Flushing. If massage can “improve” any tissue — unknown — one way it might do it is through simple hydraulics: physically pumping tissue fluids around, and/or stimulating the circulation of blood and lymph. I won’t get into the evidence about it here. Suffice it to say that it might be true, and if it’s true then it may not much matter if the process is uncomfortable. While gentler massage may feel pleasant and satisfying, it is possible that more biological benefits can only be achieved hydraulically — whether it’s comfortable or not. This is even more plausible because of trigger points: it’s likely that the tissue fluids of a trigger point are quite polluted with waste metabolites, and the need for flushing is greater, but it’s especially uncomfortable to squish those polluted patches of tissue.
Traditionally designed to apply pressure to layers of muscle, tendons and other tissues deep under the skin, deep tissue massage can be very effective in relieving problem areas and is highly therapeutic. Deep tissue massage is generally a modality to consider for athletes as well as the eight-to-five desk job. Muscles easily become tense and deep tissue massage can relieve some chronic patterns of pain and tension, specifically in the back, shoulder and neck areas.
Many students at my school were actually angry that things like therapeutic touch were even being taught. I recall some heated debates between skeptical students and more “open-minded” instructors and school officials. It may surprise you to hear that I was not one of the skeptics back in those days — it was only just starting for me then. BACK TO TEXT
In New Zealand, massage is unregulated. There are two levels of registration with Massage New Zealand, the professional body for massage therapists within New Zealand, although neither of these levels are government recognised. Registration at the Certified Massage Therapist level denotes competency in the practice of relaxation massage. Registration at the Remedial massage therapist denotes competency in the practice of remedial or orthopedic massage. Both levels of registration are defined by agreed minimum competencies and minimum hours.
Craniosacral therapy is another classic example — popular for decades, it is a touch therapy, not “massage,” and it has never enjoyed any respect from the majority of doctors or scientists. It has even been criticized by many alternative health professionals.36 And yet it is sold with overconfidence by countless manual therapists as though it were proven effective.
This review is called a meta-analysis, which is weird, because “only 1 study met inclusion criteria for intrarater agreement and therefore no meta-analysis was performed.” So it was just a regular old review of 6 studies of how much different experts can agree on the location of myofascial trigger points. Lacking adequate data for statistical pooling, they had to “estimate” an agreement score of 𝛋=0.452 — a rather precise etimate! Of the criteria used to determine the location of trigger points, the most reliable were localized tenderness (.68) and pain recognition (.57). Those are actually decent reliability scores, but the authors conclude that “manual palpation for identification of MTrPs is unreliable.” Based on their estimated scores, this is technically correct but a bit misleading: most attempts to detect pathologies in the body are technically “unreliable,” falling well short of a score of κ=1.0 (perfect agreement), but still much better than κ=0 (coin flipping agreement).
BC 722-481: Huangdi Neijing is composed during the Chinese Spring and Autumn period. The Nei-jing is a compilation of medical knowledge known up to that date, and is the foundation of Traditional Chinese Medicine. Massage is referred to in 30 different chapters of the Nei Jing. It specifies the use of different massage techniques and how they should be used in the treatment of specific ailments, and injuries. Also known as "The Yellow Emperor's Inner Canon", the text refers to previous medical knowledge from the time of the Yellow Emperor (approx 2700 BC), misleading some into believing the text itself was written during the time of the Yellow Emperor (which would predate written history).
deep tissue massage putney
Trigger point masssage is still 100% experimental. It has rarely been directly tested and it has never been done well (and never for back pain specifically, which is probably of the greatest interest).78 If you squint optimistically, you could call the best of the evidence “promising.” You could say that where there’s smoke, there’s fire. But it’s like the smoke from last night’s campfire — more of a smokey smell than a smoke where any fire might be hiding. Dial up even a mild cynical impulse, and the evidence collectively looks more like a damning failure to produce any clearly good news.
Massage is big business in Thailand. It is regulated by the Public Health Ministry. The Commerce and Tourism and Sports Ministries have set a target of 20 billion baht per year to be generated by the spa business, but only 500 of the 2,000 spas nationwide are legally registered with the authorities. The legal difference between a "spa" and a "massage parlour" is unclear. The Federation of Thai Spa Associations (FTSPA) in 2016 urged authorities to clamp down on sexual services being offered at some massage parlours. The FTSPA maintains that influential figures have used legal loopholes to open "pretty spas" or massage parlours where tourists can buy sexual services.
Trigger points may respond to massage, and that is certainly my impression from three decades of rubbing my own trigger points and trying to help other people with theirs. It’s also what legions of massage therapists believe. But don’t ask science for confirmation — it’s playing hard-to-get here. I get dorky in detail about the science of trigger point massage in the trigger points tutorial, but here’s the bottom line …