There are dozens of lines of evidence showing that structural treatment concepts of all kinds have failed to deliver the goods over the decades (see the structuralism article). But one recent large study of massage — the big back pain one described above (Cherkin) — produced particularly clear evidence that structuralist-style massage does not work. (And yet again, there’s an entire other article covering this in greater detail: the remainder of this section is just a summary.)
5. Emerging: the key in this final step is calmly reentering the world. Rather than just stopping this process and jumping back in, focus on going back to what you need to do with the same peace you might have when you wake up from a nice sleep. Just gently getting back into the flow of your day. This should keep your mind and body both staying in a more relaxed and positive state.
Although a lot of Bastian 2014 is certainly relevant to the concept of “good pain,” strictly speaking I don’t think they are writing about the good pain paradox, which is defined by simultaneous pleasure and pain. They are writing about pleasure following pain (relief from pain). This is more comfortable scientific ground: it’s pretty straightforward that relief from pain might be “associated with positive consequences” or lead to “activation of the brain’s reward circuitry,” for instance. Lance a boil, then feel better, right? Of course. But that’s definitely not what we mean by “good pain” in massage. BACK TO TEXT

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I agree with almost every detail of the article and wrote a letter of support to Dr. Barrett, which is published as an addendum to it. That said, the article does neglect some nice things that can be said about massage therapy, and it contains a few minor errors. But I applaud the intent and embrace and welcome most of the criticism. I wish it weren’t mostly true, but I believe that it is.
A short but clear, compelling, and strong critique of cranial osteopathy. As an osteopath himself, Dr. Hartman’s opinion carries considerable weight, and he writes well. He concludes that techniques based on the assumptions of cranial osteopathy “should be dropped from all academic curricula; insurance companies should stop paying for them; and patients should invest their time, money, and health elsewhere.”
More technically and most seriously, massage research is plagued by a “stark statistical error”: the error of reporting statistical significance of the wrong thing, or the wrong comparison.5 Dr. Christopher A. Moyer is a psychologist and a rare example of a real scientist — someone trained and expert in research methodology — who has chosen to focus on massage therapy:
Get up off your chair and walk around the desk. Take a quick but deliberate walk to the water cooler and drink a sip of water. This will help increase circulation and get your body moving more during the day. It can be calming to break up the tension that can come from sitting in one place especially since we spend so much time in front of screens!
Sometimes confused with pressure point massage,[10] this involves deactivating trigger points that may cause local pain or refer pain and other sensations, such as headaches, in other parts of the body. Manual pressure, vibration, injection, or other treatment is applied to these points to relieve myofascial pain. Trigger points were first discovered and mapped by Janet G. Travell (President Kennedy's physician) and David Simons. Trigger points have been photomicrographed and measured electrically[71] and in 2007 a paper was presented showing images of Trigger Points using MRI.[72] These points relate to dysfunction in the myoneural junction, also called neuromuscular junction (NMJ), in muscle, and therefore this technique is different from reflexology, acupressure and pressure point massage.
The more often people check social media accounts, texts, and email, the higher their level of stress, revealed the American Psychological Association's 2017 Stress in America report. Findings from the Pew Research Center underline another negative Facebook effect: Women are particularly vulnerable to stress from social media due to being aware of lousy stuff happening to friends.
Acupressure [from Latin acus "needle" (see acuity) + pressure (n.)[31]] is a technique similar in principle to acupuncture. It is based on the concept of life energy which flows through "meridians" in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in those meridians. Pressure may be applied by fingers, palm, elbow, toes or with various devices.
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An Indian physician named Shivago Kumar Bhucca, a contemporary of the Buddha, is often credited with developing Thai massage. The impetus was to give monks and nuns the flexibility to sit for long hours in meditation. Whatever its genesis, massage was considered such a crucial aspect of medical treatment in Thailand that until the early 20th century, the Thai Department of Health included an official massage division. Thai massage is based on releasing blockages along ten lines of energy called sen, which are similar to the meridians of traditional Chinese medicine. The technique incorporates stroking and kneading of muscles, manipulation of joints, and pressure applied to specific points in order to balance the body’s four elements—earth, water, fire, and air. But there’s also rocking, breathing, and lots of stretching—Thai massage is often referred to as “lazy yoga.”
A sports massage is typically a combination of several massage techniques that are tailored to your affected muscle groups based on the activities that you do. A properly administered sports massage can help flush the lactic acid out of your body. There are two types of sports massages that can benefit triathletes depending on when you schedule your appointment and your race schedule.

