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What is a “release” in manual therapy? (Member Post)

 •  • by Paul Ingraham
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The concept of “release” is unavoidable in the fix-people-with-your-bare-hands therapies like massage and chiropractic (plus some physical therapy). It is baked right into the names of famous methods like Myofascial Release Therapy and Active Release Therapy. Other therapy brands just creatively imply release, as with MELT. Or it gets puffed up into something complex and grandiose, like with Rolfing, which claims to “reorganize the connective tissues”! 😬

Rolfing, you can just stay the hell away from my connective tissues! I have them all organized just how I like them.

I have written about and around the idea of “release” for many years, but I have never just come straight out and defined it … or explained what kinds of experiences might inspire the term. This post is destined to become a permanent PainScience.com article on the topic — consider this a preview (and the best time to offer feedback).

So, what might be actually going on when therapists or patients declare a release? Anything important?

My quick definition of “release”

A “release” is a significant improvement in sensation or mobility during or after manual therapy, usually believed to be the result of a helpful change in tissue state.

However, I think almost all releases are just over-interpreted sensation. But what exactly is being over-interpreted? The idea doesn’t come out of nowhere. Even taken as-is, that definition is the tip of an iceberg.

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If you like it, you’ve been released

“Release” is not a technical term with a strict definition. It means whatever people want it to mean. And so almost any positive experience in the context of manual therapy — any shift in sensation that feels profound and/or helpful — gets tossed into the “release” bucket.

This imprecision can be viewed cynically: it’s sloppy, amateurish, and slightly deceptive by implying more precision and formality than actually exists. This is my bias, to some degree. The widespread use of “release” is a good example of alt-med putting on airs, obnoxiously pretending to know more than it does.

But we can also be more pragmatic and magnanimous. English is messy! And so are bodies and sensations! It’s fair game to use fuzzy terms for fuzzy experiences. “Release” can be a perfectly cromulent word for “some kind of nice change during therapy.”

Physically released?

Some kind of tissue upgrade is supposedly involved in a release — a happy change in tissue state, an objective, concrete, physical elimination of some hypothetical obstruction or limitation on normal function and sensation, especially “tight” tissue getting “loosened.”

There might be a measurable improvement in range of motion, for instance, or the sudden ability to move without pain — these experiences seem to strongly substantiate the physicality of the release.

But changes in sensation and function definitely don’t always mean that tissue has changed, and in fact it’s unlikely. I think the idea of a release as a physical change is mostly illusory, just straight up fooling ourselves, a kind of pareidolia — seeing shapes in the “clouds” of sensation and perception. We are probably perceiving (and maybe even creating) what we expect, like playing with a ouija board.

“It moved, I felt it!” Did you really, though?

The three main things that supposedly get released

There are three main candidates for an hypothetical physical change in tissues that correlates with what we call a release:

  1. Looser fascia (sheets of connective tissue).
  2. Reduced muscle tone.
  3. Increased joint mobility and function.

There could be others, but those are the big three.

Release as a change in fascia

Fascia is “gristle” — thin sheets of shiny, tough tendon-like tissue that permeate and wrap every part of our anatomy. Fascia science and therapy have been fashionable for twenty years now. This mostly started with physician Stephen Typaldos, who hypothesized in 1991 that most musculoskeletal complaints are caused by deformations of fascia, which could be fixed with skilful force, like banging dents out of a car — a “release.”

There are many different ideas about exactly how to release fascia — how hard, what to pull on, tools or no tools, and so on — but all are speculative and/or pseudoscientific. No one has ever demonstrated that painful fascial distortions exist or that they can be repaired. And it’s unlikely, because fascia is shockingly tough stuff.

And yet many massage therapists do not just have a hunch that they are changing fascia, they passionately and dogmatically believe it. Their overconfidence is the main source of my release cynicism.

Fascial release was a marketable idea that went viral without a shred of clinical or scientific merit. For much more detail, see Does Fascia Matter? A detailed critical analysis of the clinical relevance of fascia science and fascia properties.

Release as a change in muscle

Muscle screws up a lot. There are many kinds of cramps, spasms, and twitches, dysfunctional muscle tissue states as diverse as dog breeds. Massage can probably sometimes change the state and behaviour of muscle tissue, just as surely as stretching can stop an acute exertional cramp.

However, most of those effects are probably clinically trivial. While it may be plausible that muscle can be affected by pressing on it, it is not plausible that it can be done in any consistent, important, and lasting way.

Many unwanted muscle contractions are clearly impervious to therapy. For instance, several forms of twitching (“fasciculation”) are simply not going to stop, no matter how you rub the muscle. The spasms caused by multiple sclerosis are not going to stop for any massage — massage might feel good, even desperately needed, but it’s clearly just a sensory bandaid.

But what about trigger points? Aren’t they a huge release candidate?

Indeed, what about the tricky idea of “trigger points”? The sore spots conventionally suspected to be painful micro-cramps? Can’t we release those? They are by far the best known of the concepts that account for releases.

And they are also extremely controversial and poorly understood, and most trigger point therapy is obviously experimental and amateurish. If only I had a buck for every time someone has told me they failed to get relief from trigger point therapy!

If relief from trigger points can explain “release” at all, they do a rather muddled job of it.

Release as a change in joint position and function

Stiffness, spinal “cricks,” and aches and pains of all kinds are often attributed to joints being stuck, “subluxated,” out of alignment, moving unevenly, and more.

Joint manipulations to the rescue! Badly behaved joints can be allegedly “released” from their prison of dysfunction — mainly by chiropractic care, but osteopathy, physical therapy, and massage therapy all peddle this service to some degree.

Joints can get into various kinds of trouble, but the variety is less impressive than it is for muscle, and some of the major problems are much better understood and clearly have nothing to do with “release.” (Good luck “releasing” a joint from the symptoms of arthritis.)

As with muscle, it is plausible that manipulating joints can have some effect on them — but only minor ones. Unlike muscle, there’s a buttload of research that confirms that the effects of spinal manipulative therapy are underwhelming. See Does Spinal Manipulation Work? Spinal manipulation, adjustment, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain.

If not a physical change, then what? It’s the sensation, stupid!

The only change that likely occurs with most releases is sensory — which isn’t an insult. Changes in sensation can be revelatory! I believe they are the main point of manual therapy, and it’s plausible that they can lead to clinically meaningful improvements in pain.

It’s well-established pain science that sensory inputs can modulate pain, and this is probably the real explanation for popularity of most of the therapies you have ever heard of — anything that produces novel sensory input can probably modestly tinker with pain. See Counterstimulation.

But this relatively simple phenomenon is also rarely, or never, what people actually mean by “release.” And it’s not a powerful medicine — just a nice one.

My cranky summary

The term “release” is messy and informal to the point of being mostly pointless. It mainly means whatever people want it to mean in the moment, usually to fit whatever clinical narrative they are spinning/consuming — and those narratives tend to be obnoxiously overconfident and conveniently self-serving, contributing to the reputation and marketability of therapeutic techniques.

This is why I tend to be so cynical about the concept of release, even though it could be a relatively harmless way of saying, “Something feels nicer!”

As usual, a little humility would go a long way to improving the world.

Release has no clear clinically significant physical correlates. There may be a few physical correlates to some release experiences, but I think they are mostly quite subtle and fleeting — things that can be felt by patients and palpated by therapists, changes that do occur at the same time you are trying to “do” something to tissue… but probably mostly just trivial muscular reactions, which provide bias-confirming pareidolia fuel.

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