Strain-counterstrain (Jones)

1. Introduction

Version followed: Lawrence H. Jones's strain-counterstrain (counterstrain, the Jones technique) as current US osteopathic teaching material and the Jones Institute describe it, with positional release therapy (Speicher) and facilitated positional release (Schiowitz) named as later developments. This is a hands-on method delivered by licensed or registered manual clinicians; this guide is written for the psychotherapist who refers to, collaborates with or prepares clients for it, not for delivering it.

What it is. A passive, indirect manual technique. The practitioner finds small, sore spots in muscle, tendon, ligament or fascia (tender points), then moves the patient's body into a position in which pressing on the spot hurts much less, holds that position while monitoring the spot, and returns the body slowly to neutral [source: AMBOSS; KCOM 2025 slides; StatPearls CE].
Origins. Developed by osteopathic physician Lawrence Jones, DO. It was first called “Spontaneous Release by Positioning” and later renamed strain-counterstrain [source: Wikipedia, Counterstrain; KCOM 2025 slides]. Most teaching sources date it to 1955; the institute's page says “the 1950's” and Speicher says the early 1950s [source: Wikipedia; counterstrain.com; Human Kinetics excerpt] [uncertain: exact year]. Speicher retells Jones's founding story: a patient with months of back pain, placed in the most comfortable (folded) position, got up pain-free, which Jones called “a lucky accident and nothing more” [source: Human Kinetics excerpt]. Jones's first paper is dated 1964 and his book Strain and Counterstrain to 1981 [source: Human Kinetics excerpt (1964)] [uncertain: not verified: 1981 book details].
Organisations. The Jones Institute was “Established in 1988 by Dr. Lawrence Jones and Randall Kusunose, PT, OCS” and runs post-graduate seminars “for health care professionals” in the US; the same site now teaches Fascial Counterstrain and 3D Counterstrain courses and certifies practitioners [source: counterstrain.com, Jones Institute page]. Later variants include positional release therapy (PRT, Speicher), facilitated positional release (FPR, Schiowitz 1990) and Chaitow's positional release techniques [source: Human Kinetics excerpt; StatPearls reference list; Wikipedia].
Core idea of change (as its developers propose; attributed, not established). Jones held that when a tissue is suddenly strained, its antagonist is “counterstrained”, leaving a continuing, inappropriate strain reflex that keeps tender points and spasm alive; placing the tissue in a shortened position of mild strain opposite to that reflex is said to switch the reflex off [source: KCOM 2025 slides; Human Kinetics excerpt]. Other proposed explanations are muscle-spindle (proprioceptive) resetting, restored local circulation and metabolism, ligament-muscle reflexes, and reduced central sensitisation [source: KCOM 2025 slides; Koura et al. 2025]. None of these mechanisms has been confirmed [synthesis].
Evidence status (brief). A systematic review with meta-analysis (Wong et al., 2014) examined whether counterstrain reduces tender-point palpation pain compared with control conditions [source: PEDro record] [uncertain: not verified: its pooled findings]. Trials are small and mixed. For example, one 2025 randomised trial in chronic low back myofascial pain (30 participants) reported benefit when counterstrain was added to exercise, but the report has internal inconsistencies; earlier trials in acute low back pain found no added benefit [source: Koura et al. 2025]. The tender-point and trigger-point concepts are themselves contested [source: StatPearls reference list, citing Quintner et al. 2015]. It is not a treatment for any disease. Present it to clients as a gentle option some people with musculoskeletal pain find helpful, with limited evidence [synthesis].

2. Framework

Who delivers it, and how they are regulated

United States. Counterstrain is part of osteopathic manipulative medicine taught to osteopathic physicians (DOs), who are licensed physicians [source: KCOM 2025 slides; StatPearls CE]. Jones Institute seminars are open to “health care professionals” [source: counterstrain.com]. Its site lists certified practitioners with physical-therapy and massage-therapy backgrounds (credential suffix JSCC or JSCCI) [uncertain: not verified]. A certificate from a technique school is not a licence: the regulator is the board for the practitioner's base profession [synthesis].
United Kingdom. “Osteopath” is a protected title under section 32 of the Osteopaths Act 1993. Using it, or implying it (e.g. “osteopathic techniques”), without registration with the General Osteopathic Council (GOsC) is a criminal offence [source: GOsC title policy; UK Regulated Professions Register]. UK osteopathic training usually involves a degree with “at least 1,000 hours of clinical training” [source: UK Regulated Professions Register]. Physiotherapists (HCPC), chiropractors (General Chiropractic Council) and massage therapists (voluntary registers) may also use the method [uncertain: not verified for this method].
Elsewhere. Outside the US, “osteopath” usually means a non-physician practitioner, regulated differently in each country (e.g. AHPRA's Osteopathy Board in Australia) [uncertain: not verified]. Check the practitioner's base registration, not only the technique certificate [synthesis].

