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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, chiropractic, osteopathy, and some physical therapy (“manual therapy”). The idea is baked right into the names of famous methods like Myofascial Release Therapy and Active Release Therapy.

Many other therapy brands just imply release, as with MELT and FasciaBlaster.

Or the idea 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.)

And finally, of course, too many brands also get a bit overzealous, chasing release through intensity. Rolfing is the most famous for this (and they have tried to tone it down in the last decade). Another classic example: the instrument assisted soft tissue mobilization (IASTM) modalities, like Graston, ASTYM, and gua sha, which are “scraping massage” and classic examples of provocation therapy.

Photo of Graston technique, a massage modality, being applied man’s upper back and shoulders, using a large, hard-edged chrome tool about a foot long, slightly curved

Care for a little scraping massage? The steel massage tools of Graston Technique® are a classic example of getting serious about trying to “release” soft tissue. There is no compelling positive evidence that it works & there are some damning results. Although at least two tool trials showing minor benefit, they — crucially — also showed only the same modest benefit measured with non-tool techniques.

I have written circles 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 inspire the term.

So what could be actually going on when therapists or patients declare a release? What’s changing in the body? Anything important? Or is it a marketing mountain being made out of a sensory mole-hill?

A quick definition of “release”

A “release” is a perceived improvement in how a body part feels or functions during or after manual therapy, usually (but not necessarily) assumed to be the result of a helpful change in tissue state.

I think most releases are just over-interpreted transient sensations — over-interpreted by both therapists and patients. But what exactly is being over-interpreted? The idea certainly doesn’t come out of nowhere. That definition is the tip of an iceberg of phenomena.

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Release déjà vu?

This post about release is a re-release of one of the most popular members-only posts from the early days of my newsletter, in early 2022, when most members were not yet members. I wouldn’t quite call this a re-write, exactly, but it’s heavily revised: I’ve added many thoughts and details, some images, and an audio version (of course, because I am now recording almost everything I write).

If you feel like you’ve been released, then you’ve been released!

“Release” is not a technical term with a strict definition. It has only ever meant whatever people want it to mean. And so almost any positive experience in the context of manual therapy — any interoceptive shift that feels helpful — gets tossed into the “release” bucket.

Like pain itself, it’s entirely subjective: if you feel “released,” then you are released. It’s more like an emotion that a physiological event.

This imprecision is a double-edged sword. When it’s used as a semi-serious term, it is a bit of disaster: sloppy, amateurish, and slightly deceptive by implying much more precision and formality than actually exists. The widespread use of “release” is a good example of alternative medicine putting on airs, obnoxiously pretending to know much more than it actually does. That’s my cynical bias talking.

But I 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.”

In other words… I prefer the way patients use the term.

Physically released, though?

Some kind of tissue upgrade is supposedly involved in most releases — a happy change in tissue state, an objective, concrete, physical elimination or even literal destruction of some hypothetical obstruction to normal function and sensation, but especially many variations on the theme of “tight” tissue getting “loosened.”

Some of these upgrades might be objectively measurable. There could be an improvement in range of motion, for instance, or the sudden ability to move without pain — these experiences seem to substantiate the physicality of the release, a change that goes beyond “just” perception and sensation.

But changes in sensation and function definitely don’t always mean that tissue has changed — or not much, or not for long — and in fact it’s somewhat unlikely. I believe that the idea of a release as a physical change is mostly illusory, that we are 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 (the most famous example of the idiomotor phenomenon, in which people direct movement unconsciously).

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

The three main things that supposedly get released

There are three major candidates for a hypothetical objective change in tissues that correlates with what we subjectively experience and call a release:

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

Those are the big three, accounting for most of the goals of all kinds of manual therapy. There are many others that don’t quite fit, but they are relatively obscure. For instance:

  • A therapist performing manual lymphatic drainage might claim to be seeking releases of restricted lymphatic circulation.
  • Craniosacral therapy might be explained as a “release” of a restrictive pattern of cerebrospinal fluid circulation.
  • Or the most notable exception: the release of stuck or stagnant “energy” that is the goal of every acupuncture session. (Not so obscure, but… acupuncture isn’t actually as popular as acupuncturists would like us to believe, which is just one of many acupuncture myths.)
Meme from the film Pulp Fiction, featuring Samuel Jackson pointing a gun directly at the viewer with a stern expression. The text over the image reads “SAY ‘RELEASE’ AGAIN, I DARE YOU.” This meme is used to make a humorous point about the overuse or misapplication of a specific word or phrase, “release” in this case.

Some readers may not get this joke. It’s a reference to Pulp Fiction; it means, “I’m so sick of hearing about ‘release’ I might shoot the next person who says it.” The term has reached annoying buzzword status when paired with faddish excitement about fascia. While many therapists may find the frustration hard to understand, many professionals really are that fed up with hearing about fascia in general & release in particular.

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, at every scale from micro to macro. Fascia science and therapy have been fashionable for twenty years now. The modern era of fascia-fascination 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 how to release fascia — how hard, what to pull on, tools or no tools, and so on — but all are speculative, if not entirely pseudoscientific. No one has ever proven that painful fascial distortions exist, let alone that they can be released or repaired in any sense.

And rapid fascial change is rather unlikely! Fascia is shockingly tough stuff. While it’s not inconceivable that it could suddenly adapt to just the right stimulus, it’s about as plausible as lengthening a tendon with one hard stretch. Short of injury, it probably just can’t be changed.

And yet many manual therapists do not just have a hopeful humble hunch that they are changing fascia, they passionately and dogmatically believe it. That industry-wide overconfid ence is a major source of my release cynicism.

