Massage Myths: Can You Really Break Up Scar Tissue, Knots, And Adhesions?

Massage therapy has been around for a VERY long time, and recent science has backed up many arguments that were formerly enveloped in mystery regarding its practice. However, there are still myths and misconceptions to address, especially since many of them are still being perpetuated by health professionals as part of their social media marketing efforts.

The concept of breaking up "knots", "adhesions", and scar tissue is one in particular.  One of the most popular questions people seek answers for is how to massage scar tissue to break it down.

Since there is no way to monitor every single event and physiological change during an actual massage session, scientists need to take facts and draw conclusions accordingly. This makes massage therapy more susceptible than many other health practices to myths and misconceptions based on subjective and personal experiences.

Thus, it is pretty common to see professional therapists continue to recommend debunked practices like drinking more water after a massage session to clear "toxins" away or using vague terminology like "freeing up scar tissue and adhesions", "releasing fascia", or "digging out knots".

According to some bodyworkers, adhesions are formed by dysfunctional fibrous tissue that attaches to the muscle, prevents it from stretching, restricts the range of motion of the body, and causes muscle pain. I specifically recall being taught these things when I first became a massage therapist.

In school we were taught that these knots were mis-aligned muscle fibers that rearrange in bunches that become hypersensitive and tense.  It's not uncommon to see topics like these all over the internet from massage therapists:

• How to break up scar tissue
• How to break up fascia
• How to break up fascial adhesions at home
• Massage for adhesions
• Scar tissue massage therapy

These concepts have become so widespread in people that even massage therapists who do not believe in them (I'm one of them!), are forced to use the language as part of the discussion with the person in order to assess their situation and convey the outcome of their therapeutic program!

There is, however, a long distance between this widely used marketing babble and what science has really found out about the musculoskeletal system.

If you look up the term "adhesion" in a medical-type textbook, the only reference you will find is to a type of scar tissue that is commonly associated with inflammation, and is capable of sticking neighboring tissues together.

These adhesions are a common outcome of surgery, and the only way to release them is by cutting through with a scalpel. You won't find any other usage of the word "adhesion" associated to muscles or surrounding tissues spontaneously gluing together, as is often implied by many bodyworkers, and there're no scientific literature on the best practices to release them by using touch therapies.

Thus, scar tissue is not likely to create adhesions without having had surgery. They are mostly post-interventional problems, except in some instances. For example, females with a prolonged history of pelvic pain may create scar tissue and adhesions around the uterus. Definitely not associated to muscle issues, and certainly can't be resolved with massage!

What about muscle "knots"? There's at least SOME truth to defend this concept because muscle tension feels different than a relaxed muscle, and it is not something that untrained individuals may realize. Even considering, this doesn't mean that the muscle fibers have somehow become distorted, or its collagen fibers become mis-aligned. Due to this, there is nothing to "re-align" with massage!

When researching about muscle knots, it is highly likely you will come across terms such as trigger points and myofascial pain.  If you look at the concept of trigger points, in essence it's the same as what has been described as a muscle knot.

A trigger point is said to be a hypersensitive muscle area that is tense and usually feels like a bump or palpable nodule.  In some cases, pressing this area would elicit pain local to the area, or radiate to another location.

Whether or not trigger points are real is a cause of ongoing debate.  What people FEEL during or after a massage isn't on trial, but the explanations for pain and discomfort are.

Trigger point supporters say muscle stress affects blood circulation and promotes the accumulation of metabolic waste in this painful area.  The area becomes acidic, stimulates nerve endings, and this contributes to tightening up muscle tissue even more in a vicious cycle.

While this explanation sounds reasonable, critics highlight that there's no scientific proof to back up these arguments, and it is no more than pure speculation.

Moreover, therapy based on the idea of trigger points have the same results as placebo therapy, contributing to the argument that the concept of trigger points is no more than a wild guess.

Whether or not muscle knots actually exit, massage therapy contributes to improving pain associated with this type of ache.  However, it is not because of a chemical or mechanical dysregulation of the muscle tissue.  It's a result of changes in the nervous system and skillful touch by a massage therapist that contributes to soothing muscle tension in these areas.

But, what about using more force and performing a super deep tissue, painful massage in order to break up adhesions, scar tissue, and release muscle knots?

This concept is very similar to what is known as tissue provocation therapy, a type of healing technique that is based on how tissues become able to adapt to stress.  According to this type of treatment, we can force adaptation in the affected tissue by applying stress.

For example, a Chinese massage technique called Gua sha uses hard tools to apply pressure and achieve maximum penetration to break up scar tissue, muscle adhesions, fascial restrictions, and other alleged musculoskeletal problems.

According to safety studies, this technique is associated with severe skin burns, dermatitis, and other nasty side effects.

Unfortunately, there is also no magical massager to break up scar tissue, no matter how fancy the tool looks.

So what do we make of the "muscle knots popping sound" that is heard when experiencing massage?

Muscle tendons can flip over bones as they move when massaged, and joints cavitate (pop) as when getting a chiropractic adjustment.  While it isn't always clear to answer the why do muscles pop during massage question, it's certainly not something like "toxins being released", as commonly stated by many massage therapists.

Provocation therapy is unnecessarily painful and has the same effects as a placebo therapy.  This only shows how people look for exotic treatments with impressive claims to raise expectations, even more if they are painful and someone with authority claims it's a necessary step for recovery.

Nope.  Inducing pain is not required to achieve what really matters, which is a change in your nervous system that will contribute to relaxing your muscles, improving neuronal chemistry, and alleviating pain!

References:

Hall, H. (2010). The Graston Technique–Inducing Microtrauma with Instruments. sciencebasedmedicine. org. Retrieved, 01-09.

Cheatham, S. W., Lee, M., Cain, M., & Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association, 60(3), 200.

Vashi, N. A., Patzelt, N., Wirya, S., Maymone, M. B., Zancanaro, P., & Kundu, R. V. (2018). Dermatoses caused by cultural practices: Therapeutic cultural practices. Journal of the American Academy of Dermatology, 79(1), 1-16.

Schleip, R. (2003). Fascial plasticity–a new neurobiological explanation: Part 1. Journal of Bodywork and movement therapies, 7(1), 11-19.

Hutson, M., & Ward, A. (Eds.). (2015). Oxford textbook of musculoskeletal medicine. Oxford University Press.