Introduction

Scientific research has transformed our understanding of how manual therapy achieves its effects. While practitioners once believed they were directly manipulating fascia or making other physical changes, research now shows that the beneficial effects of manual therapy occur primarily through neurological mechanisms. This curated “top 10” list focuses on papers that either debunk commonly held beliefs in manual therapy or explain some of the actual mechanisms through which these therapies work.

Debunking Mechanical Explanations

1. "Does Fascia Matter?" (Ingraham, 2019)

https://www.painscience.com/articles/does-fascia-matter.php

This comprehensive article examines common claims about fascial manipulation and explains why many traditional beliefs about "releasing" fascia are biomechanically impossible. It provides an excellent foundation for understanding why we need to rethink how manual therapy works.

What it debunks: The idea that fascia is a treatable therapeutic target in the way commonly believed.

2. "Three-dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy" (Chaudhry et al., 2008)

https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2008.108.8.379/html

This foundational paper uses mathematical modeling to demonstrate that the forces required to mechanically deform fascia far exceed what human hands can generate. The researchers calculated that it would take hundreds of pounds of force to create even small changes in fascial tissue - far beyond what's possible in manual therapy.

What it debunks: The entire premise that therapists can manually "release" or "stretch" fascia through mechanical force.

3. "Fascial Plasticity – A New Neurobiological Explanation: Part 1" (Schleip, 2003)

https://www.bodyworkmovementtherapies.com/article/S1360-8592(02)00067-0/abstract

This groundbreaking paper systematically examines the traditional mechanical model of fascial manipulation and demonstrates why it cannot work as previously believed. Using a combination of histological evidence and biomechanical principles, Schleip shows that fascia's inherent properties make it resistant to the kind of mechanical deformation many practitioners believe they are creating.

What it debunks: Traditional mechanical models of fascial manipulation.

4. "A Fundamental Critique of the Fascial Distortion Model" (Thalhamer, 2018)

https://www.sciencedirect.com/science/article/pii/S1360859217302097

This paper systematically examines and challenges common claims about fascial manipulation, providing a thorough scientific analysis of why direct mechanical changes to fascia during treatment are unlikely.

What it debunks: The entire fascial distortion model with systematic scientific analysis.

5. "Biomechanical Properties of the Human Superficial Fascia" (Berardo et al., 2024)

https://pubmed.ncbi.nlm.nih.gov/38914036/

This paper provides the most recent biomechanical data on fascial properties. This updates and confirms the earlier Chaudhry papers with fresh data.

What it confirms: Recent evidence supporting the impossibility of mechanically deforming fascia with manual pressure.

Debunking Specific Treatment Myths

6. "Massage Impairs Postexercise Muscle Blood Flow and 'Lactic Acid' Removal" (Wiltshire et al., 2010)

https://pubmed.ncbi.nlm.nih.gov/19997015/

This study directly challenges the pervasive belief that massage improves circulation and helps remove lactic acid from muscles. The research shows that massage actually impairs blood flow to muscle and therefore also impairs lactic acid removal after exercise. This is the opposite of what nearly every massage therapist has been taught.

What it debunks: Two major myths at once—that massage increases circulation to muscle tissue and that it helps clear lactic acid.

7. "Why Drink Water After Massage?" (Ingraham, 2018)

https://www.painscience.com/articles/drinking-water-after-massage.php

This article thoroughly debunks the ubiquitous advice to "drink lots of water after massage to flush out toxins." It explains why massage doesn't release toxins into the bloodstream, why lactic acid is not a toxin or waste product, and why the entire concept is biologically illiterate. Written with both scientific rigor and humor.

What it debunks: The detoxification myth and the idea that massage releases metabolic waste products that need to be flushed out.

Explaining Actual Mechanisms

8. "Fascial Plasticity – A New Neurobiological Explanation: Part 2" (Schleip, 2003)

https://www.sciencedirect.com/science/article/abs/pii/S1360859202000761

Having established in Part 1 why mechanical explanations are insufficient, this second paper presents a revolutionary new model based on neurobiological responses. Schleip details how fascia is densely innervated with mechanoreceptors and free nerve endings, making it an important sensory organ. The paper explains how manual contact triggers responses in the autonomic nervous system.

What it explains: The actual neurological mechanisms through which manual therapy affects fascial tissue.

9. "Unraveling the Mechanisms of Manual Therapy: Modeling an Approach" (Bialosky et al., 2018)

https://www.jospt.org/doi/10.2519/jospt.2018.7476

This accessible article explains how touch influences our nervous system, demonstrating why gentle pressure can be as effective as forceful manipulation. It helps both practitioners and patients understand the actual mechanisms behind successful treatment.

What it explains: The neurological mechanisms through which manual therapy actually works.

10. "The Mechanisms of Manual Therapy: A Living Review" (Keter et al., 2025)

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0319586

This comprehensive 2025 living review synthesizes evidence on neurological, autonomic nervous system, and neuroimmune mechanisms underlying manual therapy effects, providing the most current evidence across multiple mechanism categories.

What it explains: A comprehensive, up-to-date synthesis of all known mechanisms through which manual therapy produces its effects.

Honorable Mentions

"Evidence of a New Hidden Neural Network into Deep Fasciae" (Fede et al., 2021)

https://www.nature.com/articles/s41598-021-92194-z

This Scientific Reports paper from the University of Padova provides electron microscopy evidence of the dense neural network in fascial tissues. It quantifies nerve density and demonstrates the rhomboid pattern of nerve distribution.

"The Role of Descending Modulation in Manual Therapy" (Vigotsky & Bruhns, 2015)

https://www.hindawi.com/journals/prt/2015/292805/

This foundational narrative review explains HOW manual therapy creates neurological changes - through descending pain modulation pathways. The paper reviews evidence that different forms of manual therapy activate different neurotransmitter systems (serotonergic, noradrenergic, endocannabinoid, adenosinergic pathways).

"Pain Science in Practice: How Does Descending Modulation Work?" (Hoegh, 2024)

https://www.jospt.org/doi/10.2519/jospt.2024.12112

This accessible explanation of descending modulation from JOSPT explicitly states that the descending pain modulatory system helps explain how manual therapy, patients' expectations and beliefs, and contextual factors influence pain experiences.

Key Takeaways

1. The forces required to mechanically change fascia exceed what human hands can generate.

2. Manual therapy's benefits come primarily through neurological mechanisms.

3. Understanding these mechanisms can lead to more effective treatment approaches.

4. Gentle touch can be as effective as forceful manipulation because the benefits occur through nervous system responses rather than mechanical tissue change.

Author

Dr. Mark Olson holds an M.A. in Education and a Ph.D. in Neuroscience from the University of Illinois, specializing in Cognitive and Behavioral Neuropsychology and Neuroanatomy. His research focused on memory, attention, eye movements, and aesthetic preferences. Dr. Olson is also a NARM® practitioner, aquatic therapist, and published author on chronic pain and trauma-informed care. He offers a variety of courses at Dr-Olson.com that provide neuroscientific insights into the human experience and relational skill training for professionals and curious laypersons.

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