Course of treatment (as published)

Assessment. History and screening; search for tender points; grading of tenderness, often on a 0–10 scale; the most painful point is treated first [source: KCOM 2025 slides; AMBOSS].
Treatment cycle per tender point. Locate and grade → move into the treatment position → fine-tune → monitored hold with the patient relaxed → slow passive return to neutral → recheck [source: KCOM 2025 slides; StatPearls CE; AMBOSS]. Teaching material times the hold; the length is the practitioner's clinical decision and is not given here [source: KCOM 2025 slides].
Criteria for moving on. Each point is judged by rechecking it. KCOM 2025 slides set the aim at zero tenderness, accepting at least a 70% reduction in tenderness. StatPearls CE accepts a reduction to about 3/10. Range of motion is rechecked too [source: KCOM 2025 slides; StatPearls CE; Wikipedia].
Course length. No standard session count appears in the primary teaching sources. One trial used three sessions a week for four weeks as its research protocol, which is not a clinical norm [source: Koura et al. 2025] [uncertain]. Recurrent tender points are to be addressed through posture, stress management, exercise, sleep and lifestyle [source: KCOM 2025 slides].
The psychotherapist's parallel phases [synthesis]. (1) Before referral: discuss the idea, screen for medical clearance and for touch-related trauma, and agree consent and communication plans. (2) During the course: briefly check in after each session, and watch for adverse effects or boundary concerns. (3) After the course: integrate any body experience into therapy, and review whether to continue.

3. Guiding principles

Patient feedback is the instrument. The method depends on the patient reporting tenderness, and a patient who cannot give feedback is a contraindication. In practice, the client's ability to speak up is a precondition [source: StatPearls CE].
Comfort, not force. The position is one of comfort or ease, described as the opposite of stretching. In practice, any pain during positioning is information to report, not something to endure [source: Human Kinetics excerpt; AMBOSS].
Relaxation of the patient. The patient must be relaxed during the hold. In practice, anxiety about being touched or positioned works against the method itself [source: KCOM 2025 slides].
Slow return. The return to neutral is slow and passive, to avoid reactivating the reflex. In practice, clients can expect no sudden movements or thrusts [source: KCOM 2025 slides].
Recheck after treatment. The tender point and the range of motion are rechecked after each point is treated. In practice, the client can ask what changed and should hear concrete measures [source: KCOM 2025 slides; Wikipedia].
Emotional reactions can occur. AMBOSS advises watching for emotional reactions after treatment. In practice, the psychotherapist plans for this in advance [source: AMBOSS].
Mechanisms are hypotheses. Jones's reflex model and the later theories are proposals. In practice, describe them to clients as ideas held by the practitioners, not as facts [source: KCOM 2025 slides; StatPearls reference list] [synthesis].
Consent before and during touch, with the right to stop. Body-psychotherapy codes require informed consent before touch, ongoing monitoring of consent, and the client's right “to refuse or end any touch… at any time”. Genital or other sexual touch is “always inappropriate”. In practice, these standards are the benchmark you explain to clients for any hands-on practitioner [source: USABP Code of Ethics].
Stay within competence. Mainstream psychotherapy codes have no explicit touch clause but require practising within competence and referring appropriately. In practice, a psychotherapist does not perform counterstrain unless their own code allows hands-on work and they hold licensed manual-therapy training. Combining the two roles with the same client also needs the dual-relationship analysis those codes require [source: UKCP Code 2019; BACP Ethical Framework 2018; APA Ethics Code; EABP Guidelines 2020] [synthesis].

4. Intervention inventory

Items A1 to A6 are the practitioner's procedures. They are described so the psychotherapist can explain them to clients and recognise proper practice; they are not instructions for performing manual work. Items B1 to B7 are the psychotherapist's own interventions.

