Twitches occur using Equal Resistance in cranial therapy

Posted 12/02/13 by Malcolm Hiort and filed under:

When teaching or treating with Craniofascial Therapy, emphasis is given to ‘indirect technique’ or exaggeration.
The opposite of conventional approaches, this is revelatory for many therapists in engaging with the body in a way where it responds regionally and ‘does the work’ in a way that does not happen with direct technique.
Temporary neuro-muscular twitch responses are often observed when employing Indirect Technique.

The treatment principle of Equal Resistance (ER) correlates strongly with the timing of these twitches. As ER is approached (see dance metaphor below), the likelihood of a client twitch is sometimes felt by the therapist. The moment that the therapist achieves this sense of Equal Resistance in the client’s tissues tends to be when the twitch starts. This process of ‘dancing’ with assymetry and restriction ends when release finishes or is minimal, and there is a calm balanced looser feel to the body area.

Direct Technique

The Direct method reduces the distortion present in the body area being treated.
ie If the shoulders and raised and hunched (superior and anterior), then the therapist’s forces will be down and backwards (inferior and posterior), the exact opposite of the direction of the distortion, thereby ‘directly’ reducing it.


Indirect Technique

Indirect technique is the converse of direct. Here the distortion pattern is supported and even gently exaggerated.
ie If the shoulders are raised and hunched they are supported in that position, and the tissue compensation forces involved (that constitute the range of motion barrier) are not challenged, but instead are eased further into the direction of distortion .

This method temporarily equalises the compensation pattern of surrounding soft tissues that occurs over time in response to postural distortion and trauma, better targeting the tension and constriction being treated by the therapist.
This therapist equalisation of the client’s compensation pattern creates a shift in some aspects of the tension package, so initial relaxation can begin and develop.
It is like succeeding in pulling a stuck drawer away from a chest of drawers, by first pushing the drawer further in, freeing its attachments to the chest (where it is stuck), before the drawer can be easily pulled out. Stronger pulling or yanking the drawer without this first step of ‘exaggeration’ may not just fail to succeed, but in fact aggravate the problem.
The therapist’s skill is in balancing client tissue resistance not just once, but continuously like a dance, when employing Indirect technique.
While both Direct and Indirect have useful roles, this school advocates Indirect Technique be generally used prior to direct technique. Doing this often provides more palpatory information for the therapist and a better understanding of the tension patterns involving the adjacent soft tissue attachments. Many compensatory aspects, that would otherwise inhibit the release of restrictions, can be resolved before direct technique, can be employed with less force and greater precision.

Equal Resistance

When applying indirect technique, the therapist uses forces asymmetrically in responding to the tightness of a mobility restriction. One hand or finger/s will use different degrees of force and angles of force compared to the other hand or finger/s. A similar, distorted, positional balancing of embedded tension within the body also occurs with the therapy methods of positional release, indirect myofascial therapy and counterstrain.

Likewise, when a person ‘gets comfortable’ before sleep, their body becomes more distorted but has less strain. Informal folk belief acknowledges the common phenomenon of a dramatic body twitch just before the onset of sleep. This may involve the internal mechanical balancing of tissue tension in a similar way to the external mechanical forces that occur during craniofascial therapy.

Dance metaphor
Perhaps a useful way to think of this interactive therapeutic exaggeration process is in terms of ‘dancing’ with tissue tension patterns. While it is the client’s pattern that ‘leads’ this paired dance, and it is the therapist who ‘follows’ that pattern, the therapist knowingly facilitates this therapeutic ‘unwinding’ of embedded tension.

Think of the famous movie star dance pair Fred Astaire and Ginger Rogers from films of the 1930’s onwards. In this analogy Astaire plays the role of the client, and Rogers the therapist. Rogers is employing Indirect Technique as she facilitates Astaire’s leading of the dance.

While perhaps it is Fred who attracts most attention, with dramatic dynamic flourishes, it is the spontaneously choreographed facilitation of Rogers, moving responsively in reverse, that actually makes the dance complete, compelling and satisfying. The light mechanical coupling of the dance pair as they move, always smooth, never jerky, is Equal Resistance in motion. A good therapist will recognise the music that moves the dance



As adequate terminology to describe this clinical phenomenon is lacking at present, client twitch responses to physical therapy technique are generally overlooked, underestimated and unexplored. Consequently, the starting points of analysis, awareness of the issue and the words to discuss it, are weak.

Some clients never twitch during treatment, some twitch once or twice locally close to the therapist’s hands and thereafter are calm and stable, some clients twitch in a succession of diminishing releases while others will jerk and twist spectacularly. There is a great variety of reaction. A visual documentation project is planned as a first step in validating the clinical experience of twitch release. See raw footage (2 minutes) of a client having a Twitch response to gentle touch.

Release of trauma such as motor vehicle accidents and sport injuries is a likely explanation for some twitch releases. A complete explanation for this phenomenon requires more collaboration and research.