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Going to sleep on time and spending seven to nine hours in bed does not ensure that you get enough sleep. Using a sleep mask can help ensure that your brain recognizes 100% darkness so it releases powerful neurochemicals that help you go to sleep. You can also use earplugs if you are having trouble with noise in your surroundings.  White noise, as from a fan or recording, can help, too.
Massage increases circulation. Massage therapists are particularly fond of claiming that massage “increases circulation,” but it doesn’t, really — certainly not consistently.535455 It’s kind of a silly claim. It doesn’t really matter if massage increases circulation, because even a modest boost would be clinically trivial, dwarfed by the effect of any amount of exercise. Metabolic demand is clearly the primary driver of circulation. The most optimistic perspective — and it is actually good news, albeit with some caveats — comes from a study that showed that a lot of massage improved “venous insufficiency”56 over several weeks. Unfortunately for the good news, regular brisk walking is very likely still better and cheaper.57 Or you could give a massage, instead of receiving one — it’s quite a lot of work!
Reducing dislocated joints; stretching muscle cramps; warming up freezing hands and feet, or restoring circulation to a leg that has fallen asleep; and nearly anything that relieves awful pressure, like lancing boils and cysts or hematomas under toenails, or childbirth, or evacuation of impacted bowels — all very painful, but also very relieving. BACK TO TEXT

So what should runners book instead? Anna Gammal, a massage therapist who works with elite runners at the Boston Marathon each year and also massaged athletes at the 2004 and 2012 Olympics, recommends either a sports massage (i.e. targeted therapeutic treatment for the unique physical and biomechanical needs of athletes) or a myofascial release massage (i.e. the application of gentle, sustained pressure on soft tissue restrictions). Both specifically target muscle release and will help improve flexibility, reduce pain and increase range of motion.

Meditation in its purest form involves focusing on one thing to clear your mind. Usually done in a quiet room, it calms the mind and the body — and can get your mind off your pain. Meditation sounds easier than it is, however, and distraction is usually a problem for beginners. Try following a recorded guided meditation, or seek the guidance of an experienced meditation teacher.

Another alarmingly common example is the sensation of skin tearing. This has been inflicted on me personally on at least three occasions, and not by poorly trained therapists — quite the opposite, the perpetrators were all well-trained massage therapists doing a kind of “fascial release” therapy that they clearly thought of as an “advanced” technique.7

Inflammation caused by chronic stress and muscle tension can lead to worsened overall health, longer recovery time, reduced immune function and cardiovascular problems, such as high blood pressure. Studies have found that massage therapy can help lower cortisol levels and even boost production of the hormone called oxytocin, which relaxes the body and has soothing effects. (7) Oxytocin is the primary hormone responsible for sustaining social bonds in humans and increasing motivation for cooperative behaviors, which is why it’s often called the “cuddle hormone” and known to be released during hugs, birth, social bonding and from touch.

Massage detoxifies or flushes lactic acid from your muscles. Detoxification myths are among the most embarrassing of all massage myths. “Detoxification” sounds good and means little or nothing. There are such things as toxins in the world, but not only is massage unable to “flush” any that matter from the body, it likely produces a mildly toxic state known as rhabdomyolysis.58 But if you challenge massage therapists to name a “toxin” that they are “flushing,” most will name lactic acid, not rhabdomyolysis. And again, the truth is ironically the reverse of to the myth: evidence has actually shown that massage interferes with lactic acid elimination. See the lactic acid section below.
Massage for low back pain is the most studied massage question, but not enough: the answer is still fairly clearly “more study needed.” Massage for trigger points is also fairly well studied, but also not enough: science has still yet to confirm that pushing on sore spots makes them less store. I discuss both of these in detail in their own sections below.
But when you take a pill, the side effect is usually unrelated to the problem (i.e. it doesn’t make the problem you’re treating worse), you are generally trading those side effects for some pretty clear benefits, and it’s usually cheap. In manual therapy, most adverse events are backfires — that is, you go for a neck adjustment at the chiropractor, and you come out with more neck pain instead of less. Other data shows this is 25% more likely than if you did nothing at all (see Carlesso). And you pay through the nose for this! Manual therapy is much more expensive than most drug therapy.