A1. Screening before treatment (practitioner)

Purpose: to exclude people for whom positioning is unsafe or the method cannot work.
Steps (as published):
- Contraindications listed in StatPearls CE: a patient unable to give feedback to the clinician, acute fracture, and (for thoracic extension positions) shoulder dislocation [source: StatPearls CE].
- General manual-therapy screening is reasonable to expect. This covers osteoporosis or fragility, anticoagulant use, recent surgery, suspected serious pathology (unexplained weight loss, night pain, neurological signs), dizziness or visual symptoms with neck positions, pregnancy, and hypermobility [synthesis] [uncertain: not verified as counterstrain-specific contraindications].
- Counterstrain is not a high-velocity thrust. The documented association between cervical manipulation and cervical artery dissection concerns thrust techniques, but neck positions in counterstrain include extension and rotation, so new dizziness, double vision, speech change or severe headache during or after any neck work needs urgent medical assessment [synthesis].
Example language (illustrative): “Before you book, it's worth asking the practitioner how they screen. Tell them about your bone density result and that you're on blood thinners.”
Watch for: practitioners who skip a history; clients who hide symptoms; unexplained pain that has not been medically assessed. Suggest a GP or physician review first [synthesis].

A2. Tender-point examination and grading (practitioner)

Purpose: to find and score the sore points that guide treatment.
Steps (as published):
- Tender points are “small discrete hypersensitive areas” in muscles, tendons, ligaments or fascia, often near motor points. Unlike trigger points, they typically do not refer pain elsewhere [source: KCOM 2025 slides; AMBOSS].
- They are named by spinal level, side and location. Over 200 locations have been mapped [source: KCOM 2025 slides; Wikipedia].
- The practitioner palpates with firm but limited pressure and asks the patient to rate tenderness, often 0–10. The KCOM slides frame the starting soreness as a sum of money (e.g. a dollar) so the patient can report how much is left [source: KCOM 2025 slides; StatPearls CE].
- Points span the front and back of the body, including the chest wall and the anterior pelvis; anterior thoracic points run from the sternal notch to the iliac crest [source: StatPearls CE; Human Kinetics excerpt]. Any point near the chest or pelvis is found by palpating over clothing or a drape, and only after explanation and consent [synthesis].
Example language (illustrative): “They'll press on a few spots and ask you for a number. You're allowed to say it hurts, and you're allowed to say stop.”
Watch for: clients who minimise their pain to please the practitioner, or who freeze. Palpation near the chest, pelvis or groin without a clear explanation, drape and consent is a red flag [synthesis].

A3. Positioning into ease and fine-tuning (practitioner)

Purpose: to reduce the tenderness of the monitored point by shortening the involved tissue.
Steps (as published):
- The practitioner moves the patient passively into a standard treatment position. This often means “wrapping the body around” the point, or bringing the origin and insertion of the involved muscle closer together [source: KCOM 2025 slides].
- The position is fine-tuned in three planes (flexion/extension, side-bending, rotation) while the patient reports the change in tenderness [source: KCOM 2025 slides].
- The target is a large reduction in tenderness, ideally to none [source: KCOM 2025 slides; StatPearls CE].
- Some positions are folded or curled (Jones's founding case used a near-foetal position) [source: Human Kinetics excerpt]. For some clients these positions carry personal meaning [synthesis].
Example language (illustrative): “Some of the positions are curled up, and the practitioner may support your leg or head. If a position feels exposing or brings up memories, you can ask for a different one or a pause.”
Watch for: breath-holding, bracing, dissociation (glazed look, delayed answers), or a client who goes silent. In the KCOM slides' terms the method needs a relaxed patient, so these responses are reasons to pause, not to push on [source: KCOM 2025 slides] [synthesis].

A4. Monitored hold (practitioner)

Purpose: to maintain the position of ease while the practitioner keeps a finger on the point.
Steps (as published):
- The patient stays relaxed while the practitioner holds the position and monitors the point [source: KCOM 2025 slides; AMBOSS].
- The hold is timed in teaching material; the length is the practitioner's decision and is not given here; clients can ask the practitioner what to expect [source: KCOM 2025 slides; StatPearls CE].
- Practitioners report signs they read as release: softening, warmth, a “therapeutic pulse” or a feeling of heaviness [source: KCOM 2025 slides]. These are practitioners' interpretations [synthesis].
Example language (illustrative): “There's a stretch of time where you just lie still with a hand resting on the spot. If stillness under someone's hand is hard for you, we can practise what you'll say if you need to move.”
Watch for: sustained contact plus stillness can evoke helplessness or trauma memories. Rising distress, tears or numbness are reasons to stop the hold [synthesis]. Release sensations should not be presented as proof of tissue change [synthesis].

