“If you want to break up scar tissue, use a scalpel” – Mike Carroll, LMT, CSC

 

Introduction:

 

Massage therapy and soft tissue techniques often hold a mysterious reputation in the realms of wellness and pain management. If you Google “benefits of massage,” you’ll find a plethora of promises ranging from “breaking up scar tissue” to “detoxifying the body,” many of which are either misunderstood or outright myths. While soft tissue work does provide significant benefits, they arise from physiological processes that we can and should explain with transparency. Dispelling misconceptions allows both therapists and clients to better understand how soft tissue therapy works, and, more importantly, how it can be used effectively to manage pain, optimize movement, and promote function.

 

Let’s break down these myths and discuss the real physiological effects of soft tissue techniques, how they influence acute and chronic pain, and which bodily systems are primarily involved in creating these benefits.

Here are some misconceptions around massage therapy and soft tissue techniques, as well as information on how they actually work, as we know it now.

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1. Demystifying the Physiological Effects of Soft Tissue Techniques

Whether it’s Swedish massage, Myofascial Release (MFR), Instrument Assisted Soft Tissue Mobilization (IASTM), or other techniques like friction massage, all soft tissue interventions work on a combination of tissue relaxation, mechanoreceptor stimulation, and nervous system modulation. However, their effects are often more neurological than physical, particularly when claims of “breaking up adhesions” or “releasing toxins” are made.

Swedish Massage

Swedish massage, commonly associated with relaxation, relies on gentle strokes to increase local blood flow and stimulate the parasympathetic nervous system (your “rest and digest” mode). While Swedish massage is one of the most widely-used techniques, myths persist that it detoxifies the body. The truth lies in its ability to influence:

• Circulatory system: By boosting venous return, Swedish massage encourages movement of blood and lymph fluid, which can support cellular nutrient exchange and mild anti-inflammatory effects.

• Neurological system: Gentle pressure and repetitive strokes calm overactive pathways, leading to reduced perception of pain and an increase in relaxation-inducing hormones like serotonin.
  Rather than physically “detoxifying,” Swedish massage assists your body by optimizing normal physiological processes—including supporting the removal of metabolic waste by the lymphatic system.

Myofascial Release (MFR)

MFR targets the body’s fascia, the connective tissue surrounding muscles, to improve tissue pliability and resolve areas of perceived restriction. A common myth surrounding MFR is that it “lengthens” fascia or “breaks up scar tissue.” Fascia has tensile strength far beyond what our hands—or even instruments—can directly manipulate. MFR is more about:

• Nervous system modulation: By applying sustained pressure, MFR influences sensory input to reduce hyperactivity in the central nervous system, helping the body perceive tissue as less “tight” or guarded.

• Hydration and sliding surfaces: Techniques may indirectly alter the ground substance in fascia, aiding tissue glide and hydration across tissue layers, but this is less significant than its neurological impact.

Instrument Assisted Soft Tissue Mobilization (IASTM)

Techniques like Gua Sha, Graston, or other IASTM use tools to create controlled mechanical stress in targeted areas. A myth of IASTM is that it “breaks up adhesions” or “removes scar tissue.” Instead, its effects are more about tissue recovery and pain modulation:

• Mechanotransduction: The application of stress signals cells in the tissue (e.g., fibroblasts) to produce beneficial structural proteins like collagen and elastin, aiding in tissue remodeling and strengthening.

• Nerve sensitivity: By stimulating mechanoreceptors, IASTM can reduce the sensitivity of pain pathways in the brain and allow the body to reinterpret the tension as less threatening.
  Importantly, scar tissue in particular is much too strong to “break up”; rather, tools assist the body’s adaptive mechanisms for desensitization and improved mobility around existing scar tissue.

Friction Massage

Friction massage uses targeted pressure across a specific area, often for tendon or ligament issues. The myth here is that this technique physically “breaks up adhesions.” In reality:

• Neuromodulation: Friction stimulates local mechanoreceptors and proprioceptors, which can dampen pain signals and improve tissue coordination.

