Can massage break up adhesions? Here’s the nuance.

It looks unlikely for the most part. At least in the context of how we medically understand adhesions. I’ll go into more detail about “the most part” below, because of course it’s not as simple as”no”.

We’re tackling this because manual therapies all over the globe have made the claim that they can break up adhesions, as one of the ways in which they help people. So we’re here to see if there’s truth to the claim or not.

Over the years, our understanding of both adhesions and of how manual therapy can work have really evolved. I’m about to take you through some things below that will help unpack a few of the myths surrounding this idea AND I’m going to leave you with a theory at the end.

What are adhesions:

Before we can talk about massage breaking them up, we have to first understand what adhesions are.

Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together, when they would normally not be stuck.

This means, we have thick bands of collagen fibers that are linking two different tissues (sometimes organs) together. They are caused by surgical incisions that lead to the linking of different layers of tissue, intrinsic physical damage to the tissues from things like infections and physical trauma, and in certain medical conditions that for unknown reasons cause you to deposit more collagen in various places.

Note that there’s a distinct lack of a mention of inactivity? We’ll get to that in a bit.

So, what about breaking them up?

Collagen, for the most part, is bound by what are called covalent bonds. These bonds are really strong. Far too strong for us to “break up” with our hands, especially if we’re staying within the scope of our practice.

Mostly, when we talk about adhesions, we’re talking about links that have been there for a while. But what about new adhesions? They’re called “immature” adhesions, and there IS a possibility that we MIGHT be able to have some kind of an effect on them through manual manipulation. (reference) The question then becomes if that’s a direct result of our pressure (stretch) to the tissue OR whether that’s the result of things like increased blood flow that are the direct result of our work?

In terms of the established/mature adhesions, most research is pointing to the answer of no, we can’t break them up (or at least if any breaking-up is occurring it’s not happening in a measurable way). These ones can really can only be broken by a scalpel and huge forces going through our tissues that again, we wouldn’t be delivering with massage.

So there’s a small chance we might be able to facilitate the release of new adhesions. By “new”, we mean 72 hours post-injury/surgery to 1 week after injury/surgery.

Okay, so what about this theory I mentioned above?

Well, tissue is complex, of course and we’re now starting to see some investigations done on fascia that suggest there are “other” bonds at play in fascial tissue as well. So not just the really strong covalent bonds, but also weaker bonds.

Now, this falls outside of the medical definition of an adhesion we talked about above – and so instead of expanding the definition to include them, it’s probably worth creating a new sub-category of adhesion that we can call “minor non-medical adhesions”, simply because we don’t have an existing term yet. By the way, this now gets into the realms of things that aren’t yet proven – which is important to note.

These weaker bonds then, are likely to be something that we CAN have an influence over. Measured here in 2016.

Something worth noting in the above study is that the release of weaker bonds (hypothesized) takes place relative to time under load.

So this MIGHT be part of what we feel when we feel a “release” of tissue after long-holds with stretches and manual techniques. Remember though too, there are other factors at play here (the nervous system especially). So there is a glimmer of potential for the old idea that we can “break up” adhesions – at least, the immature ones and the minor non-medical ones.

On the note of breaking things up – even though it might be possible for some situations, I think it’s really important to not let that term be the guide of our approach. As in, don’t try to break things up. It’s a pretty harsh approach and can often lead to unnecessary intensity (or pain) for your clients, or worse – injury. If we approach it from a “facilitation of release” perspective, we’re still getting the benefits of the work (whether they’re from the release of adhesions or not) and we’re doing it in a way that’s allowing the body to do its thing – rather than it being forced in any paticular direction.

Hopefully that helps.

Drew.

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If you liked this article, you might also enjoy: Runner’s Knee – the Myth & the Solution and Trigger Points: Those “Money Spots” in Massage.