A5. Slow return and recheck (practitioner)

Purpose: to end each treatment without re-provoking the reflex, then confirm the effect.
Steps (as published):
- The practitioner moves the patient slowly and passively back to neutral; the patient does not help [source: KCOM 2025 slides; AMBOSS].
- The tender point is pressed again and rated, and range of motion is rechecked [source: KCOM 2025 slides; Wikipedia].
Example language (illustrative): “At the end they'll check the spot again. It's fine to say honestly if nothing has changed.”
Watch for: clients who report improvement to please the practitioner. Lightheadedness on standing up; StatPearls CE lists lightheadedness among possible effects [source: StatPearls CE].

A6. Variants and later developments (practitioner)

Purpose: to recognise the names a client may meet.
Steps (as published):
- Facilitated positional release (FPR). Developed by Schiowitz. It combines counterstrain-type positioning with a brief activating force (compression or torsion) after segmental diagnosis [source: StatPearls CE; StatPearls reference list].
- Positional release therapy (PRT). Speicher presents PRT as a “position of comfort” approach treated as equivalent to strain-counterstrain, and describes it as the opposite of stretching [source: Human Kinetics excerpt].
- Fascial Counterstrain and 3D Counterstrain. Courses of the Jones Institute site. Their claims extend the method to fascia and other systems [source: counterstrain.com] [uncertain: not verified: full claims]. Tuckey and colleagues proposed a new rationale for tender points in 2017 [source: Wikipedia].
- Leon Chaitow wrote on positional release techniques within broader manual therapy [source: Wikipedia; StatPearls reference list].
Example language (illustrative): “These are related methods with different names. What matters is the practitioner's base licence and how they handle consent.”
Watch for: expanded claims (e.g. organ, emotional or “tissue memory” effects). These go beyond the evidence; ask the practitioner what supports them [synthesis].

B1. Deciding when to suggest it

Purpose: to match a referral to a real musculoskeletal need without medicalising distress.
Steps [synthesis]:
- Consider it when a client has localised musculoskeletal pain, such as neck, back or chest-wall pain or headache linked to muscle tension. StatPearls CE lists these presentations as indications [source: StatPearls CE].
- First ask: has a doctor assessed the pain? Is the client open to touch? Can they say “no” to an authority figure?
- Do not suggest it as treatment for trauma, anxiety or any disease. Do not suggest it while an untreated medical red flag is present.
- Offer it as one option among others, such as physiotherapy exercise, GP review or pain-management programmes.
Example language (illustrative): “Your neck pain seems to sit alongside the stress we work on. One gentle option some people use is a positional technique from osteopathy. The evidence is limited, so let's see whether it fits for you.”
Watch for: a client agreeing in order to please you; your own enthusiasm for body methods outrunning the evidence.

B2. Referral and collaboration

Purpose: to ensure a safe, regulated practitioner and coordinated care.
Steps:
- Help the client check the practitioner's base registration. In the UK, “osteopath” is a protected title under the GOsC [source: GOsC title policy]. In the US, check the licence for the practitioner's profession, such as DO, PT or massage therapist [synthesis].
- With the client's written consent, share relevant information only, such as trauma-related touch sensitivities and the client's preferred stop signal [synthesis].
- The EABP Guidelines ask therapists to consider the implications when a client receives similar services from another professional, and to discuss this with the client to minimise confusion [source: EABP Guidelines 2020].
- Agree how the practitioner will contact you about emotional reactions, which AMBOSS advises practitioners to watch for [source: AMBOSS] [synthesis].
Example language (illustrative): “Would it help if I let the practitioner know that you prefer to be told before each touch? I'd share only what you agree to.”
Watch for: practitioners who discourage medical care, promise to cure psychological problems, or refuse to explain their training.