• Tissue remodeling: Friction can trigger localized hyperemia (increased blood flow) and stimulate fibroblasts to improve the structure of collagen during the healing process. This can help align fibers in the direction of load, improving overall tissue resilience.

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2. Pain: The Intersection of Soft Tissue Work and the Nervous System

One of the most impactful benefits of soft tissue techniques is their role in managing acute and chronic pain. Soft tissue work doesn’t just address the mechanical aspects of the body—it influences pain through an intricate interplay of the nervous, circulatory, and endocrine systems.

Acute Pain

Soft tissue work provides immediate yet temporary relief from acute pain through:

• Neurological “gate control” theory: Soft tissue techniques stimulate low-threshold sensory receptors (like A-beta fibers), which “close the gate” to pain signals (transmitted via unmyelinated C fibers) in the spinal cord, making pain less noticeable.

• Reduction of guarding and splinting: Pain often leads to protective muscle contractions, which create a cycle of tension and further pain. Gentle massage or MFR can reduce these reflexive spasms.

Chronic Pain

Chronic pain—whether due to conditions like fibromyalgia, fascial dysfunction, or persistent musculoskeletal issues—stems largely from nervous system sensitivity rather than ongoing tissue damage. Massage therapy and soft tissue work address this through:

• Central nervous system desensitization: Techniques like light touch or gentle sustained pressure (e.g., during MFR) send sensory signals that calm an overactive pain processing system.

• Promoting neuroplasticity: By improving proprioception and sensory input, soft tissue work can help the nervous system “re-learn” normal movement patterns and dampen its threat response.

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3. Let’s Talk About Scar Tissue and Adhesions

A persistent myth in the massage therapy world is that we can break up scar tissue and adhesions with our hands or tools. Let’s set the record straight.

Scar Tissue

Scar tissue is primarily composed of collagen fibers, and its tensile strength is far too high to be physically “broken apart” by massage or manual techniques. However:

• Massage therapy can influence surrounding tissues, improving mobility around scars instead of breaking them.

• Friction or sustained pressure can promote tissue remodeling, encouraging realignment of collagen fibers and improving the pliability of the scar over time.

Adhesions

Adhesions—areas where connective tissues bind together abnormally—are less structural than they are neurologically derived. Adhesions often result from hyperactive nervous system activity, leading to the perception of restriction or “sticking.” Through soft tissue work:

• Neurological signaling can be modulated, helping the body “release” areas of guarded movement.

• The process is more about reconciling signals between the central nervous system and the tissues, rather than breaking physical structures.

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4. The Bodily Systems Involved in Soft Tissue Work

The benefits of massage therapy and soft tissue work arise from its multifaceted effects on several bodily systems, primarily:

The Nervous System

Massage stimulates sensory receptors in the skin and deeper layers, influencing pain perception, reducing muscle tone, and activating relaxation responses.

The Circulatory and Lymphatic Systems

Soft tissue techniques enhance blood flow and lymphatic drainage, which supports cell nourishment and waste removal. While these processes are helpful for recovery, the idea of “detoxification” should be reframed as supporting normal physiological function.

The Musculoskeletal System

While massage doesn’t “lengthen muscle” or “break things apart,” it does improve the function of soft tissues by optimizing neuromuscular communication and facilitating coordinated movement patterns.

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Conclusion

Massage therapy and soft tissue work are powerful tools for supporting pain management and overall body function—not through breaking scar tissue or undoing adhesions as often claimed, but by working with the nervous system, enhancing circulation, and supporting tissue recovery. By understanding and communicating the true physiological effects, we can empower clients to see massage therapy not as a mystical intervention, but as a scientifically grounded approach that helps the body move and feel better. Let’s dispel the myths and focus on what soft tissue therapy truly has to offer.