What I don’t do
My commitment
to evidence-based and ethical practice means that I do not endorse or promote many of the benefits or methods commonly claimed in the massage therapy industry
Posture assessment
These are commonplace and used to determine causes of pain. However this is not supported by the evidence. Over the last 15 years numerous high-quality studies have shown that:
posture does not predict pain
posture barely correlates with pain
posture is greatly affected by our mood
there is no such thing as good/bad posture
posture assessments are unreliable - different practitioners make different judgements
the bony lumps and bumps we use as landmarks to assess the position of bones vary so much that accurate assessment is impossible
Often if we have back pain we will unconsciously adopt a different posture because it’s more comfortable. So this creates a huge risk of causation errors - we falsely blame posture for back pain. No posture assessments here, guaranteed.
Psoas release
The psoas (pronounced ‘so-ass’) muscles are deeeeep in your abdomen attaching from the front of your lumbar spine, though your pelvis and hook onto the top of your thigh bones. When you lift your knee up, that’s psoas working. This muscle is no more or less important that any other, yet has beed elevated to ridiculous levels by several great works of pseudoscience - even being claimed to contain the soul (I’m not joking).
Without doubt, the psoas release is the most clinically indefensible technique performed by massage therapists. It is incredibly uncomfortable, does carry risks, and achieves nothing that cannot be done with more comfortable methods.
The psoas often gets blamed for low back pain based on outdated and non-evidenced beliefs about the relevance of pelvic positions, and that they can be meaningfully changed - they can’t.
It can be involved in reduced hip extension (moving your leg backwards), along with several other muscles.
The technique involves digging into your victim’s abdomen and magically ‘releasing’ it. This is wishful thinking. We cannot dig through subcutaneous fat, 3 layers of abdominal muscles and large intestines to meaningfully affect a muscle. A muscle does not get ‘released’, it’s a meaningless term with no basis in anatomy, physiology or pathology.
Improve posture
As there is no clear scientific definition of good or bad posture so improving it this is a problematic claim. Interestingly, the history of good posture (in the west) is rooted in elitism invoking terrible ideas about superior (rich, white) versus inferior (poor, everyone else) people.
Whatever is causing your pain, it’s almost certainly not your posture, so trying to fix it really is digging in the wrong place.
It is entirely possible to feel more upright or open-chested with shoulders back after a massage. We can indeed experience short-term changes in how we hold ourselves. Notably, if we’re stressed or in pain we are tense, we may be holding our selves in a rigid position (think shoulder up, bent over a little etc.). This is about the difference between holding tension and getting back to a relaxed state - not correcting posture per se. So while we might appear to have a different post-massage posture (short-term) it’s not really changing, and it doesn’t need changing.
Taken together, all things posture, pelvic tilt and psoas are part of the same overall concept: that structure matters, is the cause of pain, can be reliably assessed, and fixed with hands-on techniques. Research over the last 20-30 years has shown this approach to be woefully inadequate. Pain is just far more complex and multifactorial than this simplistic approach can ever hope to inform.
Maintenance Massage
I’m actually being a bit pedantic here.
I don’t ever suggest you need maintenance massage, I think the term is misleading. Your car needs maintenance and without it, it will eventually fail to function. Not so for your body. It’s down to you to look after it. Without doubt, many people find regular massage very helpful, I’m one of them, and I have always seen people on a regular basis. But it’s just a small matter your agency, by that I mean it’s your choice so long as you value it. It can be for physical symptoms, psychological or purely time out to feel good. It’s just vital to me that you are empowered to choose this.
What I’m actively trying to avoid is ‘creating dependency’. Practitioners can lead their clients to believe that without their regular fix they are in danger of causing themselves damage. This is disempowering and wholly unethical practice. We should always serve to empower you to make informed choices.
Increase blood flow - Improve circulation
There is evidence (just 1 study) of a very small possible increase in blood flow during a massage. However, this is meaninglessly trivial. The main driver of blood flow is the pumping heart. The quality of circulation is dependent on the overall health of the cardiovascular system.