B3. Preparing clients with trauma histories for touch

Purpose: to make consent real and to reduce the risk of overwhelm or re-enactment.
Steps [synthesis unless cited]:
- Walk through what a session involves: lying on a couch, being palpated and rating soreness, being placed in folded positions, and lying still under a resting hand [source: KCOM 2025 slides; AMBOSS].
- Map the client's no-go areas and triggering positions, such as lying prone, having the head held, or folded positions.
- Agree a stop word or hand signal, and rehearse saying it aloud in your session. The right to refuse or end touch at any time is the standard in the USABP code [source: USABP Code of Ethics].
- Plan the practical details: clothing (remaining clothed is usual for positional work) [uncertain: not verified], whether to bring a companion or request a chaperone, and the room set-up.
- Plan a grounding routine for after the session, and a brief check-in with you.
Example language (illustrative): “Let's practise. I'll be the practitioner asking for a number, and you tell me 'that's too much, I'd like to stop'.”
Watch for: the client's consent sounding scripted; the client planning to dissociate through it. Either is a reason to postpone.

B4. Strengthening the client's reporting voice

Purpose: the method depends on accurate feedback, and a patient who cannot give it should not be treated [source: StatPearls CE].
Steps [synthesis]:
- Practise rating sensations from 0 to 10 in your sessions.
- Normalise saying “it's worse”, “I don't know” or “I need a break”.
- Address people-pleasing directly.
Example language (illustrative): “Your number helps them find the right position. A wrong number to be polite actually makes the treatment work less well.”
Watch for: reports that are always low and always “fine”; difficulty noticing sensation (alexithymia, numbing). These may mean the method is not a good fit yet.

B5. Integrating body experiences into psychotherapy

Purpose: to make sense of emotions, images or memories that arise during or after sessions, without over-interpreting them.
Steps [synthesis]:
- Ask what happened, what was felt, and what the client made of it.
- Treat emotions as responses in the present: to vulnerability, to relief from pain, to being cared for.
- Do not interpret images or sensations as evidence of forgotten events. Ideas of “tissue” or “body memory” are not supported by memory research, and suggestive interpretation risks creating false memories.
- Use the experience to explore themes such as trust, control and receiving care.
Example language (illustrative): “You cried when your shoulder was held. Let's stay with what that was like now, rather than decide what it means about the past.”
Watch for: a practitioner or the client building a story of recovered memories; sudden shifts in belief about past abuse after bodywork. Slow down and keep to the present.

B6. Recognising and passing on adverse effects

Purpose: to ensure physical and emotional harms are noticed and handled.
Steps:
- Know the expected effects. StatPearls CE lists minor muscle soreness, headache and lightheadedness, with soreness possibly lasting 1 to 5 days, and says patients should be warned of these. It reports no serious complications when the techniques are performed appropriately [source: StatPearls CE].
- Refer urgently, by advising emergency care, for neurological symptoms (sudden severe headache, dizziness with double vision, weakness, speech change), chest pain, or severe or escalating pain [synthesis].
- Encourage the client to report effects to the practitioner, and with consent tell the practitioner yourself [synthesis].
- Treat emotional after-effects lasting more than a day or two (nightmares, flashbacks, dissociation) as a reason to pause the bodywork [synthesis].
Example language (illustrative): “Soreness for a day or two is commonly described. Dizziness, a strange headache or vision changes are different, and you'd get those checked straight away.”
Watch for: clients attributing new symptoms to a healing crisis and delaying care.

B7. Recognising boundary violations and supporting reports

Purpose: to protect clients from sexual or exploitative touch.
Steps:
- Know the standard: genital or other sexual touch is always inappropriate [source: USABP Code of Ethics]. Every regulated code prohibits sexual contact with patients or clients [source: UKCP Code 2019; APA Ethics Code; AAMFT Code; BACP Ethical Framework 2018].
- Red flags [synthesis]:
  - touching the breasts, genitals or buttocks, or near them, without clinical explanation and consent;
  - undressing that the technique does not require;
  - secrecy, compliments about the body, or contact outside sessions.
- Intimate-area work (pelvic, coccyx, intraoral) belongs only with appropriately regulated clinicians, with explicit consent and a chaperone offered; it is outside the core counterstrain procedure as described above [synthesis].
- Help the client report to the practitioner's regulator, e.g. the GOsC for UK osteopaths, or the licensing board for the practitioner's profession in the US. Report to the police where a crime is alleged. Concerns about someone falsely using the title “osteopath” can be sent to the GOsC [source: GOsC title policy] [synthesis].
Example language (illustrative): “What you describe isn't part of the technique. You have the right to report it, and I can help you with how.”
Watch for: self-blame; the client feeling bound to protect a likeable practitioner. Also follow any safeguarding duties of your own.