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I’m on a padded floor mat wearing loose pants and a T-shirt (standard Thai-massage garb) while Pailin Winotaka uses her fingers, palms, elbows, knees, feet, indeed her whole body as ballast, slowly getting me into such familiar yoga positions as “bridge” (a backward arch) and “bow” (on my stomach, reaching back to grab her wrists rather than my own ankles for a deeper stretch). I actually feel taller when she’s done.
The ability to detect the painful side by feel alone is difficult for reasons that make sense, consistent with what we actually know about how neck and back pain work— that is, they don’t cause obvious, consistent changes in tissue texture and they correlate poorly (really barely at all) with obvious structural problems. Being able to detect nonexistent signs actually an important diagnostic skill. BACK TO TEXT
“The brain can’t distinguish between reality and imagination, so visualization can be a powerful tool to help you unwind in a snap,” Lindor said. She suggested visualizing yourself at a favorite spot. Be as specific as you can. Note what’s around you. Are you by the ocean? Is it a calm current or are the waves crashing? Are there kids playing? Are they making sand castles or playing in the water? Is the sand white and smooth? Or is it a sparkling black like the Muriwai Beach in New Zealand?
This powerful relaxation technique requires that you lay down somewhere comfortable and firm, like a rug or mat on the floor or a firm bed.  Choose a warm - but not hot - dark room if possible. This technique involves progressively contracting and relaxing the main muscle groups around the body that store tension.  If at any point during this technique you feel pain or cramp then stop. 

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Massage may be an appropriate technique for helping certain sports injuries, especially muscle injuries, to heal. When treating an injury, however, it is best to seek advice from a qualified sports therapist or a specialist in sports medicine before performing any massage. Certain ligament and joint injuries that need immobilization and expert attention may be aggravated by massage.
And yet some medical benefits are plausible despite the lack of evidence. For instance, many apparently successful treatments may be due to the effects of pressure on “muscle knots,” which are a likely factor in many common pain problems, but poorly understood (and difficult to treat). And regardless, the effects on mood and mental health are so profound that patients can’t really lose — it’s a valuable service whether it “works” for pain or not.

Let go of guilt. Many religious and cultural beliefs instill the value of hard work very deeply. Over time, and increasingly so with the advent of smart technology that keeps us hyper-wired 24/7, many of us have come to believe that being "on-the-go" constantly is the only way to prove our value. Having an unrealistic interpretation of "hard work" will end up wearing you down. Hard work is giving your tasks the attention they deserve at the time they deserve, not letting it bleed into all hours of your day!
This study evaluated the effectiveness of a 15-min. on-site massage while seated in a chair on reducing stress as indicated by blood pressure. 52 employed participants' blood pressures were measured before and after a 15-min. massage at work. Analysis showed a significant reduction in participants' systolic and diastolic blood pressure after receiving the massage although there was no control group. 

Unfortunately, such massage therapists are quite rare. Most are poorly trained and uncertified. Most work in spas or resorts and on cruise ships, doing treatments that are infamously fluffy and skin deep, with little therapeutic value other than the comfort of a quiet hour of touching (even though many patients find skin-deep massage to be more annoying than anything else). Most of these therapists are earnest and view themselves as medical semi-professionals, despite their comparative lack of training. It’s actually inappropriate to call them “therapists” at all, and in some places (here) it’s actually illegal — they have to use terms like “bodyworker” or “masseuse.”

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