Walking into a therapy room and sitting down will increase flow more than any massage technique.
More importantly though, there’s no benefit to any pain or injury of increasing blood flow. Your body knows what to do by itself.
Break down adhesions
There is an idea that when we do lots of physical activity or intensive training, and weirdly if we are sedentary bits of our fascia - the white connective tissue that surrounds and connects muscle, gets stuck forming adhesions. We then use techniques that break these down to restore your normal function. This idea is not true. Take an evolutionary perspective - why would our bodies have evolved to get sticky adhesions that require an external force to break down? It just makes no sense. Beyond that, adhesions or not, these tissues are strong, really strong and the amount of force required to physically deform tissue under the skin would be unbearably painful and require dangerously strong hands.
Many massage techniques can improve a range of movement, but it has nothing to with adhesions of breaking stuff down.
Flush toxins
This is one of the most ubiquitous and absurd claims. What toxins? No-one ever says what toxins.
Your lymphatic system, liver and kidneys to a fantastic job of removing everything your body doesn’t need. Rubbing you any which way cannot influence this in any meaningful way. There is some very specific instances where post-surgical lymphatic drainage techniques may be helpful especially where lymph nodes have been removed, but for the rest of the population it's an absolute no.
Advanced techniques
Weill, yes I do use then, but there’s really nothing advanced about them. In massage therapy the advanced techniques are muscle energy techniques (METs), soft tissue release (STRs) and positional release (PR). They can indeed be useful. With a basic grasp of anatomy and some basic massage skills these are not difficult to master.
The reason these are called advanced is rooted in the massage schools. Early versions of sports massage courses used to teach all the advanced techniques. These courses were broken up into different levels so you did more courses and had to work up to these ‘advanced’ techniques. Advanced techniques are much more a product of marketing than super-skilled finely honed techniques.
I use these techniques but attach no elevated status to them.
Speed up recovery
This is a dubious claim, with a kind of truth to it.
Injured tissues heal of their own accord via several complex and elegant stages. There is nothing we can do to speed this up. We’re not flushing out any metabolic waste or getting nutrients to the damaged site any quicker than the body does all by itself - there’s millions of years of evolution gone into this. What we can do help with the pain and that’s a really good thing.
A sports person will certainly benefit from a massage between event days by helping to reduce pain and helping to restore normal movement.
So, pain reduction and improvements in mobility - yes, just no change to the actual state of the injured tissue.
injury prevention
Mostly no but with some possibility.
Massage isn’t going to stop you spraining your ankle on the football field or stepping off a curb. It’s not going to stop you getting a hamstring strain or precent you rupturing your anterior cruciate ligament (ACL) either. This belief probably harks back to the long held beliefs that stretching prevents injury. This is also untrue, stretching does not reduce injury rates at all and yes it has been tested.
There’s actually not a great deal you can do to prevent injury in any sport providing the training program has all been sensibly managed. Strength training does help your overall resilience to the rigours of sport and life in general - a strong hamstring will be less likely to strain if you sprint, but it’s really hard to prevent an injury.
There is a small chance massage could help prevent injury. If you’ve been blasting yourself competing in a series of events, it’s entirely plausible that having massage to calm the body down and restore your normal movement might just make the difference between an injury and not. This is not supported by evidence but it is a reasonable proposition.
Myofascial Realease
Fascia is the white connective tissue that wraps muscles, connects them, separates them into nice bundles - think looking at the end of a leg of lamb. It stretches a bit then goes back to it’s original size and shape. It helps transfer loads though the body. It adapts to load by thickening. It’s strong stuff, really strong, and it cannot be deformed by manual techniques. You would need either a scalpel or a large hammer to deform it, and you certainly wouldn’t want to be conscious. The modern evidence-based practitioners are in agreement that while the techniques are good, the are most certainly not releasing fascia. Same goes for the cult of self-myofascial release spikey balls, and foam rollers etc. Things feel nice and can be wonderful but is has way more to do with your nervous system that actually controls the tissues, than the physical tissues themselves.