5. Handling problems

The published sources address only physical side effects, contraindications, recurrence and emotional reactions. Everything else below is [synthesis].

No improvement after several sessions. Teaching material links recurrent tender points to posture, stress, sleep and conditioning, and advises lifestyle change [source: KCOM 2025 slides]. Review the medical diagnosis, consider active approaches such as physiotherapy-led exercise, and avoid open-ended courses. Ask the practitioner how they measure progress (tender-point ratings, range of motion) [synthesis].
Client's pain is maintained by stress or mood. Keep the psychological work central, and frame bodywork as an adjunct, not the answer. Pain-psychology approaches remain your territory [synthesis].
Overwhelm or dissociation during sessions. Agree in advance that the client may stop, sit up and leave a position at once. Afterwards, ground the client and review. Pause the bodywork until the client can stay present, and work on the window of tolerance in therapy first [synthesis]. Because the method requires a relaxed patient who can give feedback, a dissociated client should not be treated [source: KCOM 2025 slides; StatPearls CE].
Fear or refusal of touch. Respect it. Offer non-touch alternatives, such as exercise-based physiotherapy or education. Never present touch as necessary for healing [synthesis].
Rupture: the client feels pushed by you towards bodywork. Name it, take responsibility, and withdraw the suggestion [synthesis].
Non-adherence to the practitioner's advice. Explore barriers as you would with any health behaviour. Do not take on the role of exercise coach [synthesis].
Dependency on the practitioner or on being touched. The USABP code notes that touch can foster dependency, which therapists must monitor [source: USABP Code of Ethics]. Discuss this with the client, and with consent with the practitioner [synthesis].
Unfounded claims (cures, released emotions, body memories, energy). Explain that these are the practitioner's beliefs, not established facts [synthesis]. In the UK, advertising concerns can go to the Advertising Standards Authority [source: GOsC title policy].
New or alarming physical symptoms. Use B6: advise medical assessment and inform the practitioner with consent. Do not reassure without a medical opinion [synthesis].
Disclosure of misconduct. Use B7: support the client's report to the regulator or police, and follow your own safeguarding and confidentiality rules [synthesis].
You are trained in both counterstrain and psychotherapy. Mainstream codes require competence and avoidance of harmful dual relationships, and contain no explicit touch clause [source: BACP Ethical Framework 2018; UKCP Code 2019; HCPC Standards of Proficiency; APA Ethics Code; AAMFT Code]. Body-psychotherapy codes require informed, ongoing and documented consent to touch [source: USABP Code of Ethics; EABP Guidelines 2020]. Consider referring the manual work to a colleague so the two roles stay separate; if you combine them, get explicit consent, document it, and use supervision [synthesis].

Sources

Pages consulted

Web sources (professional codes on touch)

Books and papers cited

Jones LH (1981). Strain and Counterstrain [uncertain: not verified: publisher].
Jones LH (1964). First paper on positioning and tender points, as cited by Speicher [uncertain: not verified: title and journal].
Speicher T. Clinical Guide to Positional Release Therapy. Human Kinetics [uncertain: not verified: year].
Wong CK, Abraham T, Karimi P, Ow-Wing C (2014). Strain counterstrain technique to decrease tender point palpation pain compared to control conditions: a systematic review with meta-analysis. Journal of Bodywork and Movement Therapies 18(2):165–173. doi:10.1016/j.jbmt.2013.09.010.
Wong CK (2012). Strain counterstrain: current concepts and clinical evidence. Manual Therapy. doi:10.1016/j.math.2011.10.001.
Schiowitz S (1990). Facilitated positional release [uncertain: not verified: journal].
DiGiovanna E, Schiowitz S, Dowling DJ (2005). An Osteopathic Approach to Diagnosis and Treatment, 3rd ed. Lippincott Williams & Wilkins (chapter 14, Counterstrain).
Chaitow L (2014). Fascial Dysfunction: Manual Therapy Approaches. Handspring Publishing (chapter 16, positional release techniques).
Quintner JL et al. (2015). A critical evaluation of the trigger point phenomenon [uncertain: not verified: journal].

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