Fascial release was a marketable idea that went viral without any clear clinical merit — merit it still lacks it after many more years of research, because most of the research is “mechanism masturbation” — studying why/how treatments might work rather than checking to see if they actually do work. 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 tissue seems a bit glitchy: there are many kinds of cramps, spasms, and twitches, dysfunctional muscle tissue states as diverse as bug species. Inducing rapid change in muscle is much more plausible than it is with fascia. Massage and manipulation almost certainly can sometimes change the state or behaviour of muscle tissue, just like stretching can often obviously stop an acute exertional cramp.

However, most of those effects are probably clinically trivial. While it may be plausible that touch/pressure can affect muscle, it is not very plausible that it can be done in any consistent, important, or lasting way. It is much more likely that muscle just reacts — twitches, clenches

Many unwanted muscle contractions — the most obvious thing we might want to change — 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 Band-Aid.

But let’s talk about the elephant in the room…

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

“Trigger points” are what we call the sore spots conventionally suspected to be painful micro-cramps, strongly associated with aching pain and stiffness. Can’t we release those?

I’d sure like to. I collect them like a squirrel hoarding summer nuts. Many of us do (while others remain blissfully ignorant).

Trigger point release is by far the best known example of something we tend to think of as a specific physical change in tissue induced by manual therapy, mostly massage, mostly from firm pressure and kneading of the sore spot.

Which is weird, because no one actually knows what a trigger point actually is, so we can really only guess what is physically changing when they are rubbed, if anything. While no one doubts the existence of the phenomenon of sore spots, trigger points 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 trigger point release can make “release” seem more physical, it’s going to need some better science to back it up.

But ask anyone who has had a good experience with trigger point therapy: nothing feels more like a “release” than a good rub of a bad trigger point! The perception of relief/release can be outrageously profound and delicious, and that phenomenon is arguably the main reason people love to love massage.

And just because we don’t understand it doesn’t mean something physical isn’t happening. For perfectly understandable reasons, we may still just not know exactly what trigger points are … but it’s not like we have no evidence at all. Trigger points are not as fanciful as acupuncture points. They probably are something measurable in tissue, which might change when rubbed. For a full exploration of what trigger point actually is, see The Trigger Point Identity Crisis.

If I had to nominate a traditional release target as Most Likely To Actually Be a Thing, I would pick trigger points.

Release as a change in joints

Stiffness, spinal “cricks,” and aches and pains of all kinds are often attributed to joints being stuck, “subluxed,” out of alignment, moving unevenly, and more. Some of these are real problems, and some are medical superstitions more than a century old. Guess which ones “release” mostly applies to?

Joint manipulations to the rescue! Joints can also be allegedly released from their prison of dysfunction — mainly by chiropractic care, but all the manual therapies peddle this service to some degree.

I had a mentor in massage therapy college that was keen on identifying specific but subtle abnormalities in spinal joint movement, and then repairing them with specific but subtle contractions (a subset of Muscle Energy Technique applied to the spine). A quarter century later, I hold this in some contempt as vague bullshit, not sophisticated subtlety. That method is hopelessly vulnerable to palpatory pareidolia (the tendency to perceive what we expect or want to); the diagnostic reliability had to be as low as it can get (how well two trained therapists can agree on a diagnosis). Perhaps it’s unethical to charge manual therapy fees to chase such hypothetical problems with joints.

Joints certainly can get into various kinds of trouble, but most of the major problems are well understood … and clearly have nothing to do with “release.” Good luck “releasing” a joint from the symptoms of arthritis. Good luck releasing a frozen shoulder — it’s mostly not possible without dramatic and traumatic tearing of joint tissues, so much so that it’s mostly only done under anaesthesia, and even then it doesn't always work.

Intriguingly, one of the most obvious manual joint repairs is “reducing” a dislocation… and while no one ever calls that a “release,” it actually fits my definition perfectly, and has a completely unambiguous physical explanation! It’s more release-y than most of the things people do call releases!

So that’s some of the obvious possibilities. Many of the more speculative joint problems aren’t well understood enough to be good targets for release.

As with muscle, manipulating joints could have some effects, but probably mostly only minor ones. For instance, spinal manipulation is the undisputed king of joint “release” techniques … and yet there’s a buttload of research showing that its effects on back pain are underwhelming. There also seem to be many exceptions, and I’ve experienced dramatic relief from a nasty neck problem from what seemed very much like a “release” of a joint. It’s a very short story: it popped, and I felt better. Release! The only thing that makes it a story is how clear it was: my neck felt painfully stuck, and it very clearly got suddenly un-stuck, and the contrast was a big damned deal.

But, in several similar incidents in the years since, I have never again experienced anything remotely like that one time.

For much more on this topic, 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. This is not an insult. I am not impugning release by saying it’s a sensory thing. Sensation is huge! I believe this is the main point of manual therapy, and it’s plausible that sensory effects can include clinically meaningful improvements in pain.

It’s well-established pain science that sensory inputs can modulate pain, and this is probably the main explanation for the popularity of most of the therapies you have ever heard of. Any technique that produces novel sensory input can tinker with pain, and sometimes it might be a big deal. See Counterstimulation, Counterirritation, and Gate Control.

I think this is a sastisfying way to understand “release.” Certainly it’s no worse an explanation than many of the other ideas I’ve explored here.

But this relatively elegant explanation is also rarely what anyone actually means by “release.”

And “tinkering with pain” is not exactly potent, reliable medicine — not in terms of what it can accomplish clinically. But it is routinely packaged with interesting stories, sympathetic attention and touch, and maybe quite emotional sensory experiences, and that can really dial up the subjective impression that something Very Therapeutic has happened.

My cranky release recap

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 selling/buying — 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 definitely has no clear and 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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