位的应用提供了限定的时间段，这样可以减少保持体位所需的时间，更重要的是，告诉了医生关于压痛点或者肌筋膜扳机点何时获得放松，以便优化效果。然而，肌束震颤不仅出现在压痛点上，也一样出现在扳机点上。
有研究发现，在肌筋膜扳机点上会出现局部抽动反应（LTR,Local twitch responses），或肌束震颤（Dommerholt,Bron & Franssen,2006）。用手拨扳机点或用干针进行针刺就可以看到抽动收缩的发生，这可以通过肌电图来监测。然而，格温和多摩尔霍特（Gerwin & Dommerholt,2002）认为，扳机点出现的局部抽搐反应可以作为评估的判断，而不需要病人出现剧烈的反应。干针（dry needling）疗法对MTrP的应用结果被用在过程中产生LTR的时候和定位在扳机点的时候（Hong,1994），从而使效果得到改善。洪、鸟越和于（Hong,Torigoe & Yu,1995）发现，用针刺兔子的扳机点邻近位置——距离MTrP半厘米，与直接刺激扳机点相比，导致了LTR下降减少。因此，MTrP处理位置的边界可能会解释查伊托（Chaitow,2002）的观点，他认为应用PRT时，轻的指压力会带来积极的治疗效果。如果一个TP是MTrP转化而来的，那么当施加极大压力的时候，它还是会变化，它还会引起LTR或肌束震颤来辅助肌筋膜紧张的放松，并且告诉从业者放松发生的时间。肌筋膜扳机点LTRs的识别和针刺疗法效果的反馈，为应用于PRT的肌束震颤反应法的进一步研究奠定了基础。
拮抗松弛术与体位放松技术
我总被提问，SCS和PRT如何区分（表1.1）？安布罗焦和罗思（D'Ambrogio & Roth,1997）是第一个使用体位放松技术这个词语的人，并且提倡将其应用于肌肉骨骼功能障碍的消除。他们提出应当搜索患者全身的压痛点和扳机点，建立一个分布图，用于指导实践。我也认同这个整体法，而且PRT优于SCS，因为SCS倾向于坚持压痛点紧张是由这个机制所导致的观点，但并不是常常如此。还有，如果应用正确，琼斯最初的技术及其他研究者，像安布罗焦和罗思、戴格（Deig,2001）、查伊托（Chaitow,2002）、梅尔斯等人（Myers et al.,2006）、斯派克和德雷珀（Speicher & Draper,2006a,2006b）这样的实践者进行的后续研究和应用，可以被当作独立的应用，也可以与别的方法相结合。虽然扳机点和压痛点的形成可能是SCS机制的结果，但是许多触发因素，诸如压力、病理生理学异常、疾病状态和累积创伤可能也会引起扳机点和压痛点的产生（Simons & Travell,1981）。
总结
体位放松技术是对于患者由疼痛、痉挛和活动范围受限导致的躯体功能障碍的一种特殊的干预方法。然而，PRT最大的作用就是缓解躯体功能障碍，它不可能成为一种独立的治疗方法。即便如此，它还是一个非常有效的工具，它通过减轻疼痛和恢复正常的组织长度来解锁愈合的过程。通过利用书中概述的肌束震颤反应法、简明的图表、方法和步骤，PRT应当给患者带来有效且持续的放松。但是组织可能不仅需要放松，还需要修复或恢复。手法治疗的经典观点一直沿用至今，也就是我提到的手法治疗中的3R原则。本书聚焦于3R中的第一个——放松，我认为这是解锁治愈过程的关键所在。有了放松，便会出现复位和组织维护。琼斯医生提供了第一把“钥匙”，我们只需要学习如何正确地使用它，以打开治愈患者的大门。
