The book J. Walaski Clinical Massage Therapy is one of the more serious works on massage therapy, presenting a clinical approach to treating musculoskeletal conditions. In theory, it should be a desk reference for any massage therapist who aims to bring a clinical perspective into their practice.
The book is not written in the simplest language, yet it remains fairly understandable for most well‑read massage therapists.
However, attempts to practically understand what exactly the author proposes run into several ambiguities that he seems not to notice at all. Each time you encounter such a passage, you can’t help but exclaim: HOW?
It should be noted that the author is a strong proponent of trigger points and places them at the core of his understanding of the pathogenesis of musculoskeletal conditions. One would expect him to be especially clear and precise on these topics. But unfortunately, he is not.
So, let’s read the book.
p.20. Step 7: Cross-Fiber Gliding Strokes / Trigger Point Therapy. The author explains that these are two different techniques: the first is performed initially, and the second afterward. He then describes in detail the technique of working with tight muscle fibers (in other books this is called a taut band). At the same time, he repeatedly associates these structures with pain. Yet he also emphasizes that work on these tissues must be performed without pain. And again any practitioner will exclaim: HOW? If these structures are associated with pain, and pain is detected even with delicate palpation, then how can one work painlessly while applying a more intense technique?
So, the author advises working along the taut band from origin to insertion. It is well known that the trigger point itself is located on such a band, since it is directly associated with it. But earlier, he advised not to touch the trigger point until the entire band has been treated from origin to insertion. And again the question arises: HOW is that supposed to be done? Jump over the trigger point? Go around it? Reach it, stop, and then start again from the other end? Nothing is said about this.
After working through the taut band, the author suggests moving on to the trigger point itself — and again performing the work pain-free. Yet earlier, he stated that an active trigger point produces pain on its own and also when palpated. THEN HOW CAN ONE WORK WITHOUT PAIN? Unfortunately, there is no answer.
Instead, the author launches into a discussion about some sort of scar tissue and, for some reason, publishes the same histological illustration of supposed “scar tissue” three times.
And again, confusion arises. The first thing that stands out is the obvious inaccuracy of the illustration. Even if it is a simplified diagram, chaotic collagen fibers can indeed be found in scars, but they can also be found in normal tissues, including fascia. Conversely, scar tissue may consist of quite orderly collagen fibers.
It then becomes clear why the author insists on portraying scar tissue as chaos: he promotes a long‑abandoned method of multidirectional frictions that supposedly “organize” the fibers. He presents this as a therapeutic benefit and a sign of successful treatment. But he does not answer simple questions that will arise… not from practitioners this time, but from those who understand histology:
- How can frictions organize a chaotic network of collagen fibers?
- And even if, for a moment, we assume that the fibers did become organized in some area — what would that actually change?
Many massage therapists with limited knowledge of histology claim that cross‑fiber frictions cause local inflammation, after which tissue remodeling occurs and the fibers become organized. Yet the mechanism of this “organization” is never explained. Allegedly, subsequent stretching of the tissues causes this organization.
Colleagues, let’s apply logic. To induce local inflammation, you must at the very least damage several dense collagen fibers. This is a rather painful process, after which hyperemia, swelling, and pain will appear. In other words, you have simply increased the pain. But why should the fibers become organized? Stretching? Then the stretching would need to be applied for several hours or even days, throughout the entire period of inflammation and subsequent tissue remodeling. Are you sure you can provide such conditions? But the main question remains: even if the fibers did become organized, what then? The scar remains a scar. Most likely, after such manipulations, it has even become slightly larger.
In the end, reading just a small fragment of the book raises a multitude of questions and confusion. And this is only a superficial review. We have not even touched upon the more fundamental principles on which the author builds his entire concept. If such elementary sections contain so many contradictions, what will happen when one tries to understand the deeper ideas of the book? This makes one question not only the quality of the exposition, but also the internal logic of the entire methodology presented.